ARTICLE IN PRESS

Laryngopharyngeal Reflux Disease and Gastroesophageal

Reflux Disease Can Mutually Influence
*,†
Xiaoyu Wang, *Jinhong Zhang, *Jiasen Wang, *,†Zhi Liu, *Chun Zhang, *Jing Zhao, *Shizhen Zou, *Xin Ma, and
*,†
Jinrang Li, *Beijing, and yHefei, China

Summary: Objective. To investigate the mutually relationship between gastroesophageal reflux disease
(GERD) and laryngopharyngeal reflux disease (LPRD).
Methods. All included patients completed simultaneous 24-hour hypopharyngeal intraluminal multichannel
impedance pH monitoring (24h-MII-pH), Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). The
LPRD diagnosis was based on the occurrence of ≥1 acid or non-acid hypopharyngeal proximal reflux episode
(HRE), GERD was defined as a length of time >4.0% of the 24-hour recording spent below pH 4.0 or a DeMeester
score >14.72. Patients with both positive LPRD and GERD were classified as LPRD & GERD group, patients
with positive LPRD and negative GERD were classified as ILPRD group, patients with negative LPRD and
positive GERD were classified as IGERD group, and patients with both negative LPRD and GERD were classified
as N group. The differences in clinical characteristics of reflux between the groups were statistically analyzed.
Results. A total of 437 patients were included, including 248 (56.75%) in the ILPRD group, 98 (22.43%) in the
LPRD & GERD group, 23 (5.26%) in the IGERD group, and 68 (15.56%) in the N group. There was no signifi-
cant difference between the types of gastroesophageal reflux in patients with GERD. The number of weak
acid/acid/gas/liquid HREs was significantly more in LPRD & GERD patients than in ILPRD patients (P <
0.01), and the number of distal acid reflux events and Longest distal acid clearance time were significantly higher
in LPRD & GERD patients than in IGERD patients (P > 0.01).
Conclusion. GERD and LPRD are not the same disease but can mutually influence. Combined GERD
increased all types of laryngopharyngeal reflux events in patients with LPRD, whereas combined LPRD only
increased acidic distal reflux events and acid clearance time in patients with GERD.
Key Words: Laryngopharyngeal reflux—Gastroesophageal reflux—24h-MII-pH monitoring—Mutually influence.

INTRODUCTION found that the typical symptoms of LPRD patients differ

Laryngopharyngeal reflux disease (LPRD) is an inflamma-
tory disease of the tissues of the upper aerodigestive tract
caused by the direct or indirect effects associated with the
reflux of gastroduodenal contents, which can cause morpho-
logical changes in the upper aerodigestive tract.1 Gastro-
esophageal Reflux Disease (GERD) is a symptoms or
complications resulting from the refl- ux of gastric contents
into the esophagus or beyond, into the oral cavity (including
larynx) or lung.2 Common symptoms of LPRD include
hoarseness, vocal fatigue, excessive throat clearing, globus
pharyngeus, chronic cough, postnasal drip, and dysphagia,
etc.3 Common signs of LPRD include subglottic edema, ven-
tricular obliteration, erythema/hyperemia, vocal fold edema,
diffuse laryngeal edema, posterior commissure hypertrophy,
granuloma/granulation tissue, and excessive endolaryngeal
mucus, etc.4 Previous studies considered LPRD an extraeso-
phageal manifestation of GERD. However, later studies have
Accepted for publication October 12, 2022.
From the *Department of otolaryngology, The Sixth Medical Center of PLA Gen-
eral Hospital of Beijing, Beijing, China; and the yNavy Clinical College, the Fifth
School of Clinical Medicine, Anhui Medical University, Hefei, Anhui Province,
China.
