Endoscopic Anti Reflux mucosectomy effective treatment option for patients with laryngopharyngeal reflux

Laryngopharyngeal reflux disease (LPRD), a condition characterized by the backflow of stomach contents into the throat and voice box, can lead to troublesome symptoms and reduced quality of life. However, the efficacy of various treatment options, including anti-reflux mucosectomy (ARMS), has remained largely unexplored. In a recent multicenter retrospective study published in Gastrointestinal Endoscopy conducted in China, researchers led by Xinke Sui sought to investigate the clinical effectiveness of ARMS in patients with LPRD.

The study, which included 183 adult patients diagnosed with LPRD, employed oropharyngeal 24-hour Dx-pH monitoring to assess the effects of ARMS on the condition. The researchers evaluated the patients' SF-36 scores (a health-related quality of life assessment), Reflux Symptom Index (RSI) scores, and 24-hour Dx-pH monitoring results before and one year after ARMS. The findings of the study were:

● The oropharyngeal pH monitoring revealed that ARMS was effective in 72.1% of the patients (132 out of 183). This demonstrated the potential of ARMS as a viable treatment option for LPRD.

● Following the surgery, patients reported significant improvements in various LPRD-related symptoms, including constant throat clearing, difficulty swallowing food, liquids, and pills, coughing after eating or lying down, troublesome or annoying cough, and breathing difficulties or choking episodes. These improvements were statistically significant (p < 0.05).

● The researchers further divided the patients into groups based on their GEFV grade to explore the effect of GEFV on prognosis. They found that ARMS was highly effective (p < 0.05) in patients with GEFV grade I to III, with significant improvements in SF-36 and RSI scores and upright Ryan index scores.

● In patients with GEFV grade IV, where regurgitation was dominant in the supine position, the outcomes were not as positive, and symptoms tended to worsen after surgery (p < 0.05).

This study is a crucial step forward in understanding the potential benefits and limitations of ARMS for treating LPRD in adults. The findings suggest that ARMS can be an effective treatment option, particularly for patients with GEFV grade I to III. However, caution is advised in patients with GEFV grade IV, as the outcomes may not be as precise and could potentially lead to symptom aggravation. To further validate these results and gain more insight into long-term outcomes, prospective studies with extended follow-up periods are warranted.

Reference:

Sui, X., Deng, C., Wang, L., Li, D., Chen, S., Zhang, B., Li, B., Xi, X., Hu, Z., Wu, W., Wu, J., & Li, L. (2023). Medium-term clinical efficacy of endoscopic antireflux mucosectomy on laryngopharyngeal reflux: a retrospective, multicenter cohort study. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2023.07.001