|
1
|
der Wall Hans V. In Response to Scintigraphic Imaging of Extra-Esophageal Manifestation of Gastroesophageal Reflux Disease. Laryngoscope 2025; 135:E7. [PMID: 39475154 DOI: 10.1002/lary.31885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 10/14/2024] [Indexed: 01/14/2025]
Affiliation(s)
- Van der Wall Hans
- CNI Molecular Imaging & Notre Dame University, Sydney, New South Wales, Australia
| |
Collapse
|
|
2
|
Van der Wall H, Burton L, Cooke M, Falk GL, Tovmassian D, Conway JJ. Scintigraphic Imaging of Extra-Esophageal Manifestation of Gastresophageal Reflux Disease. Laryngoscope 2025; 135:73-79. [PMID: 39210662 DOI: 10.1002/lary.31748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/16/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES There is currently no reference standard test for the detection of the extra-esophageal manifestations of gastroesophageal reflux disease (GERD). The current suite of diagnostic tests principally assesses reflux events in the esophagus. A new scintigraphic technique has been developed and validated against reference standards. It allows direct visualization of refluxate in the laryngopharynx and lungs. METHODS Fifty patients were assessed by scintigraphy before and after fundoplication at a single nuclear medicine facility. Standardized reflux symptom indices (RSIs) were obtained from each patient before and after surgery. Patients were scanned after oral 99 m technetium Fyton administration with early dynamic images and delayed SPECT/CT images of the head, neck, and lungs. ANOVA, Spearman correlation, and the Student's t-test were utilized for analysis. RESULTS The study population (35F, 15 M) had a mean age of 63.9 years. Mean BMI was 26.8 with 67% being overweight or obese. All patients had significant reflux. SPECT/CT showed LPR events in 45/50 and pulmonary micro-aspiration (PMA) in 45/50 preoperatively and in 36/50 and 20/50 postoperatively, respectively. The RSI, cough, and throat clearing indices showed a significant fall postoperatively (p < 0.001). Frequency of scintigraphic reflux events was reduced from a mean of 4.5 in 30 min to 2.9 (t = 9.1, p = 0.004). CONCLUSION The novel scintigraphic test detects esophageal and extra-esophageal reflux events and permits direct visualization of refluxate in the head and neck structures and lungs. It correlates well with symptoms of reflux in the esophagus and extra-esophageal structures and the response to therapy. LEVEL OF EVIDENCE Although prospective, the study did not randomize patients and in effect each patient became their own control following an intervention (fundoplication). Thus, the study is Level 3 evidence Laryngoscope, 135:73-79, 2025.
Collapse
Affiliation(s)
- Hans Van der Wall
- CNI Molecular Imaging & Notre Dame University, Sydney, New South Wales, Australia
| | - Leticia Burton
- CNI Molecular Imaging & Notre Dame University, Sydney, New South Wales, Australia
| | - Michelle Cooke
- CNI Molecular Imaging, Sydney, New South Wales, Australia
| | - Gregory L Falk
- Concord Hospital & University of Sydney, Sydney, New South Wales, Australia
| | | | | |
Collapse
|
|
3
|
Burton L, Joffe D, Mackey DW, Van der Wall H, Falk GL. A transformational change in scintigraphic gastroesophageal reflux studies: A comparison with historic techniques. Clin Physiol Funct Imaging 2020; 41:136-145. [PMID: 33155748 DOI: 10.1111/cpf.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The inclusion of scintigraphy in the diagnostic algorithm for gastroesophageal reflux is controversial due to variability in methodology and reporting. A novel scintigraphic reflux study has been developed and validated against the current standards for the diagnosis of gastroesophageal reflux disease (GORD). OBJECTIVE To compare a new scintigraphic reflux test against historic techniques and standardised diagnostic reference tests for gastroesophageal reflux disease. METHODS Paired scintigraphic studies were conducted in seventeen patients. All patients underwent at least one other standardised diagnostic reflux test such as 24- hour oesophageal impedance/ pH, and oesophageal manometry, barium swallow, gastroscopy or the Peptest. Patients inadvertently presented at sites B for scintigraphic reflux testing rather than at Site A which was part of an approved study. The findings from sites B did not correlate with clinical symptoms and other diagnostic reference tests from GORD. These studies were then repeated at Site A with approval from the patients. A second reflux study was performed at site A, utilising a novel technique with the capability of assessing oesophageal and extra-oesophageal disease. RESULTS The Site A technique shows good concordance with the reference diagnostic tests with an accuracy of 82.4% and kappa of 0.64 (SE: 0.16, p = 0.00). Site B had an overall accuracy of 47.1% and kappa of 0.066 (SE: 0.068, p = 0.45). CONCLUSION The Site A technique shows higher accuracy than either site B or the historic reflux techniques. It has characteristics that make it an effective screening tool for assessment of local oesophageal disease and its extraoesophageal manifestations.
