Correlation between Reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers

Jetté, Marie E.; Gaumnitz, Eric A.; Birchall, Martin A.; Welham, Nathan V.; Thibeault, Susan L.

doi:10.1002/lary.24737

Cited by 26 publications

(39 citation statements)

References 29 publications

(53 reference statements)

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“…The levels of salivary pepsin on waking correlated with both MII‐pH data and RSI scores but were not significantly correlated with RFS. This corroborates prior data, which suggests the RFS has a poor correlation with objective evidence of reflux events and has only modest specificity for the diagnosis of LPR . In conjunction with a randomized, blinded study of the RFS in which Branski et al demonstrated the measure's poor interrater reliability, this data raises concern regarding the use of the RFS as a diagnostic tool …”

Section: Discussionmentioning

confidence: 88%

“…This corroborates prior data, which suggests the RFS has a poor correlation with objective evidence of reflux events and has only modest specificity for the diagnosis of LPR. 14,20 In conjunction with a randomized, blinded study of the RFS in which Branski et al demonstrated the measure's poor interrater reliability, this data raises concern regarding the use of the RFS as a diagnostic tool. 21 Although pepsin was only detected in nasal lavage specimens of a minority of patients with LPR in this study, all of these patients exhibited either pepsin in their saliva or evidence of proximal reflux on MII-pH monitoring.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of salivary and nasal lavage pepsin with MII‐pH testing

et al. 2019

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Objectives Laryngopharyngeal reflux (LPR) is a common upper airway disease. Salivary pepsin is a proposed marker for LPR; however, the optimal time for collection of specimens for pepsin detection and pepsin's presence in the oral and nasal secretions relative to concurrent multichannel intraluminal impedance‐pH (MII‐pH) monitoring are unknown. Study Design Prospective case‐control study with an experimental design. Methods Patients undergoing MII‐pH testing for evaluation of LPR and asymptomatic control subjects were selected. Nasal lavage and saliva samples were collected in the clinic prior to MII‐pH probe placement. Additional saliva samples were obtained an hour after each meal and upon waking the following morning. Nasal lavage and salivary pepsin were measured by ELISA. Results Twenty‐six patients undergoing MII‐pH testing and 13 reflux‐free control patients were enrolled. Salivary pepsin was detected in 11 of 26 patients with suspected LPR and 0 of 13 controls. Pepsin was most frequently detected in the specimen provided upon waking at an average concentration of 186.9 ng/mL. A significant correlation was observed between salivary pepsin in waking samples to MII‐pH measurements, including reflux bolus duration, and proximal and distal recumbent reflux episodes (P < 0.05). A significant correlation was also observed between salivary pepsin upon waking or sinus lavage and reflux symptom index (P < 0.05). Conclusion Pepsin in salivary and nasal lavage samples demonstrated an association with MII‐pH‐documented LPR. Pepsin detection was most frequent in morning samples, supporting use of morning salivary pepsin levels as a potential noninvasive technique for LPR diagnosis. Level of Evidence 2 Laryngoscope, 130:961–966, 2020

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Correlation of salivary and nasal lavage pepsin with MII‐pH testing

et al. 2019

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“…Subglottic oedema score showed a statistically ules and granulomas were more likely to be found in patients who proved to have pharyngeal reflux during pH monitoring. 6 Jette et al 18 compared RFS ratings to MII-pH data in healthy, untreated volunteers. They found that posterior commissure hypertrophy was negatively correlated with exposure time to non-acid reflux, with no other correlations being significant.…”

Section: Resultsmentioning

confidence: 99%

“…Jette et al compared RFS ratings to MII‐pH data in healthy, untreated volunteers. They found that posterior commissure hypertrophy was negatively correlated with exposure time to non‐acid reflux, with no other correlations being significant.…”

Section: Discussionmentioning

confidence: 99%

Do laryngoscopic findings reflect the characteristics of reflux in patients with laryngopharyngeal reflux?

