Background
Laryngopharyngeal reflux (LPR) can cause atypical symptoms, asthma, and pulmonary fibrosis. The aim of this study was to establish the normative data for LPR using hypopharyngeal multichannel intraluminal impedancepH (HMII).
Methods
Asymptomatic subjects underwent endoscopy followed by 24-h HMII using a specialized impedance catheter configured to detect LPR before and after a 2-week course of proton pump inhibitors (PPI). Subjects were excluded if they had esophageal pathology or a positive DeMeester score. A cohort of 24 LPR patients who had a complete response to treatment was used for comparison with the normative data.
Results
Forty subjects were enrolled. Thirty-four subjects completed one, and 25 completed both HMII testing periods off and on PPI. There was no difference in the total number of reflux events between off and on PPI [22 (8–32) and 24 (10–28), respectively, p=0.89]. The 95th percentiles of LPR off and on PPI were 0 and 1, respectively. All patients with treatment responsive LPR had pre-treatment HMII values of LPR greater than the 95th percentile.
Conclusion
LPR events are rare in an asymptomatic population. One or more LPR events should be considered abnormal in patients with LPR symptoms regardless of whether there is a positive DeMeester score.
Background
Endoscopic screening for esophageal neoplasia can identify patients eligible for early intervention for pre-cancerous lesions. Unsedated transnasal esophagoscopy may provide an efficient and accurate endoscopic assessment with fewer risks and less cost compared to conventional upper endoscopy.
Objective
To assess the feasibility, safety, acceptability and yield of unsedated transnasal esophagoscopy in a primary care population.
Design
Multi-center, prospective, cross-sectional study.
Setting
Two outpatient tertiary centers.
Patients
General medical clinic population between the ages of 40 and 85.
Interventions
Unsedated, office-based transnasal esophagoscopy.
Main outcomes measurements
1) Procedure yield, 2) Completeness of examination, 3) Procedure length, 4) Adverse events and complications, 5) Choking, gagging, pain or anxiety during the examination, and 6) Overall tolerability
Results
Four hundred and twenty-six participants (mean age 55.8 ± 9.5, 43% male) enrolled in the study, and 422 (99%) completed the examination. Mean examination time was 3.7 ± 1.8 minutes. There were no serious adverse events and 12 participants (2.8%) reported minor complications. Participants reported minimal choking, gagging, pain or anxiety. The examination was well tolerated by most participants. Overall, 38% of subjects had an esophageal finding that changed management (34% erosive esophagitis, 4% Barrett’s esophagus).
Limitations
Nonrandomized study; tertiary centers only; self-selected population with a large proportion reporting esophageal symptoms.
Conclusions
Unsedated transnasal esophagoscopy is a feasible, safe, and well-tolerated method to screen for esophageal disease in a primary care population. Endoscopic findings are common in this patient population.
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