Does Presence of Laryngotracheal Pepsin Increase Severity of Symptoms in Patients with Laryngotracheal Stenosis?

Abstract

Objectives:

Extraesophageal reflux has been implicated in the development of laryngotracheal stenosis, and presence of pepsin has been reported in up to 59% of patients with idiopathic subglottic stenosis. The objective of this study was to determine 1) the incidence of a positive pepsin biopsy in patients with laryngotracheal stenosis (LTS) and 2) if presence of laryngotracheal pepsin increases the severity of symptoms as perceived by the patients.

Methods:

A retrospective cohort was conducted on 24 patients with LTS who underwent pepsin biopsy. Severity of symptoms was determined by using Reflux Symptom Index (RSI), Voice Handicap Index-10 (VHI-10), and Glottal Function Index (GFI) scores on initial presentation. Student T-test was used for statistical analysis.

Results:

The incidence of positive pepsin biopsy was 37.5% (9/24). Three patients were tracheostomy tube dependent and were excluded from further analysis, which resulted in 8 pepsin positive and 13 pepsin negative patients. The mean RSI, VHI-10, and GFI scores were higher in the pepsin positive group; only the GFI scores were statistically significant (P = 0.034) between the two groups.

Conclusions:

In this cohort only 37.5% of patients with laryngotracheal stenosis tested positive for pepsin. Our study did not show a correlation of presence of pepsin with RSI or VHI-10 scores but was statistically significant for GFI scores. This suggests that higher GFI scores may predict presence of pepsin at the site of stenosis. Larger studies are needed to determine if presence of pepsin plays a role in the severity of laryngotracheal stenosis.