Lee

Kwon

Park

et al. 2017

Clinical Otolaryngology

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Objective: To analyse the association between 24-hour multichannel intraluminal impedance-pH (24-h MII-pH) parameters and each item of the reflux finding score (RFS) to determine whether the laryngoscopic findings of the RFS could reflect the characteristics of reflux in patients with laryngopharyngeal reflux (LPR).Study Design: Prospective cohort study.Settings: Tertiary care referral medical centre.Participants: Patients complaining of LPR symptoms were evaluated via a 24-hour MII-pH. Among them, 99 patients whose LPR was confirmed via 24-hour MII-pH were enrolled in this study. Main outcome measures:Correlations between RFS ratings and 24-hour MII-pH parameters were evaluated and compared between patients with or without each laryngoscopic finding used in the RFS.Results: Subglottic oedema had a statistically significant positive correlation with number of non-acid LPR and non-acid full column reflux events. Ventricular obliteration and posterior commissure hypertrophy showed a significant correlation with non-acid exposure time and total reflux exposure time. We also found a significant correlation between granuloma/granulation score and number of acid LPR events. The numbers of non-acid LPR and full column reflux events in patients with subglottic oedema were significantly higher than those without subglottic oedema.Conclusion: Among the laryngoscopic findings used in the RFS, subglottic oedema is specific for non-acid reflux episodes, and granuloma/granulation is specific for acid reflux episodes.

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“…However, they can be present in up to 86% of asymptomatic subjects 11 and both the intraobserver and interobserver reproducibility of these signs is poor. The Reflux Finding Score based on select laryngoscopic signs is used by some 12,13 ; however, recent studies question the clinical validity of this scoring system. A recent study in 77 children showed that Reflux Finding Score could not predict the presence of abnormal gastroesophageal reflux.…”

Section: Laryngoscopymentioning

confidence: 99%

Extraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now?

Vaezi

Katzka

Zerbib

2018

Clinical Gastroenterology and Hepatology

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The purpose of this review is to outline the recent developments in the field of extraesophageal reflux disease and provide clinically relevant recommendations. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: Best Practice Advice 1: The role of a gastroenterologist in patients referred for evaluation of suspected extra esophageal symptom is to assess for gastroesophageal etiologies that could contribute to the presenting symptoms. Best Practice Advice 2: Non-GI evaluations by ENT, pulmonary and/or allergy are essential and often should be performed initially in most patients as the cause of the extraesophageal symptom is commonly multifactorial or not esophageal in origin. Best Practice Advice 3: Empiric therapy with aggressive acid suppression for 6-8 weeks with special focus on response of the extraesophageal symptoms can help in assessing association between reflux and extraesophageal symptoms. Best Practice Advice 4: No single testing methodology exists to definitively identify reflux as the etiology for the suspected extra esophageal symptoms. Best Practice Advice 5: Constellation of patient presentation, diagnostic test results and response to therapy should be employed in the determination of reflux as a possible etiology in extra esophageal symptoms. Best Practice Advice 6: Testing may need to be off or on proton pump inhibitor (PPI) therapy depending on patients' presenting demographics and symptoms in assessing the likelihood of abnormal gastroesophageal reflux. A. On therapy testing may be considered in those with high probability of baseline reflux (those with previous esophagitis, Barrett's esophagus or abnormal pH). B. Off therapy testing may be considered in those with low probability of baseline reflux with the goal of identifying moderate to severe reflux at baseline. Best Practice Advice 7: Lack of response to aggressive acid suppressive therapy combined with normal pH testing off therapy or impedance-pH testing on therapy significantly reduces the likelihood that reflux is a contributing etiology in presenting extraesophageal symptoms. Best Practice Advice 8: Surgical fundoplication is discouraged in those with extra esophageal reflux symptoms unresponsive to aggressive PPI therapy. Best Practice Advice 9: Fundoplication should only be considered in those with a mechanical defect (e.g., hiatal hernia), moderate to severe reflux at baseline off PPI therapy who have continued reflux despite PPI therapy and have failed more conservative non-GI treatments.

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Correlation between Reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers

Cited by 26 publications

References 29 publications

Correlation of salivary and nasal lavage pepsin with MII‐pH testing

Correlation of salivary and nasal lavage pepsin with MII‐pH testing

Do laryngoscopic findings reflect the characteristics of reflux in patients with laryngopharyngeal reflux?

Extraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now?

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