Esophageal motor dysfunction may underlie impaired bolus/refluxate clearance in laryngopharyngeal reflux (LPR). However, the prevalence of esophageal dysmotility and its correlation with reflux parameters and symptoms in LPR is not well established.
This was a retrospective cohort study of 194 consecutive patients with LPR symptoms referred for high-resolution esophageal manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing (HEMII-pH) at a tertiary center in 3/2018-8/2019. Validated symptom surveys were prospectively collected at time of testing, including Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Questionnaire (GERD-Q), dominant symptom intensity (DSI), and 12-item short-form health survey (SF-12). HRM findings were categorized using Chicago Classification v3.0.
Abnormal findings on HRM were identified in 84 (43.3%) patients, with ineffective esophageal motility (n=60, 30.9%) as the most common diagnosis. A disorder of esophagogastric junction (EGJ) outflow or a major disorder of peristalsis was identified in 26 (13.4%) patients, including 2 (1%) with achalasia and 7 (3.6%) with jackhammer esophagus. Reflux burden (distal, proximal, or pharyngeal) on HEMII-pH did not differ across HRM findings. Patients reporting esophageal symptoms were more likely to have a primary motility disorder (OR 2.34, p=0.04). However, no significant differences in RSI, GERD-Q, or SF-12 were noted across HRM diagnoses.
Esophageal motility disorders are prevalent among patients with LPR symptoms, including up to one in seven with EGJ outflow or major peristaltic disorder. Patients with abnormal motility more likely report esophageal symptoms. Clinicians should be aware of these co-existing conditions, particularly in those with refractory symptoms.

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