Background: The PeptestTM is a non-invasive diagnostic test for measuring the pepsin concentration in saliva, which is thought to correlate with laryngopharyngeal reflux (LPR). The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR. Methods: Patients with suspected LPR were examined with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), fasting Peptest, and MII-pH monitoring. We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Peptest, RSI, and RFS based on the threshold of one and six hypopharyngeal reflux episodes. Results: Altogether, the data from 46 patients were analyzed. When one hypopharyngeal reflux episode was used as a diagnostic threshold for LPR, the accuracy, sensitivity, specificity, PPV, and NPV were, respectively, as follows: 35%, 33%, 100%, 100%, and 3%, for the Peptest; 39%, 40%, 0%, 95%, and 0%, for the RSI; and 57%, 58%, 0%, 96%, and 0%, for the RFS. The accuracy, sensitivity, specificity, PPV, and NPV of the Peptest for diagnosing gastroesophageal reflux disease (GERD) were 46%, 27%, 63%, 40.0%, and 48%, respectively. Conclusions: A positive Peptest is highly supportive of a pathological LPR diagnosis. However, a negative test could not exclude LPR.

To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention. OBJECTIVE To evaluate EER presence and severity in patients with different degrees of ITH. DESIGN, SETTING, AND PARTICIPANTSProspective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed.INTERVENTIONS Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH.MAIN OUTCOMES AND MEASURES Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5. RESULTSOf the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%] male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1 (34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%]; difference, 9.1% [95% CI, 4.1%-11.8%]) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, −0.17 [95% CI, −0.50 to 0.30]), or between the anterior and posterior parts of the nasal cavity (Cohen g, −0.21 [95% CI, −0.50 to 0.17]). CONCLUSIONS AND RELEVANCEIn this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.

ObjectivesMulberry‐like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction. Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute to sinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT formation. Therefore, this study is aimed to investigate the 24‐h pharyngeal pH value in patients with MPINT.Study designProspective case–control multi‐center study.MethodsFifty‐five patients with chronic EER symptoms were included in the study. They filled in questionnaires aimed at reflux and sinonasal symptoms (RSI®, SNOT‐22) and underwent video endoscopy evaluating the laryngeal findings (RFS®) and the presence or absence of the MPINT. And, 24‐h oropharyngeal pH monitoring was used to detect the acidic pH environment in the pharynx.ResultsOut of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group 2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidic pH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p = 0.001). Moreover, in group 1, a significantly higher median total percentage of time spent below pH 5.5 (p = 0.005), as well as a higher median number of events lasting more than 5 min (p = 0.006), and higher median total number of events with pH drops (p = 0.017) were observed.ConclusionIn this study, the MPINT was significantly more often present in patients with acidic pH events detected by 24‐h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation.Level of Evidence3 Laryngoscope, 2023

Úvod a cíl: Mimojícnový reflux (EER) je zpětný tok žaludečních šťáv (nejčastěji kyselých) nad úroveň horního jícnového svěrače (tím se liší od gastroezofageálního refluxu). Příznaky mimojícnového refluxu jsou nespecifické, různé intenzity a závisí na lokalizaci patologického působení refluxátu. V případě působení refluxátu na zubní tkáň může EER přispívat ke vzniku zubních erozí. Vedle refluxátu jsou zvažovány i další faktory, jako je složení slin a mikrobiom ústní dutiny. V posledních letech došlo k významnému posunu v chápání mimojícnového refluxu, zejména patogeneze a z toho vyplývajících důsledků pro diagnostiku a léčbu. Cílem článku je informovat o EER a podat přehled o současných možnostech diagnostiky a jeho léčby a také shrnout výsledky nedávných metaanalýz týkajících se role EER při vzniku zubních erozí. Metodika: Podkladem pro článek byly odborné publikace získané v databázích PubMed, Cochrane Library a Scopus z let 2002-2022. Publikace se vyhledávaly pomocí kombinace klíčových slov v anglickém i českém jazyce: mimojícnový reflux, gastroezofageální reflux, zubní eroze. Celkem bylo analyzováno 21 studií pojednávajících o souvislosti mezi refluxem a zubními erozemi prostřednictvím přehledových, klinických prospektivních a retrospektivních studií a metaanalýz. Zahrnuté studie byly provedeny u dospělé populace a informace o gastroezofageálním refluxu ve vztahu ke vzniku zubních erozí byly využity jen za předpokladu jeho diagnostiky multikanálovým intraluminálním monitorováním pH impedance. V první části článku je prezentován současný pohled na patofyziologii, diagnostiku a léčbu EER. Druhá část shrnuje poznatky o dentálních erozích. Ve třetí části jsou prezentovány studie zabývající se vlivem EER na zubní eroze. Výsledky: Získané informace svědčí o vyšší prevalenci dentálních erozí u pacientů s EER v porovnání se zdravou populací. Důvodem je, že kyseliny jak exogenního, tak endogenního původu hrají důležitou roli v rozpouštění minerálů skloviny, což ve výsledku vede ke vzniku zubních erozí. Na základě analyzovaných studií nelze v současnosti považovat vztah mezi refluxem a vznikem zubních erozí za kauzální, a to zejména z důvodu nízké kvality studií. Autoři doporučují provádění dalších studií, ve kterých by