Collapse
Affiliation(s)
- Leticia Burton
- CNI Molecular Imaging & University of Notre Dame, Sydney, NSW, Australia
| | - David Joffe
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Douglas W Mackey
- CNI Molecular Imaging & University of Notre Dame, Sydney, NSW, Australia
| | - Hans Van der Wall
- CNI Molecular Imaging & University of Notre Dame, Sydney, NSW, Australia
| | - Gregory L Falk
- Sydney Heartburn Clinic, Concord Hospital & University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
|
4
|
Abdul-Hussein M, Khalaf M, Castell D. Throat Clearing, Frequently Reported, But is it GERD Related? J Clin Gastroenterol 2018; 52:869-872. [PMID: 29356788 DOI: 10.1097/mcg.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS To identify the association of throat clearing (TC) with gastroesophageal reflux disease (GERD) during objective reflux monitoring in a large number of patients studied in our esophageal testing laboratory. BACKGROUND TC is frequently reported and considered to be an atypical symptom of GERD. Atypical GERD symptoms have been widely investigated and empirically treated with proton pump inhibitors. STUDY We reviewed ambulatory impedance-pH studies of 186 patients referred for evaluation of possible GERD from January 2011 to December 2015 to evaluate the symptom association (SA) of TC with both an abnormal number of reflux episodes and also abnormal esophageal acid exposure (EAE). Patients were divided into 2 groups; group 1: TC is the only reported symptom, group 2: TC is one of the symptoms. All patients were studied off proton pump inhibitors therapy. RESULTS Group 1 where TC was the only symptom in 27/186 (14.5%) patients. There was no significant difference in positive SA between this group (6/27; 22%) and group 2 (43/159; 27%) (Z score P=0.59). There was also no significant association between SA and abnormal EAE whether TC was the only presenting symptom (χ, P=0.7) or one of the reported symptoms (χ, P=0.10). None of the 6/27 had abnormal EAE. CONCLUSION Although TC is often considered a possible GERD-related symptom, we found a low probability of objective association. TC is not likely to be the only presenting symptom, and if it happens, it is unlikely to be associated with GERD. Perhaps, TC should not be considered as a GERD symptom, even as an atypical one.
Collapse
|
|
5
|
Dulery C, Lechot A, Roman S, Bastier PL, Stoll D, de Gabory L, Zerbib F. A study with pharyngeal and esophageal 24-hour pH-impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors. Neurogastroenterol Motil 2017; 29. [PMID: 27424517 DOI: 10.1111/nmo.12909] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/22/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of gastroesophageal reflux in chronic laryngeal symptoms is difficult to establish. The aim of this study was to characterize pharyngeal and esophageal pH-impedance reflux patterns in a group of patients with suspected laryngopharyngeal reflux and to determine predictive factors of response to proton pump inhibitors. METHODS Patients with chronic pharyngolaryngeal symptoms were evaluated with a symptom score questionnaire, laryngoscopy, and 24-hour pharyngeal and esophageal pH-impedance monitoring at baseline and after 8-week treatment with esomeprazole 40 mg b.i.d. Response to treatment was defined by a diminution of more than 50% of the score for the primary symptom. Reflux patterns and baseline impedance values were compared to those obtained in 46 healthy subjects. KEY RESULTS Twenty-four patients were included (17 women, median age 54 years), all previously refractory to antisecretory therapy. Symptom scores were 46 (32-62) and 40 (27-76) off and on therapy, respectively (P=.1). There was no significant difference between patients and controls for pH-impedance reflux parameters and baseline values off and on therapy in distal and proximal esophagus and in the pharynx. Median numbers of pharyngeal reflux were 0 and 0 off and on therapy, respectively. Only two patients were responders to treatment, both with excessive distal reflux but no pharyngeal reflux. Only one patient had abnormal pharyngeal reflux but did not respond to proton pump inhibitors. CONCLUSIONS Patients with suspected laryngopharyngeal reflux refractory to therapy do not exhibit abnormal pharyngeal or esophageal pH-impedance reflux. In these patients, laryngopharyngeal reflux is unlikely.
