Treatment for LPR Does the LINX Procedure Work?
We’ve previously written articles on LPR (Laryngopharyngeal Reflux), which is sometimes (and we think wrongly) called “silent reflux”.
Patients with symptoms affecting the throat and lungs are often the most frustrated of all those suffering from reflux. Indeed, they often say they are trapped in what we call “the cycle of frustration”. Too often people feel that they’re pushed from one doctor to another, prescribed ever higher doses of the same PPI drugs which don’t work and they go round and round in circles without finding a solution. Sadly, we see many patients in this situation.
The importance of diagnosing LPR
The key, as with all clinical problems, starts with reaching a diagnosis. This is relatively easy in many patients with the more typical heartburn and oesophageal “reflux” symptoms but relying on the common investigations performed in ENT and gastroenterology clinics such as endoscopy are often not sensitive enough and insufficient with LPR. This is where reflux physiology testing, including high resolution manometry, Impedance and Bravo can be so vital in understanding what is causing LPR symptoms.
The LINX Procedure for LPR
But what of surgery such as LINX? Can anti-reflux procedures help cure LPR symptoms?
Most gastroenterologists and indeed surgeons will be very cautious in considering surgery in LPR patients. This is mostly on the basis that much of the available evidence has been inconclusive, probably because the definitions in most published papers of how to diagnose and define LPR have been so variable.
We’ve previously published and discussed the findings of our results of 200 patients followed up for 5 years following LINX surgery. We used the RIS, otherwise known as modified HRQL scores, to record baseline and post-operative outcomes. This uses a validated questionnaire to record patients’ LPR symptoms and of course these are what matter most to patients (which is why they’re known as PROMS, meaning patient reported outcome measures). The majority with high scores and LPR symptoms enjoyed significant and sustained improvements in their symptoms. And last week a paper from an expert reflux centre in the USA has published its results following LINX specifically in patients with LPR. No less than 80% of patients enjoyed good outcomes. Notably while patients with heartburn as well as LPR tended to do best, the majority with only throat symptoms also faired very well. And similarly, while response to PPIs helped predict a good outcome after LINX, many who didn’t find PPIs of any help did enjoy a significant improvement in their symptoms.
Why most doctors don’t understand that many patients suffering with difficult to treat LPR will benefit from surgery, and that there’s now lots of evidence that LINX helps the majority when performed following the right tests and in high volume expert centres, remains a mystery to us.
To us, the answer is obvious: fundamentally LINX can be a very effective treatment for the right LPR patients and when performed by the right surgeon.
