Esophageal Baseline Impedance is Associated with Laryngopharyngeal Reflux and Treatment Response

Abstract

ObjectiveTo evaluate the efficacy of distal esophageal mean nocturnal baseline impedance (MNBI), a general marker of esophageal mucosal barrier integrity, in predicting laryngopharyngeal reflux (LPR) and symptomatic response to acid reflux therapy.MethodsThis retrospective study analyzed 173 patients who presented with symptoms of laryngopharyngeal reflux and underwent 24‐h multichannel intraluminal impedance‐pH (MII‐pH) testing. Mean nocturnal baseline impedance values were calculated and assessed for their association and ability to predict LPR symptoms, MII‐pH results, treatment response, and other markers of LPR.ResultsNotably, 153 of the 173 patients were tested off acid suppression medication and included in statistical analysis. Based on the MII‐pH probe data, 108 (71%) patients had LPR, 8 (5%) had gastroesophageal reflux disease (GERD), and 37 (24%) were without pathologic reflux. Distal esophageal MNBI of LPR patients was significantly lower in LPR patients than patients with negative studies (1332 ± 94.8 vs. 2158 ± 173.5, p = 0.001). Among 118 patients who trialed antireflux therapy, a distal esophageal MNBI cutoff value of <1580 Ω was an independent predictor of treatment response (OR = 4.148 [1.877–9.189]). This value better predicted improvement with antireflux therapy for LPR than other objective MII‐pH probe data, which were not independent predictors of treatment response.ConclusionDistal esophageal MNBI values may have value in the diagnosis of LPR and potentially predict medication responsiveness in LPR patients.Level of Evidence3 Laryngoscope, 134:4071–4077, 2024