Collapse
Affiliation(s)
- C Dulery
- Gastroenterology Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - A Lechot
- ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - S Roman
- LabTAU, Inserm U1032, Univ Lyon, Lyon, France.,Digestive Physiology Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - P-L Bastier
- ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - D Stoll
- ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - L de Gabory
- ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - F Zerbib
- Gastroenterology Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| |
Collapse
|
|
6
|
|
|
7
|
Hu ZW, Wu JM, Liang WT, Wang ZG. Gastroesophageal reflux disease related asthma: From preliminary studies to clinical practice. World J Respirol 2015; 5:58-64. [DOI: 10.5320/wjr.v5.i1.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 01/16/2015] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of asthma requires the presence of episodic respiratory difficulties characterized by variable and reversible airway obstruction. It has a high prevalence worldwide and is traditionally considered to be an allergic disease. Most cases are responsive to treatment with bronchodilators and anti-inflammatories, as recommended by national and international guidelines; however, approximately 10% of asthmatic patients are refractory even to optimal therapy. Gastroesophageal reflux disease (GERD) is a common disorder in asthmatic patients and the two disorders may be linked pathophysiologically. Here we review data from preliminary studies that suggest asthma could be induced or exacerbated by gastroesophageal reflux. The optimal strategies for the diagnosis of GERD-related asthma and its therapy are still debated. However, there is evidence to suggest that antireflux treatment is effective and practical for asthmatic patients with well-defined reflux disease.
Collapse
|
|
8
|
Zerbib F, Sifrim D, Tutuian R, Attwood S, Lundell L. Modern medical and surgical management of difficult-to-treat GORD. United European Gastroenterol J 2014; 1:21-31. [PMID: 24917938 DOI: 10.1177/2050640612473964] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/13/2012] [Indexed: 12/15/2022] Open
Abstract
Approximately 30-40% of patients taking proton pump inhibitors (PPIs) for presumed gastro-oesophageal reflux (GOR) symptoms do not achieve adequate symptom control, especially when no oesophageal mucosal breaks are present at endoscopy and when extra-oesophageal symptoms are concerned. After failure of optimization of medical therapy, a careful work up is mandatory that aims at determining whether symptoms are related to GOR or not. Most patients with refractory symptoms do not have GOR-related symptoms. Some may have symptoms related to weakly acidic reflux and/or oesophageal hypersensitivity. Baclofen is currently the only antireflux compound available as add-on therapy to PPIs, but its poor tolerability limits its use in clinical practice. There is room for pain modulators in patients with hypersensitive oesophagus and functional heartburn. Antireflux surgery is a suitable option in patients responding to medical therapy who want to avoid taking medication or if persisting symptoms can be clearly attributed to poorly controlled GOR.
Collapse
Affiliation(s)
- Frank Zerbib
- Gastroenterology and Hepatology Department, Saint André Hospital, CHU Bordeaux and Bordeaux Segalen University, Bordeaux, France
| | - Daniel Sifrim
- Barts and The London School of Medicine and Dentistry, Wingate Institute for Neurogastroenterology, Queen Mary University of London, UK
| | - Radu Tutuian
- Division of Gastroenterology, University Clinic of Visceral Surgery and Medicine, Bern University Hospital, Inselspital Bern, Bern, Switzerland
| | - Stephen Attwood
- Department of Surgery, North Tyeneside Hospital, Durham University, Northumbria Healthcare, United Kingdom
| | - Lars Lundell
- Department of Surgery, Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
|
9
|
Desjardin M, Roman S, des Varannes SB, Gourcerol G, Coffin B, Ropert A, Mion F, Zerbib F. Pharyngeal pH alone is not reliable for the detection of pharyngeal reflux events: A study with oesophageal and pharyngeal pH-impedance monitoring. United European Gastroenterol J 2014; 1:438-44. [PMID: 24917995 DOI: 10.1177/2050640613513016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/16/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Pharyngeal pH probes and pH-impedance catheters have been developed for the diagnosis of laryngo-pharyngeal reflux. OBJECTIVE To determine the reliability of pharyngeal pH alone for the detection of pharyngeal reflux events. METHODS 24-h pH-impedance recordings performed in 45 healthy subjects with a bifurcated probe for detection of pharyngeal and oesophageal reflux events were reviewed. Pharyngeal pH drops to below 4 and 5 were analysed for the simultaneous occurrence of pharyngeal reflux, gastro-oesophageal reflux, and swallows, according to impedance patterns. RESULTS Only 7.0% of pharyngeal pH drops to below 5 identified with impedance corresponded to pharyngeal reflux, while 92.6% were related to swallows and 10.2 and 13.3% were associated with proximal and distal gastro-oesophageal reflux events, respectively. Of pharyngeal pH drops to below 4, 13.2% were related to pharyngeal reflux, 87.5% were related to swallows, and 18.1 and 21.5% were associated with proximal and distal gastro-oesophageal reflux events, respectively. CONCLUSIONS This study demonstrates that pharyngeal pH alone is not reliable for the detection of pharyngeal reflux and that adding distal oesophageal pH analysis is not helpful. The only reliable analysis should take into account impedance patterns demonstrating the presence of pharyngeal reflux event preceded by a distal and proximal reflux event within the oesophagus.