Address correspondence and reprint requests to Jinrang Li, MD, Department of
Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Bei-
jing, 100048. And Navy Clinical College, the Fifth School of Clinical Medicine,
Anhui Medical University, Hefei, 230032, Anhui Province, China. E-mail:
entljr@sina.com
Journal of Voice, Vol. &&, No. &&, pp. &&−&&
0892-1997
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jvoice.2022.10.008
from those of GERD patients.5
Chong et al and Wang et al used simultaneous esophageal
and oropharyngeal Dx-pH monitoring to find that LPRD
and GERD are not the same diseases and can exist indepen-
dently or together.6,7 Recent studies based on the 24-hour
hypopharyngeal intraluminal multichannel impedance
pH monitoring(24h-MII-pH) have shown that combined
GERD affects hypopharyngeal proximal reflux episodes
(HREs) in patients with LPRD. Among them, patients with
GERD and LPRD had significantly more acid HREs than
those with LPRD only.8 In addition, Feng et al found that
patients both have LPRD and GERD had significantly
higher Reflux Symptom Index (RSI) scores,9 Patients with
GERD who also had LPR also had substantially higher
Reflux Disease Questionnaire(RDQ) scores.10 In contrast,
studies on the effect of LPRD on GERD reflux events are
still in the gap, and to our knowledge, no one has studied
the mutual influence between the LPRD and GERD in
reflux events using 24h-MII-pH monitoring. The aim of this
study is to investigate the relationship between the LPRD
and GERD through 24h-MII-pH, RSI, and the Reflux
Finding Score (RFS).11
METHODS
Patients with reflux symptoms who visited the Department
of Pharyngology, Laryngology & Phonosurgery at the Sixth
Medical Center of the PLA General Hospital from
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2 Journal of Voice, Vol. &&, No. &&, 2022
FIGURE 1. Schematic representation of the recording catheter and its placement. UES, upper esophageal sphincter; LES, lower
esophageal sphincter.
November 2014 to October 2021 were included. Included
patients underwent simultaneous 24h-MII-pH monitoring
and completed the RSI and RFS. Inclusion criteria are as
follows: 1. age 18-65 years old, male or non-pregnant
female; 2. Patients require endoscopy via laryngoscopy due
to throat discomfort, foreign body sensation, hoarseness,
and other pharyngeal symptoms. Exclusion criteria are as
follows: 1. taking proton pump inhibitors or gastrointestinal
motility drugs within one week; 2. requiring long-term oral
hormonal drugs or having other diseases that require
hormonal therapy after diagnosis; 3. history of Zollinger-
Ellison syndrome, cardiac failure, esophageal spasm, esoph-
ageal stricture, and other esophageal lesions; 4. history of
major chronic diseases and neurological diseases; and 5.
Patients with vagus nerve disease and abnormal sensory
function. The LPRD diagnosis was based on the occurrence
of ≥1 acid or non-acid hypopharyngeal proximal reflux epi-
sode (HRE). GERD was defined as a length of time >4.0%
of the 24-hour recording spent below pH 4.0 or a DeMeester
score >14.72.12
24h-MII-pH monitoring
24 h-MII-pH monitoring was performed on each enrolled
patient, and a monitoring catheter was placed in the appro-
priate location in the patient’s esophagus before morning
mealtime. Each patient was required to discontinue acid-
suppressing medication during the monitoring period. The
monitoring device we used was a Zephr MII-pH portable
monitoring system (Sandhill, USA), model ZAL-BL-55
electrode catheter. The catheter has six impedance channels
and two pH channels, of which two impedance channels are
located in the lower and middle esophagus. The other four
are located approximately 0 cm, 3 cm, and 5 cm above and
below the upper esophageal sphincter. One pH monitoring
sensor located at 1 cm above the upper esophageal sphinc-
ter. In addition, another pH sensor positioned at 5 cm above
the upper border of lower esophageal sphincter (LES)13
(Figure 1).
We placed the pharyngeal pH sensor in the posterior
region of the cricoid cartilage under direct electronic laryngos-
copy and wrapped it in the mucosa.14 We confirmed that the
location of the lower channels (Z5 and Z6) was above the
LES. The monitor was hung on the subject’s chest. The cath-
eter is secured to the nasal cavity, behind the ear, and to the
ear canal with a piece of tape. This prevents the catheter
from flowing out and controls the position of the electrodes
from being changed, which could affect the monitoring
results. During the 24-hour monitoring process, subjects were
asked to maintain as normal a lifestyle as possible (regular
food intake, adequate rest, and active exercise). Patients were
also instructed to prohibit smoking, alcohol, and medications
that interfere with gastrointestinal motility and acid suppres-
sion. A HRE is defined as an episode that reached two
impedance sensors in the hypopharynx, with one or more
acidic or non-acidic HREs being diagnosed as LPRD.15 A
HRE with a pharyngeal pH ≤ 4 was considered an acid
reflux episode, a pharyngeal pH between 4 and 7 was consid-
ered a weak acid reflux episode. Fluid reflux was defined as a
decrease of more than 50% in the calculated impedance value
when there were at least two consecutive retrograde imped-
ance channels. The reflux lasted for at least 3 seconds before
 ARTICLE IN PRESS
Xiaoyu Wang, et al Reflux Disease and Gastroesophageal Reflux Disease 3

being included in the calculation. Gas reflux is defined as a
rapid increase (at a rate ≥ 3 kV/s) of at least two consecutive
impedance channels retrograde with a final impedance
increase greater than 5000 V. Mixed gas-liquid reflux was
defined as gas reflux that occurred instantaneously or simulta-
neously before liquid reflux. All GER episodes were charac-
terized by pH electrode 5 cm above the upper border of LES
as acid or weakly acidic. Distal esophageal acid reflux was
defined as a distal reflux episode with pH<4. Esophageal
weakly acid reflux was defined as a distal reflux episode with
4<pH<7.16 Acid clearance time at the distal esophagus was
defined as the time for pH < 4 detected by the distal esoph-
ageal pH electrode associated with reflux. Esophageal weak
acid reflux time was defined as the time for 4 < pH < 7
detected by the esophageal pH electrode associated with bolus
reflux. Monitoring data from each patient were analyzed by
two physicians to classify the type of reflux according to the
above criteria. Each reflux type was counted separately for
each patient during the day and during the sleep phase.
