{
  "abstract": "Introduction Patients presenting with laryngopharyngeal symptoms (LPS) are frequently treated empirically with proton pump inhibitors (PPIs) without objective evidence of pathological reflux. It remains uncertain whether motility phenotypes observed on high-resolution manometry (HRM) are associated with PPI response in this population, and whether motility assessment could help identify those most likely to benefit from acid suppression.Methods This retrospective two-centre study included 143 patients referred for oesophageal physiology with ≥2 laryngopharyngeal symptoms (e.g., cough, throat clearing, excess phlegm, dysphonia, throat pain). HRM and 24-hour pH-impedance studies were performed in line with current guidance. Those with confirmed laryngopharyngeal reflux disease (LPRD) were excluded. The remaining 117 patients were classified as PPI responders (partial/complete) or non-responders based on subjective reporting. Motility was categorised as normal or abnormal (absent contractility, hypotensive motility, or hypercontractility) using a protocol of single water swallows and a rice meal. Symptom severity was assessed using the Esophageal Hypervigilance and Anxiety Scale (EHAS) and the Health-Related Quality of Life in LPR (HRQL-LPR).Results Of 117 patients with LPS and without pathological oesophageal acid exposure, 44 (38%) were PPI responders and 73 (62%) were non-responders. Abnormal motility was significantly more common among responders (18/44; 41%) than non-responders (7/73; 10%) (p<0.001). No significant differences were observed between groups in any HRM metrics beyond motility classification, or in reflux parameters on pH-impedance. Symptom severity scores on both the EHAS and HRQL-LPR were comparable between responders and non-responders.Conclusions In patients with laryngopharyngeal symptoms and without objective evidence of pathological reflux, response to PPI therapy appears to be more closely associated with oesophageal motility than reflux burden or symptom severity. These findings suggest that treatment responsiveness in this group cannot be explained by acid or non-acid reflux metrics alone. High-resolution manometry may therefore provide useful physiological insight to help identify which LPS patients are more likely to benefit from empirical PPI therapy.Abstract P401 Table 1Demographics and physiological metrics of PPI responders vs non-responders in patients with LPSMetricsResponders (n=44)Non-responders (n=70)p-valueMedian Age5552N Female (%)26 (59%)47 (64%)Normal motility2666<0.001Abnormal motility187Median LOS tone (mmHg)27.125.90.68Median AET (%)0.91.00.16Median no. of reflux events30270.22Median no. of proximal reflux880.76Median MNBI193719420.81",
  "authors": [
    {
      "affiliations": [
        "University College London Hospitals NHS Trust, London, United Kingdom"
      ],
      "name": "James Endersby"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Trust, London, United Kingdom"
      ],
      "name": "Holly Mills"
    },
    {
      "affiliations": [
        "St George’s University Hospitals NHS Trust, London, United Kingdom"
      ],
      "name": "Minerva De Silva"
    },
    {
      "affiliations": [
        "St George’s University Hospitals NHS Trust, London, United Kingdom"
      ],
      "name": "Jamal Hayat"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Trust, London, United Kingdom"
      ],
      "name": "Rami Sweis"
    }
  ],
  "title": "P401 Oesophageal motility phenotype predicts PPI response in patients with laryngopharyngeal symptoms",
  "uid": "686c8aa9-47f6-53a8-9288-49f055317e0d"
}