pH Impedance and high-resolution manometry in laryngopharyngeal reflux disease high-dose proton pump inhibitor failures§


  • This work was performed at Tufts Medical Center, Boston, Massachusetts, U.S.A.

  • Thomas L. Carroll, MD, is a workshop leader for Merz Aesthetics.

  • §

    The authors have no other funding, financial relationships, or conflicts of interest to disclose.



Laryngopharyngeal reflux disease (LPRD) patients often fail empiric treatment with high-dose, twice-daily (BID) proton pump inhibitors (PPIs). Further testing is warranted to rule in or out nonacid reflux (NAR) or breakthrough acid reflux (BAR) as the etiology of the symptoms. Results of coordinated multichannel intraluminal pH impedance (MII) and high-resolution esophageal manometry (HRM) testing while patients are on high-dose BID PPIs is lacking in the LPRD population. The objective of this study is to evaluate if coordinated MII and HRM aid in the management of patients with persistent LPRD symptoms despite high dose BID PPIs.

Study Design:

Retrospective case series.


MII and HRM were administered while on medication to 23 persistent LPRD subjects who had failed 3 months of high-dose BID PPIs. Number and pH of total and proximal reflux episodes, DeMeester score, reflux symptom correlation, and motility/physiology findings were recorded. Subjects were grouped into significant NAR, BAR, or nonsignificant NAR.


Fifty-two percent of subjects had significant NAR and 22% had BAR despite high-dose BID PPIs. Statistically significant differences were found between groups for the MII outcomes of DeMeester score, number of total and proximal reflux events, and nonacid reflux events. HRM demonstrated dysmotility in five subjects.


For recalcitrant LPRD subjects who fail empiric high-dose BID PPI therapy, this study demonstrated significant NAR or BAR in 74% of subjects. Evaluation by MII and HRM performed on PPI therapy proved useful for diagnosis and further management. Laryngoscope, 2012