Manometric Esophageal Abnormalities in Laryngopharyngeal Reflux Disease: A Systematic Review.

OBJECTIVE

To investigate the prevalence and findings of esophageal manometric abnormalities underlying dysphagia in laryngopharyngeal reflux disease (LPRD).

METHODS

Three independent investigators conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic literature search in PubMed, Scopus, and Cochrane databases for studies reporting manometry and high-resolution manometry (HRM) findings in LPRD patients. Methodological bias analysis was conducted with two validated bias tools.

RESULTS

Twenty-four papers met the inclusion criteria (2337 patients). The LPRD diagnosis was based on objective testing in 3/24 (12.5%) studies, with one study using hypopharyngeal-esophageal impedance-pH testing. Manometric studies consistently suggested increased upper esophageal sphincter baseline and residual pressures, whereas lower esophageal sphincter baseline and relaxation pressures were decreased in LPRD patients. Esophageal body motility was characterized by a high prevalence of ineffective swallows, and impaired bolus clearance. Reflex mechanisms were also altered. There was substantial heterogeneity across studies for LPRD diagnosis, exclusion criteria, and manometric parameters, which were reported with the Chicago classification 3.0/4.0 in 10/24 (42%) studies. The mean MINORS was 7.5 ± 2.4, highlighting an overall low quality of studies.

CONCLUSION

This systematic review suggests a trend toward ineffective esophageal motility, esophageal sphincter hypotension, or impaired dynamics in patients with swallowing, voice, and breathing LPRD-related symptoms and findings. Further prospective controlled studies including patients with a demonstrated LPRD are needed to establish the prevalence of esophageal abnormalities in LPRD.