Fundoplication for laryngopharyngeal reflux disease

Carl J. Westcott, M. Benjamin Hopkins, Kevin Bach, Gregory N. Postma, Peter C. Belafsky, James A. Koufman

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background Laryngopharyngeal reflux (LPR) disease arises from the effects of refluxed gastric contents on the proximal aerodigestive tract. LPR patients are often lumped into the category of "atypical" reflux. LPR symptoms are hoarseness, globus, cough, and pharyngitis. Severe disease is associated with subglottic stenosis and laryngeal cancer. Treatment includes lifestyle modifications and medications. The role of fundoplication for LPR has yet to be defined. Study design Forty-one patients underwent fundoplication for LPR. They were prospectively followed with three outcomes measures: The Reflux Symptom Index, a laryngoscopic grading scale (Reflux Finding Score), and a reflux-based specific quality-of-life scale. Results Average early followup was at 4 months and late followup was at 14 months. The Reflux Symptom Index improved by 5.4 early (p < 0.05) and 6.5 late (p < 0.05). Improvement between early and late periods approached significance (p < 0.09). Reflux Finding Score improved 3.8 (p < 0.05) early and 4.4 (p < 0.05) late. The Quality of Life Index improved 0.6 early and 2.3 (p < 0.05) late. By Reflux Symptom Index criteria, 26 patients were improved early versus 35 late (p < 0.05). Factors associated with poor outcomes were structural laryngeal changes in five patients (p < 0.05) and no response to proton pump inhibitors in six patients (p < 0.05). Conclusions Fundoplication augments treatment of LPR. Improvement of symptoms continues past the first 4 months. Laryngoscopy is critical in patient selection because selected findings are associated with outcomes, diagnosis, and management.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalJournal of the American College of Surgeons
Volume199
Issue number1
DOIs
StatePublished - Jul 1 2004

Fingerprint

Laryngopharyngeal Reflux
Fundoplication
Quality of Life
Hoarseness
Gastrointestinal Contents
Laryngoscopy
Laryngeal Neoplasms
Pharyngitis
Proton Pump Inhibitors
Cough
Patient Selection
Life Style
Pathologic Constriction
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • GERD
  • LES
  • LPR
  • PPI
  • RFS
  • RSI
  • Reflux Finding Score
  • Reflux Symptom Index
  • UES
  • gastroesophageal reflux disease
  • laryngopharyngeal reflux
  • lower esophageal sphincter
  • proton pump inhibitor
  • upper esophageal sphincter

ASJC Scopus subject areas

  • Surgery

Cite this

Fundoplication for laryngopharyngeal reflux disease. / Westcott, Carl J.; Hopkins, M. Benjamin; Bach, Kevin; Postma, Gregory N.; Belafsky, Peter C.; Koufman, James A.

In: Journal of the American College of Surgeons, Vol. 199, No. 1, 01.07.2004, p. 23-30.

Research output: Contribution to journalArticle

Westcott, Carl J. ; Hopkins, M. Benjamin ; Bach, Kevin ; Postma, Gregory N. ; Belafsky, Peter C. ; Koufman, James A. / Fundoplication for laryngopharyngeal reflux disease. In: Journal of the American College of Surgeons. 2004 ; Vol. 199, No. 1. pp. 23-30.
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AB - Background Laryngopharyngeal reflux (LPR) disease arises from the effects of refluxed gastric contents on the proximal aerodigestive tract. LPR patients are often lumped into the category of "atypical" reflux. LPR symptoms are hoarseness, globus, cough, and pharyngitis. Severe disease is associated with subglottic stenosis and laryngeal cancer. Treatment includes lifestyle modifications and medications. The role of fundoplication for LPR has yet to be defined. Study design Forty-one patients underwent fundoplication for LPR. They were prospectively followed with three outcomes measures: The Reflux Symptom Index, a laryngoscopic grading scale (Reflux Finding Score), and a reflux-based specific quality-of-life scale. Results Average early followup was at 4 months and late followup was at 14 months. The Reflux Symptom Index improved by 5.4 early (p < 0.05) and 6.5 late (p < 0.05). Improvement between early and late periods approached significance (p < 0.09). Reflux Finding Score improved 3.8 (p < 0.05) early and 4.4 (p < 0.05) late. The Quality of Life Index improved 0.6 early and 2.3 (p < 0.05) late. By Reflux Symptom Index criteria, 26 patients were improved early versus 35 late (p < 0.05). Factors associated with poor outcomes were structural laryngeal changes in five patients (p < 0.05) and no response to proton pump inhibitors in six patients (p < 0.05). Conclusions Fundoplication augments treatment of LPR. Improvement of symptoms continues past the first 4 months. Laryngoscopy is critical in patient selection because selected findings are associated with outcomes, diagnosis, and management.

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KW - upper esophageal sphincter

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