Laryngopharyngeal reflux: a prospective analysis of a 34 item symptom questionnaire

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Abstract
Objectives:  Laryngopharyngeal reflux is increasingly diagnosed, but both its symptoms and relationship to gastro‐oesophageal reflux disease remain confused. Aims: (i) To assess symptoms in potential laryngopharyngeal reflux patients according to a comprehensive symptom list based on both a gastro‐oesophageal reflux questionnaire and a laryngopharyngeal reflux questionnaire. (ii) To assess whether there are statistically discrete symptom clusters which might map to specific syndromes e.g. globus pharynges.Design:  Prospective single cohort questionnaire survey.Methods:  A 34‐item questionnaire comprising all symptoms identifiable on (i) the original 25‐item Gastroesophageal Symptom Assessment Scale (GSAS) and (ii) the nine Reflux Symptom Index (RSI) items, ‘unbundled’ as necessary, were administered to 62 ENT clinic attenders. Descriptive, correlation and cluster analysis was performed.Results:  All but two of the combined 34‐symptom list were endorsed by at least 20% of 62 patients. Certain symptoms which the Reflux Symptom Index groups as a single item were only weakly correlated. No specific symptom clusters were identified.Conclusions:  Neither the most popular ‘lower’ oesophageal (GSAS) nor the ‘throat’ reflux (RSI) questionnaire adequately captures the full range of potential reflux symptoms regularly encountered in otolaryngology patients: inadequate evaluation of patients’ symptoms may have contributed to the ongoing uncertainty about the role of acid or pepsin suppression. A more comprehensive reflux questionnaire is needed to characterise the true reflux correlations of laryngopharyngeal symptoms, and offer a symptom‐specific measure of response to placebo and anti‐reflux therapy.

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