Association of Reflux Characteristics on 24-Hour pH-Impedance Monitoring with Clinical Manifestations of Laryngopharyngeal Reflux: A Cross-sectional Study

Abstract

Laryngopharyngeal reflux (LPR) is characterized by the retrograde movement of gastric contents into the laryngopharynx. The clinical relevance of specific reflux characteristics detected by 24-hour pH-multichannel intraluminal impedance (pH-MII) monitoring remains incompletely understood. This study evaluated the association between reflux acidity and physical composition with clinical manifestations of LPR. This cross-sectional observational study included 40 patients with LPR at two tertiary hospitals in Makassar, Indonesia. Clinical manifestations were assessed using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Reflux episodes were characterized according to acidity (acid, weakly acid, and non-acid) and physical composition (liquid, gas, and mixed) using 24-hour pH-MII monitoring. Associations were analyzed using the Kruskal–Wallis test. Weakly acid reflux was the predominant reflux type, accounting for 2,825 episodes, whereas mixed reflux was the most frequent physical composition, with 1,650 episodes. The mean RSI and RFS scores were 16.23 ± 2.74 and 10.38 ± 2.98, respectively. Reflux acidity was not significantly associated with any RSI or RFS component (P > 0.05). In contrast, reflux composition was significantly associated with heartburn/regurgitation (P = 0.018), with the highest mean score observed in the mixed-reflux group (3.38 ± 1.43). No other RSI or RFS component differed significantly according to reflux composition. In conclusion, reflux acidity was not associated with LPR symptoms or laryngoscopic findings, whereas reflux composition was associated with heartburn/regurgitation. Further prospective studies with larger and more balanced cohorts are warranted to clarify the clinical significance of distinct reflux phenotypes.