Collapse
Affiliation(s)
- Marie Desjardin
- CHU Bordeaux, Bordeaux, France ; Bordeaux Segalen University, Bordeaux, France
| | - Sabine Roman
- Hospices Civils de Lyon, Lyon, France ; Claude Bernard Lyon 1 University, Lyon, France
| | | | | | - Benoit Coffin
- Assistance Publique-Hôpitaux de Paris, Colombes, France ; INSERM U987, Boulogne Billancourt, France
| | | | - François Mion
- Hospices Civils de Lyon, Lyon, France ; Claude Bernard Lyon 1 University, Lyon, France
| | - Frank Zerbib
- CHU Bordeaux, Bordeaux, France ; Bordeaux Segalen University, Bordeaux, France
| |
Collapse
|
|
10
|
Martinucci I, de Bortoli N, Savarino E, Nacci A, Romeo SO, Bellini M, Savarino V, Fattori B, Marchi S. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chronic Dis 2013; 4:287-301. [PMID: 24179671 DOI: 10.1177/2040622313503485] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Laryngopharyngeal reflux is defined as the reflux of gastric content into larynx and pharynx. A large number of data suggest the growing prevalence of laryngopharyngeal symptoms in patients with gastroesophageal reflux disease. However, laryngopharyngeal reflux is a multifactorial syndrome and gastroesophageal reflux disease is not the only cause involved in its pathogenesis. Current critical issues in diagnosing laryngopharyngeal reflux are many nonspecific laryngeal symptoms and signs, and poor sensitivity and specificity of all currently available diagnostic tests. Although it is a pragmatic clinical strategy to start with empiric trials of proton pump inhibitors, many patients with suspected laryngopharyngeal reflux have persistent symptoms despite maximal acid suppression therapy. Overall, there are scant conflicting results to assess the effect of reflux treatments (including dietary and lifestyle modification, medical treatment, antireflux surgery) on laryngopharyngeal reflux. The present review is aimed at critically discussing the current treatment options in patients with laryngopharyngeal reflux, and provides a perspective on the development of new therapies.
Collapse
|
|
11
|
Carroll TL, Fedore LW, Aldahlawi MM. pH Impedance and high-resolution manometry in laryngopharyngeal reflux disease high-dose proton pump inhibitor failures. Laryngoscope 2012; 122:2473-81. [PMID: 22965767 DOI: 10.1002/lary.23518] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 04/17/2012] [Accepted: 05/23/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngopharyngeal reflux disease (LPRD) patients often fail empiric treatment with high-dose, twice-daily (BID) proton pump inhibitors (PPIs). Further testing is warranted to rule in or out nonacid reflux (NAR) or breakthrough acid reflux (BAR) as the etiology of the symptoms. Results of coordinated multichannel intraluminal pH impedance (MII) and high-resolution esophageal manometry (HRM) testing while patients are on high-dose BID PPIs is lacking in the LPRD population. The objective of this study is to evaluate if coordinated MII and HRM aid in the management of patients with persistent LPRD symptoms despite high dose BID PPIs. STUDY DESIGN Retrospective case series. METHODS MII and HRM were administered while on medication to 23 persistent LPRD subjects who had failed 3 months of high-dose BID PPIs. Number and pH of total and proximal reflux episodes, DeMeester score, reflux symptom correlation, and motility/physiology findings were recorded. Subjects were grouped into significant NAR, BAR, or nonsignificant NAR. RESULTS Fifty-two percent of subjects had significant NAR and 22% had BAR despite high-dose BID PPIs. Statistically significant differences were found between groups for the MII outcomes of DeMeester score, number of total and proximal reflux events, and nonacid reflux events. HRM demonstrated dysmotility in five subjects. CONCLUSIONS For recalcitrant LPRD subjects who fail empiric high-dose BID PPI therapy, this study demonstrated significant NAR or BAR in 74% of subjects. Evaluation by MII and HRM performed on PPI therapy proved useful for diagnosis and further management.
