High-resolution manometry findings in laryngopharyngeal reflux: A systematic review

Objectives To investigate the role of high-resolution manometry (HRM) in the evaluation of laryngopharyngeal reflux (LPR) and to identify recurrent patterns of esophageal and upper esophageal sphincter (UES) motility abnormalities and their potential pathophysiological relevance. Methods Publications were screened for eligibility based on predetermined criteria through a literature search conducted on PubMed and Web of Science according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies published between January 2015 and December 2025 evaluating HRM or high-resolution manometry with impedance in adults with LPR were considered. Results From 148 publications, 20 studies were kept for analysis. Diagnostic approaches for LPR varied considerably and included symptom questionnaires, laryngoscopy findings, pH monitoring, and multichannel intraluminal impedance-pH monitoring. There was substantial heterogeneity between studies regarding patient selection, swallow protocols, and reported HRM outcomes. Findings related to upper esophageal sphincter resting pressure, sphincter length, and integrated relaxation pressure were inconsistent. In contrast, several studies reported a higher prevalence of abnormal esophageal motility, including ineffective peristalsis, weak or failed swallows, and impaired bolus clearance in LPR patients. Parameters such as proximal esophageal contractile integral and upper esophageal sphincter impedance integral showed promising but limited evidence. Conclusion Abnormal esophageal motility emerges as a recurrent finding associated with LPR symptoms. However, given the substantial heterogeneity among the included studies, these findings should currently be regarded only as a starting point for future research. Future standardized protocols, including the Leuven Consensus recommendations, may improve comparability and help identify meaningful HRM parameters.