Response of Laryngopharyngeal Symptoms to Transoral Incisionless Fundoplication in Patients with Refractory Proven Gastroesophageal Reflux

Abstract

Objective: Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. Methods: Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett’s esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. Results: Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P < .001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF ( P < .001). Conclusion: In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. Level of Evidence Level 4

Correlation Between Refractory Laryngopharyngeal Reflux Disease and Symptoms of Anxiety and Depression

“…8 Further, because of the limitations of clinical tools, many symptoms and extrapharyngeal manifestations were not considered. 9 Although knowledge on nonacidic LPR has recently progressed, a treatment plan based on PPIs has not been developed. 2 The therapeutic effect of PPIs alone to inhibit acid reflux is not ideal and therefore has also been evaluated incorrectly.…”

Review article: Diagnosis and management of laryngopharyngeal reflux

“…At a median of 14 months follow‐up, RSI score decreased from 19.2 to 6.1 after TIF ( p < 0.001). Snow et al 137 similarly showed in 49 patients with refractory LPR symptoms (RSI > 13) and either erosive oesophagitis, Barrett's oesophagus and/or pathological acid reflux undergoing TIF or TIF with hiatal hernia repair, 85% had normalisation of their RSI post‐procedure.…”

Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going?

“…In 2017, FDA allowed modification of the TIF device instructions for use, permitting TIF to be performed with hiatal hernia repair, similar to surgical fundoplication. There is growing evidence of the safety and efficacy of cTIF procedures for typical and atypical GERD symptoms [26 ▪ ,32–34]. A recent study by Jaruvongvanich et al compared hiatal hernia repair followed by LNF to cTIF and showed comparable results between the two groups for postprocedural PPI use, dysphagia, esophagitis, disrupted wrap, and hiatal hernia recurrence.…”