Collapse
Affiliation(s)
- Thomas L Carroll
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts 02111, USA..
| | | | | |
Collapse
|
|
12
|
Lee JH, Park SY, Cho SB, Lee WS, Park CH, Koh YI, Joo YE, Kim HS, Choi SK, Rew JS. Reflux episode reaching the proximal esophagus are associated with chronic cough. Gut Liver 2012; 6:197-202. [PMID: 22570748 PMCID: PMC3343157 DOI: 10.5009/gnl.2012.6.2.197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 12/30/2022] Open
Abstract
Background/Aims Gastroesophageal reflux (GER) has been implicated in the pathogenesis of chronic cough. The aims of this study were to evaluate the diagnostic usefulness of multichannel intraluminal impedance combined with pH monitoring (MII/pH monitoring) in patients with suspected symptoms of gastroesophageal reflux disease (GERD) and to assess the correlation between GER symptoms and reflux nature. Methods Seventy patients with suspected symptoms of GERD (such as heartburn, acid regurgitation, non-cardiac chest pain, globus and chronic cough) were enrolled. All patients were asked to discontinue medications that would influence esophageal motor function and gastric acid secretion at least one week ago. All subjects underwent MII/pH monitoring. Results Forty-five patients (64.3%) were diagnosed with GERD. Among these patients, eleven patients (15.7%) had pathologic acid reflux by pH data and thirty-four patients (48.6%) had pathologic bolus exposure by impedance. Subjects with chronic cough had a higher DeMeester score (p=0.009), percentage of acid exposure time (p=0.007), acid bolus exposure % time (p=0.027), distal acid reflux episodes (p=0.015) and proximal acid reflux episodes (p=0.030) than subjects without chronic cough. Conclusions The results of this study showed that the impedance monitoring enhanced diagnostic sensitivity than pH-monitoring alone by 48.6%. In addition, reflux episodes at the distal and proximal esophagus were noted to be important factors associated with chronic cough.
Collapse
Affiliation(s)
- Jeong-Hyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
13
|
Ang D, Ang TL, Teo EK, Hsu PP, Tee A, Poh CH, Tan J, Ong J, Fock KM. Is impedance pH monitoring superior to the conventional 24-h pH meter in the evaluation of patients with laryngorespiratory symptoms suspected to be due to gastroesophageal reflux disease? J Dig Dis 2011; 12:341-8. [PMID: 21955426 DOI: 10.1111/j.1751-2980.2011.00519.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cough and laryngo-pharyngeal symptoms (LPS) are associated with gastroesophageal reflux disease (GERD). The role of acid reflux (AR) and non-acid reflux (NAR) in atypical GERD pathogenesis is controversial. The aims of the study were to determine the prevalence of high esophageal acid exposure time (AET) in patients presenting with cough or LPS and determine the incremental yield of multichannel intraluminal impedance-pH (MII-pH) monitoring. METHODS We undertook a prospective study of patients with cough or LPS referred for GERD evaluation between January 2009 and May 2011. All patients underwent esophageal manometry, gastroscopy and MII-pH. Patients' characteristics, gastroscopy findings, distal esophageal AET, bolus exposure (BE) time and numbers of AR and NAR episodes in the proximal and distal esophagus were studied. RESULTS Overall 50 patients (22 male, mean age 47.5 ± 14.2 years) were evaluated for unexplained chronic cough (n = 23, 46.0%), and LPS symptoms including globus (n = 10, 20.0%), sore throat (n = 12, 24.0%) and hoarse voice (n = 5, 10.0%). A normal gastroscopy, Los Angeles grade A and B esophagitis occurred in 44 (88.0%), 5 (10.0%) and 1 (2.0%) patient, respectively. Seven (14.0%) recorded elevated AET (chronic cough, 4; sore throat, 2; and hoarse voice, 1). Nine patients recorded abnormal impedance characteristics (raised BE time and/or increased reflux numbers) despite a normal AET leading to an incremental diagnostic yield of 18%. CONCLUSION An isolated high AET is uncommon in patients with cough or LPS. Combined MII-pH improves the diagnostic yield in patients with atypical GERD manifestations.
