Original Article|Articles in Press

The key timing of pharyngeal reflux in patients with laryngopharyngeal reflux

  • Jeong Wook Kang
    Department of Otolaryngology-Head and Neck surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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  • Young Chan Lee
    Department of Otolaryngology-Head and Neck surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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  • Seong-Gyu Ko
    Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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  • Young-Gyu Eun
    Corresponding author: Young-Gyu Eun, Department of Otolaryngology-Head and Neck surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea, #23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea
    Department of Otolaryngology-Head and Neck surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Published:December 03, 2022DOI:



      To analyze the incidence of pharyngeal reflux in laryngopharyngeal reflux patients over a 24-hour period and find out the key timing of pharyngeal reflux.


      We reviewed 69 patients who visited our clinic with LPR-related symptoms and were proven to have pharyngeal reflux via 24‐hour multichannel intraluminal impedance‐pH (24hr MII‐pH) monitoring. Quantitative analysis was conducted for the LPR profiles, such as the acidity of reflux, nighttime reflux, and positional reflux. The time series of pharyngeal reflux episodes and mealtimes were analyzed over a 24-hour period. Also, we recruited 26 normal controls. We compared the timing of pharyngeal reflux between LPR patients and asymptomatic controls.


      The quantitative analysis revealed that pharyngeal reflux occurred 4.88 ± 4.59 times over 24 hours. Weakly acidic pharyngeal reflux was more abundant than acidic or weakly alkaline reflux. Pharyngeal reflux occurred mainly during daytime in the upright position. The most frequent timing of pharyngeal reflux episodes was within 2 hours after meals. Additionally, there was no significant difference of the timing of post-prandial reflux between LPR patients and asymptomatic controls.


      The key timing of pharyngeal reflux in patients with LPR was post-prandial 2 hours.