Patients who were positive for both LPRD and GERD
were classified as LPRD & GERD group, patients who
were positive for LPRD and negative for GERD were clas-
sified as the ILPRD group, and patients who were negative
for LPRD and positive for GERD were classified as the
IGERD group. Patients who were negative for both LPRD
and GERD were classified as the N group.
Scales screening
All subjects completed the RSI3 on their own with the guid-
ance of their healthcare provider. The patients were examined
with fiberoptic laryngoscopy by experienced laryngologists. In
addition, the results of the laryngoscopy were scored by two
experienced physicians according to the RFS,11 and the
mean score was calculated as the final RFS score.
Statistical analysis
Statistical Package for the Social Sciences for Windows
(SPSS version 23.0; IBM, Armonk, NY) was used for the
statistical analysis. Normally distributed data are shown as
mean § standard deviation (SD). The chi-square test was
used to compare the differences between groups. Parametric
data differences were compared using a t test. The Mann-
Whitney U test was used to compare differences between
two groups of nonparametric data. A level of significance of
P < 0.05 was used.
RESULT
A total of 437 patients were included, 362 males and 75
females, with a mean age of 54.7 § 11.23 and a body mass
index (BMI) of 24.77 § 3.69 (kg/m2). There were statistical
differences between ILPRD, LPRD & GERD, IGERD and
N groups in terms of gender (x2 = 12.866, P < 0.01), smok-
ing history (x2 = 11.533, P < 0.01), and total RSI score
(F = 6.949, P < 0.01). The proportion of female patients
was significantly higher in the ILPRD group than in the
remaining three groups. The proportion of patients with a
history of smoking was significantly higher in the LPRD &
GERD group than in the remaining three groups. The RSI
scores were significantly higher in the LPRD & GERD
group than in the remaining three groups, and in the
ILPRD group than in the IGERD and N groups (Table 1).
Grouping of reflux disease
Of the 437 patients, 68 were in the N group, 248 in the
ILPRD group, 98 in the LPRD & GERD group, and 23 in
the IGERD group. A total of 346 patients had LPRD, of
which 28.32% also had GERD. 121 patients had GERD, of
which 80.09% also had LPRD.
Comparison of the types of HREs in patients with
LPRD & GERD and ILPRD
The number of total HREs was significantly higher in
patients with LPRD & GERD than in patients with ILPRD
(P < 0.01), and the proportion of various types of HREs in
total HREs was not significantly different in patients with
LPRD & GERD compared to patients with ILPRD

TABLE 1.
Patient’s General Condition.
General Condition ILPRD LPRD&GERD IGERD N x2/F P
Gender (male/female) 194/54 83/15 21/2 64/4 12.866 0.005
Smoking (Yes/No) 134/114 60/38 20/3 42/26 11.533 0.009
Drinking alcohol (Yes/No) 59/189 23/75 9/14 17/51 2.767 0.429
Medication use (Yes/No) 67/181 21/77 5/18 16/52 1.108 0.775
Age 54.44 § 10.97 54.65 § 11.3 57.52 § 9.32 54.78 § 12.65 0.530 0.662
Height 2.39 § 10.94 1.72 § 4.90 1.72 § 0.06 1.71 § 0.05 0.242 0.867
Body weight 71.5 § 11.79 74.13 § 14.12 71.96 § 12.31 71.8 § 11.24 1.100 0.349
BMI 24.67 § 3.58 25.38 § 4.2 24.15 § 3.4 24.49 § 3.34 1.295 0.276
RSI 10.46 § 6.38 14.5 § 12.02 13.22 § 5.98 10.4 § 5.74 6.949 0.001
RFS 8.12 § 2.98 8.19 § 2.7 9.13 § 3.27 8.12 § 3.05 0,857 0.464
Abbreviations: ILPRD, Idependent laryngopharyngeal reflux disease; LPRD&GERD, laryngopharyngeal reflux disease and gastroesophageal reflux disease;
IGERD, Idependent gastroesophageal reflux disease; N, Normal; RSI, Reflux Symptom Index; RFS, Reflux Finding Score.
