Clinical predictors of pathological gastroesophageal reflux: a pH-impedance study of 2688 adults with laryngopharyngeal reflux symptoms.

Gastroesophageal reflux disease (GERD) is implicated as a potential cause of chronic laryngopharyngeal symptoms, including laryngitis, cough, dysphonia, and throat clearing, often grouped under laryngopharyngeal reflux (LPR). This study aimed to assess the predictive value of clinical and demographic factors for GERD in patients with LPR symptoms using multichannel intraluminal impedance-pH monitoring. Analytical cross-sectional study of 2688 adults with upper airway symptoms and suspected LPR undergoing pH-impedance monitoring between January 2019 and December 2022. Pathological GERD was defined as acid exposure time (AET) >6%, or AET 4%-6% with abnormal reflux parameters (total reflux events >80 and/or positive symptom association). Proximal reflux episodes were recorded but not used diagnostically. Multivariable logistic regression analyses identified independent predictors. Among 2688 patients (73.6% female; mean age 54.5 years), only 8.4% had pathological GERD. Independent predictors included higher body mass index, male sex, older age, heartburn, and hiatal hernia. The final model demonstrated moderate discrimination area under the curve (AUC) 0.676. Only a small proportion of patients with suspected LPR have objective GERD. Pathological reflux is better predicted by traditional GERD-related factors than by isolated laryngopharyngeal symptoms, supporting a more cautious interpretation of LPR and consideration of alternative diagnoses.