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        • Campagnolo AM
        • Priston J
        • Thoen RH
        • Medeiros T
        • Assuncao AR.
        Laryngopharyngeal reflux: diagnosis, treatment, and latest research.
        Int Arch Otorhinolaryngol. 2014; 18: 184-191
        • Gelardi M
        • Ciprandi G.
        Focus on gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR): new pragmatic insights in clinical practice.
        J Biol Regul Homeost Agents. 2018; 32 (Suppl. 2): 41-47
        • Kim SI
        • Kwon OE
        • Na SY
        • Lee YC
        • Park JM
        • Eun YG.
        Association between 24-hour combined multichannel intraluminal impedance-pH monitoring and symptoms or quality of life in patients with laryngopharyngeal reflux.
        Clin Otolaryngol. 2017; 42: 584-591
        • Salihefendic N
        • Zildzic M
        • Cabric E.
        Laryngopharyngeal Reflux Disease - LPRD.
        Med Arch. 2017; 71: 215-218
        • Vakil N
        • van Zanten SV
        • Kahrilas P
        • Dent J
        • Jones R
        Global Consensus G.
        The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006; 101 (quiz 43): 1900-1920
        • Lee YC
        • Jung AR
        • Kwon OE
        • Kang JW
        • Huh JH
        • Eun Y-G.
        The effect of baclofen combined with a proton pump inhibitor in patients with refractory laryngopharyngeal reflux: A prospective, open-label study in thirty-two patients.
        Clin Otolaryngol. 2019; 44: 431-434
        • Holloway RH
        • Hongo M
        • Berger K
        • McCallum RW.
        Gastric distention: a mechanism for postprandial gastroesophageal reflux.
        Gastroenterology. 1985; 89: 779-784
        • van Wijk MP
        • Blackshaw LA
        • Dent J
        • Benninga MA
        • Davidson GP
        • Omari TI.
        Distension of the esophagogastric junction augments triggering of transient lower esophageal sphincter relaxation.
        Am J Physiol Gastrointest Liver Physiol. 2011; 301: G713-G718
        • Li S
        • Shi S
        • Chen F
        • Lin J.
        The effects of baclofen for the treatment of gastroesophageal reflux disease: a meta-analysis of randomized controlled trials.
        Gastroenterol Res Pract. 2014; 2014307805
        • Lechien JR
        • Bobin F
        • Dapri G
        • Eisendrath P
        • Salem C
        • Mouawad F
        • et al.
        Hypopharyngeal-Esophageal Impedance-pH Monitoring Profiles of Laryngopharyngeal Reflux Patients.
        Laryngoscope. 2021; 131: 268-276
        • Kim SI
        • Jeong SJ
        • Kwon OE
        • Park JM
        • Doo JG
        • Park SI
        • et al.
        Pharyngeal reflux episodes in patients with suspected laryngopharyngeal reflux versus healthy subjects: a prospective cohort study.
        Eur Arch Otorhinolaryngol. 2021;
        • Belafsky PC
        • Postma GN
        • Koufman JA.
        Validity and reliability of the reflux symptom index (RSI).
        J Voice. 2002; 16: 274-277
        • Hoppo T
        • Sanz AF
        • Nason KS
        • Carroll TL
        • Rosen C
        • Normolle DP
        • et al.
        How much pharyngeal exposure is "normal"? Normative data for laryngopharyngeal reflux events using hypopharyngeal multichannel intraluminal impedance (HMII).
        J Gastrointest Surg. 2012; 16 (discussion -5): 16-24
        • Wang AJ
        • Liang MJ
        • Jiang AY
        • Lin JK
        • Xiao YL
        • Peng S
        • et al.
        Gastroesophageal and laryngopharyngeal reflux detected by 24-hour combined impedance and pH monitoring in healthy Chinese volunteers.
        J Dig Dis. 2011; 12: 173-180
        • Kawamura O
        • Kohata Y
        • Kawami N
        • Iida H
        • Kawada A
        • Hosaka H
        • et al.
        Liquid-containing Refluxes and Acid Refluxes May Be Less Frequent in the Japanese Population Than in Other Populations: Normal Values of 24- hour Esophageal Impedance and pH Monitoring.
        J Neurogastroenterol Motil. 2016; 22: 620-629
        • Kuo C-L.
        Laryngopharyngeal Reflux: An Update.
        Archives of Otorhinolaryngology-Head & Neck Surgery. 2019; 3
        • Kang HJ
        • Park JM
        • Choi SY
        • Kim SI
        • Lee YC
        • Eun YG
        • et al.
        Comparison Between Manual and Automated Analyses in Multichannel Intraluminal Impedance: pH Monitoring for Laryngopharyngeal Reflux.
        Otolaryngol Head Neck Surg. 2021; (1945998211006929)
        • Park W
        • Hicks DM
        • Khandwala F
        • Richter JE
        • Abelson TI
        • Milstein C
        • et al.
        Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response.
        Laryngoscope. 2005; 115: 1230-1238
        • Yoon YH
        • Park KW
        • Lee SH
        • Park HS
        • Chang JW
        • Koo BS.
        Efficacy of three proton-pump inhibitor therapeutic strategies on laryngopharyngeal reflux disease; a prospective randomized double-blind study.
        Clin Otolaryngol. 2019; 44: 612-618
        • Pandolfino JE
        • Zhang QG
        • Ghosh SK
        • Han A
        • Boniquit C
        • Kahrilas PJ.
        Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry.
        Gastroenterology. 2006; 131: 1725-1733
        • Moonen A
        • Aguilera-Lizarraga J
        • Bisschops R
        • Moonen P
        • Tack J
        • Boeckxstaens GE.
        24-hour multi-pH recording of the postprandial acid pocket and the nocturnal acid distribution at the esophagogastric junction in healthy volunteers.
        Neurogastroenterology & Motility. 2019; 31
        • Schneider JH
        • Kuper MA
        • Konigsrainer A
        • Brucher BL.
        Transient lower esophageal sphincter relaxation and esophageal motor response.
        J Surg Res. 2010; 159: 714-719
        • Szczesniak MM
        • Williams RB
        • Cook IJ.
        Mechanisms of Esophago-Pharyngeal Acid Regurgitation in Human Subjects.
        PLoS One. 2011; 6: e22630
        • Gourcerol G
        • Verin E
        • Leroi AM
        • Ducrotté P.
        Can multichannel intraluminal pH-impedance monitoring be limited to 3 hours? Comparison between ambulatory 24-hour and post-prandial 3-hour recording: Three-hour pH-impedance monitoring.
        Dis Esophagus. 2014; 27: 732-736
        • Merati AL
        • Lim HJ
        • Ulualp SO
        • Toohill RJ.
        Meta-analysis of upper probe measurements in normal subjects and patients with laryngopharyngeal reflux.
        Ann Otol Rhinol Laryngol. 2005; 114: 177-182