Mucosal integrity of the larynx and hypopharynx and the response to proton pump inhibitors in patients with laryngopharyngeal reflux.

PURPOSE: To evaluate whether impairment of integrity of laryngeal and hypopharyngeal mucosa in laryngopharyngeal reflux (LPR) could be related to response to proton pump inhibitors (PPIs).

METHODS

Chronic hoarseness with Reflux Finding Score (RFS) > = 7 was evaluated using the Reflux Disease Questionnaire (RDQ) and Reflux Symptoms Index (RSI). Upper endoscopy was performed and samples of the laryngeal posterior commissure were collected to evaluate ex vivo laryngeal mucosal integrity by transepithelial resistance (TER) using Ussing chamber. In vivo, hypopharyngeal integrity was measured using intraluminal impedance. Clinical responders scored < 13 and had a drop of at least 50% in the initial RSI after 8 weeks of pantoprazole.

RESULTS

Eighteen patients completed the protocol, Esophagitis was detected in 28% of the patients, and one patient presented acid exposure above 6%. After treatment, 66.67% responded to PPI. Laryngeal basal TER and TER drops after the weakly acidid challenge showed no difference between PPI responders and non-responders. Hypopharyngeal basal impedance was similar between the groups. After acid exposure test, there was a lower impedance in non-responders.

CONCLUSION

In laryngopharyngeal reflux, hypopharyngeal mucosal integrity was lower in PPI non-responders. These preliminary results suggest that the weaker laryngopharyngeal mucosa in refractory LPR may require new therapies aimed at improving barrier function.

LEVEL OF EVIDENCE: N/A.