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4 Journal of Voice, Vol. &&, No. &&, 2022

TABLE 3.
Comparison of the Types of HRE in Patients With LPRD & GERD and ILPRD.
Types of HRE ILPRD LPRD&GERD Z P
Number of total HRE 14.08 § 11.9 19.89 § 13.9 4.019 0.001
Number of gas reflux 5.47 § 5.31 7.39 § 6.34 2.794 0.005
Number of mixing reflux 0.83 § 1.81 1.36 § 2.17 2.322 0.2
Number of liquid reflux 0.74 § 1.89 1.37 § 2.69 2.497 0.013
Number of weak acid reflux 6.51 § 5.63 8.6 § 6.77 2.654 0.008
Number of acid reflux 0.53 § 1.6 1.17 § 2.01 3.088 0.002
Abbreviations: HRE, hypopharyngeal proximal reflux episode; ILPRD, Idependent laryngopharyngeal reflux disease; LPRD&GERD, laryngopharyngeal reflux
disease and gastroesophageal reflux disease.

have similar symptoms. Because refluxate can be microaspi-

TABLE 2. rated into the lungs to result in cough through tracheobron-
Percentage of Each Type of HRE in the Total Number of chitis and pneumonitis. 24h-MII-pH monitoring is the gold
HRE in Patients With LPRD.
standard for the diagnosis of LPRD and GERD and allows
Percentage of HRE by Type ILPRD LPRD&GERD the recording of all types of HREs and distal esophageal
Percentage of gas reflux events 78% 72% reflux events. The effect of GERD on LPRD has been
Percentage of mixed reflux 10% 14% observed previously, but no one has studied the impact of
events LPRD on GERD. A symptom-based study showed that
Percentage of fluid reflux 12% 14% GERD and LPRD mutually influence in terms of symp-
events toms, Patients with LPRD who also had GERD had signifi-
Percentage of acid reflux 8% 12% cantly higher RSI scores than those with LPRD only.10
events Lechien et al reported that patients both had LPRD and
Percentage of weak acid reflux 92% 88% GERD had more acidic LPR events than patients only had
Abbreviations: HRE, hypopharyngeal proximal reflux episode; ILPRD, LPRD, but no significant difference was seen between the
Idependent laryngopharyngeal reflux disease; LPRD&GERD, laryngo-
pharyngeal reflux disease and gastroesophageal reflux disease.
two in weak acidic LPR events.8 Our results show that
LPRD and GERD are mutually influential in reflux events.
To our knowledge, this is the first time that 24h-MII-pH
(Table 2). However, all types of reflux except mixed gas-liq-
uid reflux of the patients with LPRD&GERD were signifi-
cantly more than patients with ILPRD (P < 0.01, Table 3). TABLE 4.
Comparison of Esophageal Reflux Parameters of IGERD
With LPRD & GERD.
Comparison of esophageal parameters of IGERD with
Distal Esophageal LPRD&GERD IGERD P
LPRD & GERD Reflux Monitoring
The number of distal acid reflux events and distal esoph- Data
ageal acid clearance time were significantly higher in Number of distal 58.91 § 33.33 51.48 § 34.26 0.215
patients with LPRD & GERD than in patients with esophageal reflux
IGERD (P<0.01). No significant differences were found DeMeester 21.49 § 26.71 25.81 § 35.46 0.384
Longest acid clear- 11.32 § 27.49 5.01 § 9.47 0.028
between the two groups in the parameters of the total num- ance time at distal
ber of distal esophageal reflux episodes, the number of distal esophagus (min)
esophageal weak acid reflux episodes, DeMeester score, and Longest clearance 3.00 § 7.71 2.75 § 3.14 0.320
time at distal
longest time to clear distal esophageal reflux episodes esophagus (min)
(Table 4). Number of distal 20.38 § 13.58 13.74 § 13.49 0.003
esophageal acid
reflux
Number of weakly 28.18 § 21.73 28.26 § 26.18 0.603
DISCUSSION acid reflux in the
LPRD has a high global prevalence.17 The prevalence of esophagus
Time to distal esoph- 0.22 § 1.64 0.08 § 0.16 0.899
GERD is also very high worldwide.18 Studies show that ageal acid reflux
LPRD and GERD are different diseases,7,19 but LPRD and (%)
GERD may present with similar symptoms. Javorkova Esophageal weakly 0.02 § 0.1 0.06 § 0.22 0.813
acid reflux time (%)
reported that in patients with GERD, distal esophageal
reflux may also lead to esophageal hypersensitivity and a Abbreviations: LPRD&GERD, laryngopharyngeal reflux disease and gas-
troesophageal reflux disease; IGERD, Idependent gastroesophageal
heightened cough reflex.20 In addition, GER can also cause reflux disease.
