Patients presenting with laryngeal symptoms tend to have heterogeneous presentations and disease mechanisms which lead to misdiagnosis of laryngopharyngeal reflux (LPR) and substandard outcomes. A new study by Yadlapati et al sought to identify the different phenotypes of patients with laryngeal symptoms on the basis of clinical and physiologic data. It also aimed to compare the characteristics across different phenotypes.

In all, 302 adult patients with chronic laryngeal symptoms were recruited in the study at 3 centers from January 2018 through October 2020 (age 57.2 ± 15.2 years; body mass index 27.2 ± 6.0 kg/m²). About 30% of the patients were male. Investigators administered the discriminant analysis of principal components (DAPC) to 12 clinical and 11 physiologic variables obtained in a stable condition in order to identify the phenotypes.

Findings from the study -

DAPC could identify 5 groups. There were significant differences across symptoms, size of hiatal hernia, and number of reflux events (P < .01). The following groups were identified:

• Group A – This group had the highest hiatal hernia size (3.1 ± 1.0 cm; P < .001), the greatest reflux events (37.5 ± 51; P < .001), and frequent cough, heartburn, laryngeal symptoms, and regurgitation.
• Group B – This group was noted to have the highest body mass index (28.2 ± 4.6 kg/m²; P < .001) and salivary pepsin levels (150 ± 157 ng/mL; P = .03). It had frequent cough, globus, heartburn, laryngeal symptoms, and regurgitation.
• Group C – This group had frequent laryngeal symptoms (93%; P < .001), with the least esophageal symptoms (9.6%; P < .001) and reflux events (10.7 ± 11.0; P < .001).
• Group D – This group frequently reported cough (88%; P < .001) and heartburn.
• Group E – This group was the oldest (62.9 ± 14.3 years; P < .001) and was differentiated based on the highest integrated relaxation pressure.

DAPC helped identify distinct clinicophysiologic phenotypes of patients having laryngeal symptoms referred for reflux evaluation:

Group A – LPR and gastroesophageal reflux disease along with hiatal hernia;

Group B – Mild LPR/GERD;

Group C – No LPR/No GERD;

Group D – Reflex cough;

Group E – Mixed or possible obstructive esophagogastric junction.

Source: Yadlapati R, Kaizer AM, Sikavi DR, et al. Distinct Clinical Physiologic Phenotypes of Patients With Laryngeal Symptoms Referred for Reflux Evaluation. Clin Gastroenterol Hepatol. 2022 Apr;20(4):776-786.e1.