Collapse
Affiliation(s)
- Daphne Ang
- Department of Gastroenterology, Changi General Hospital, Singapore.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
14
|
Becker S, Schmidt C, Berghaus A, Tschiesner U, Olzowy B, Reichel O. Does laryngopharyngeal reflux cause intraoral burning sensations? A preliminary study. Eur Arch Otorhinolaryngol 2011; 268:1375-81. [PMID: 21359587 DOI: 10.1007/s00405-011-1543-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
Intraoral burning sensations are a common problem in the otolaryngological practice. The aim of this study was to evaluate if laryngopharyngeal reflux can cause intraoral burning sensations by measuring oropharyngeal acid reflux. Patients with recurring intraoral burning sensations underwent oropharyngeal pH monitoring in our outpatient clinic. The pH catheter was placed at the level of the uvula. The catheter contained an externally worn transmitter, which wirelessly sent the data to a monitor. In addition, patients were instructed to indicate meals or the occurrence of burning sensations by pressing provided buttons on the monitor. Corresponding events of burning sensations and a significant decrease in oropharyngeal pH values should be visualized. Twenty two patients suffering from recurring intraoral burning sensations underwent oropharyngeal pH measurement for 21-25 h. We could find oropharyngeal reflux episodes in 11 patients. However, we could not detect any episodes of burning sensations in the mouth corresponding with a decrease in oropharyngeal pH values. Our results suggest that there is no causal connection between LPR episodes and the occurrence of intraoral burning sensations in the examined patients. Although further studies with more patients are necessary in the future, we conclude from our findings that recurring intraoral burning sensations are not an indication for proton pump inhibitor therapy.
Collapse
Affiliation(s)
- Sven Becker
- Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | | | | | | | | | | |
Collapse
|
|
15
|
Lee BE, Kim GH, Ryu DY, Kim DU, Cheong JH, Lee DG, Song GA. Combined Dual Channel Impedance/pH-metry in Patients With Suspected Laryngopharyngeal Reflux. J Neurogastroenterol Motil 2010; 16:157-165. [PMID: 20535346 PMCID: PMC2879840 DOI: 10.5056/jnm.2010.16.2.157] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 03/26/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS Laryngopharyngeal symptoms of gastroesophageal reflux disease (GERD) such as globus sensation, hoarseness and chronic cough are becoming increasingly recognized. This study was aimed to investigate the diagnostic usefulness of combined dual channel multichannel intraluminal impedance (MII)/pH-metry in 'off-proton pump inhibitor (PPI)' patients with suspected laryngopharyngeal reflux. METHODS Ninety-eight patients with laryngopharyngeal symptoms of GERD were included. All patients were 'off-PPI' state for at least 2 weeks prior to the study, and underwent endoscopy and dual channel combined MII/pH-metry. RESULTS The mean age of the patients was 49.8 +/- 10.9 years and there were 44 males (44.9%). Fifty-three patients (54.1%) showed pathologic gastroesophageal reflux (GER). Combined dual channel MII/pH-metry achieved highest diagnostic yield of 49.0% and diagnostic yield of single channel combined MII/pH-metry was 37.8%. Addition of MII to standard pH-metry increased twofold of the diagnostic yield for detecting GER. Among 37 patients (37.8%) who had pathologic GER being detected by MII/pH-metry, 19 patients (19.4%) had nonacid GER (nonacid GER group) while 18 patients (18.4%) had acid GER (acid GER group). Pathologic GER group, as classified by MII/pH-metry showed more frequent globus sensation than nonpathologic GER group. Acid GER group had more proximal reflux than nonacid GER group, especially in the upright position. CONCLUSIONS In this study, combined dual channel MII/pH-metry showed the highest diagnostic yield for detecting GER. This technique can be performed primarily to accurately diagnose laryngopharyngeal reflux disease and exclude other causes of laryngopharyngeal symptoms.
Collapse
Affiliation(s)
- Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Yup Ryu
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jae Hoon Cheong
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Gun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|