globus sensation.21 And many patients with LPRD also
 ARTICLE IN PRESS
Xiaoyu Wang, et al Reflux Disease and Gastroesophageal Reflux Disease
monitoring has been used to study the relationship of LPRD
and GERD in objective reflux events.
Feng et al conducted an epidemiological survey in the
gastroenterology department showing that the percentage
of patients with LPRD & GERD was 71.01% in the LPRD
population and 47.91% in the GERD population.10 A study
based on MII-pH monitoring showed that 52.78% of
patients with LPRD also had GERD, while 46.34% of
patients with GERD also had LPRD, leading to the conclu-
sion that people with LPRD are more likely to have GERD
in combination.22 Our study found that 28.32% of patients
with LPRD also had GERD, while 80.09% of patients with
GERD also had LPRD, suggesting that perhaps the GERD
population is more likely to have LPRD at the same time.
This is entirely contrary to the results of previous studies,
and we believe that the reason for this discrepancy is the dif-
ference in the study population. Feng et al and Wu et al
studied gastroenterology patients, while our study was on
Department of Otolaryngology Head and Neck Surgery
patients. Because gastroenterology patients are already
more likely to have GERD, Department of Otolaryngology
Head and Neck Surgery patients are also more likely to
have LPRD. The specific percentage of patients with LPRD
& GERD in patients with reflux disease needs further multi-
disciplinary joint investigation.
Wang et al reported that proximal esophageal reflux
events were dominated by acid reflux events.13 However,
our study found patients with LPRD have significantly
more non-acidic reflux episodes than acidic reflux episodes,
and gas reflux episodes were significantly higher in total
reflux events than the remaining two types of reflux events.
We believe the results differ because Wang selected patients
from the department of gastroenterology, and these patients
were more likely to have severe GERD. Previous studies on
the type of LPRD reflux have shown that weak acid reflux
accounts for a high proportion of total reflux episodes,23
and our results are consistent with this. Now, we find that
the number of gaseous reflux episodes is significantly higher
in weak acid reflux episodes than in the remaining types of
reflux episodes, we must increase our attention to gaseous
reflux episodes. This is consistent with the findings of Hou
et al. 24 We believe that more gas reflux is mainly because
the gas is less influenced by gravity when it rises. In contrast,
there was no significant difference in the number of acid
reflux and weak acid reflux episodes in GERD as a percent-
age of the total number of reflux episodes. Weak acid reflux
predominated in LPRD, whereas there was no difference in
the number of weak acid and acid reflux episodes in GERD.
This also validates that LPRD and GERD are different dis-
eases in terms of the percentage of each type of HRE in the
total reflux episodes.
Our results showed that the number of distal acid reflux
episodes and distal clearance times were significantly higher
in patients with LPRD&GERD than in patients with
IGERD. However, there was no significant difference in the
number of weak acidic distal reflux episodes and total distal
reflux episodes between LPRD&GERD patients and
5
IGERD patients. This seems to indicate that the influence
of LPRD on GER is weak and selective. It may be because
acid reflux episode is the main pathogenesis of GERD, but
the exact cause should be further investigated in the
future.25 Conversely, LPRD may increase acidic distal
reflux episodes in GERD patients through several mecha-
nisms. On the one hand, common in patients with LPRD
include cough and dyspnea, while recent studies have found
that gastrointestinal symptoms such as diarrhea and consti-
pation are also common in patients with LPRD.26 Respira-
tory symptoms such as cough and dyspnea can lead to a
sharp increase in negative chest pressure in patients with
LPRD, making it easier for the patient’s LES to relax
instantaneously and even for systolic blood pressure to
drop. Gastrointestinal symptoms such as diarrhea and con-
stipation can increase abdominal pressure in patients, and
some studies have reported that increased abdominal pres-
sure also leads to decreased LES pressure, and that transient
relaxation of the LES and decreased systolic pressure is the
main cause of GERD.27,28 These factors make it easier for
gastric contents to break the barrier of the LES and enter
the esophagus.29 On the other hand, chronic sinusitis and
chronic pharyngitis are also common complications.30
These complications lead patients to produce significantly
more mucus, which enters the stomach with swallowing
movements, and the increased gastric contents can lead
directly to reflux. We believe that these mechanisms mutual
influence and may ultimately cause GERD in patients with
hypoglycemia. Our results are a preliminary validation of
these mechanisms described above, which showed signifi-
cantly higher RSI scores in LPRD & GERD patients. How-
ever, the higher RSI scores in patients with LPRD &
GERD may also be due to the overlap in symptoms
between LPRD and GERD. Therefore, this conjecture
requires further study. The recent results of Wu et al.
showed that the total number of distal reflux episodes was
not significantly higher in LPRD & GERD.22 This is consis-
tent with our findings.
Using a self-designed laryngopharyngeal reflux symptom
scale, Chen et al reported significantly higher symptom
scores in patients with LPRD who also had GERD.31 Our
results showed that RSI scores were significantly higher in
patients with LPRD and GERD than in patients only with
LPRD because more laryngopharyngeal reflux occurred in
patients with LPRD & GERD, and carbonic anhydrase in
pharyngeal mucosal cells activity, an enzyme that neutral-
izes refluxed acid, is expressed at a lower level. Pepsin is acti-
vated in an acidic environment32 and causes a range of
symptoms by destroying mucosal cells in the pharynx. Hou
et al reported that patients with LPRD & GERD had signif-
icantly more HREs than patients with ILPRD.24 The results
of 24h-MII-pH monitoring in 111 patients by Lechien et al
showed that acid HREs in patients with LPRD & GERD
were more significantly than ILPRD patients, but there was
no significant difference in weak acid reflux between the
two.8 And our results showed that patients with
LPRD&GERD had a significantly higher total number of
 ARTICLE IN PRESS
6 Journal of Voice, Vol. &&, No. &&, 2022
HREs and weak acid/acid/gas/fluid reflux events than
patients with ILPRD, but the percentage of each type of
HRE in total HREs of ILPRD patients did not differ from
the LPRD&GERD patients. We believe that this difference
may be related to the small number of patients included in
Lechien et al. Wu et al. showed that patient both had
LPRD and GERD had significantly more HREs than
patients only had LPRD,22 and our results are consistent
with this. In addition, we found for the first time that gas/
fluid reflux events were also significantly higher in patients
with LPRD & GERD than in patients with ILPRD. This
suggests that the combination of GERD may influence the
incidence of all types of laryngopharyngeal reflux in patients
with LPRD and is not limited to a single type of reflux.
Therefore, the influence of GERD on LPRD is stronger.
Many scholars believe that LPRD originates from
GERD and occurs after GERD,6 and our data suggest
that GERD patients with LPRD have significantly more
distal reflux events than patients with GERD only. In
addition, Johnston et al reported that 50 GER per day
are normal, but more than 3 HREs per week can lead to
pathological changes.33 Unlike the mucous cells of the
esophagus, the pharyngeal mucosal cells have a lower
activity of carbonic anhydrase. And this enzyme converts
acid to carbon dioxide, so a small amount of HRE can
damage the pharyngeal mucosal cells.33 This leads us to
wonder whether GERD in some patients is caused by
symptoms associated with LPRD, and the question of
which disease occurs first, LPRD or GERD, should be
studied in the future.
Limitations of our study:1. The RSI and RFS we used
were a subjective scale, the results of both scales only
can be a reference; 2. The placement of the 24 h-MII-pH
monitoring catheter, mucus following, and the interpreta-
tion of the results may affect the results of the test; 3.
There is an imbalance in the number of GERD patients
by gender; 4. We did not record the time point at which
each reflux occurred.
CONCLUSION
In conclusion, we further verified that GERD and LPRD
are different diseases, with GERD having a stronger influ-
ence on reflux in patients with LPRD and LPRD having a
weaker influence on reflux in patients with GERD. GERD
can increase laryngopharyngeal reflux symptoms and all
types of laryngopharyngeal reflux in patients with LPRD,
whereas LPRD only increases acid reflux and acid clearance
time in patients with GERD.
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