Does the Reflux Symptom Index Predict Increased Pharyngeal Events on HEMII-pH Testing and Correlate with General Quality of Life?

DeVore, Elliana Kirsh; Chan, Walter W.; Shin, Jennifer J.; Carroll, Thomas L.

doi:10.1016/j.jvoice.2019.11.019

Cited by 7 publications

(9 citation statements)

References 36 publications

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“…However, there was consistency in the referral pattern from our otolaryngology colleagues, and consecutive patients presenting for esophageal function testing were included. In addition, although the RSI may not be proven to diagnose reflux, it is able to assess and follow the symptom burden of LPR patients and our finding was comparable with that of similar studies evaluating patients with dual pH monitor‐confirmed LPR 10,39 …”

Section: Discussionsupporting

confidence: 84%

“…In addition, although the RSI may not be proven to diagnose reflux, it is able to assess and follow the symptom burden of LPR patients and our finding was comparable with that of similar studies evaluating patients with dual pH monitor-confirmed LPR. 10,39 In conclusion, a nearly 50% prevalence of esophageal motility disorders in one of the largest series of patients with suspected LPR systematically evaluated with HRM and HEMII-pH is reported. In particular, approximately one in seven patients were found to have either a disorder of EGJOO or a major disorder of peristalsis.…”

Section: Discussionmentioning

confidence: 80%

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Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Sikavi

Cai

Carroll

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Esophageal motor dysfunction may underlie impaired bolus/refluxate clearance in laryngopharyngeal reflux (LPR). However, the prevalence of esophageal dysmotility and its correlation with reflux parameters and symptoms in LPR is not well established. The aim of this study was to evaluate the prevalence of coexisting esophageal dysmotility among patients with suspected LPR. Methods: This was a retrospective cohort study of 194 consecutive patients with LPR symptoms referred for high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing at a tertiary center in March 2018 to August 2019. Validated symptom surveys were prospectively collected at time of testing, including Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, dominant symptom intensity, and 12-Item Short-Form Health Survey. HRM findings were categorized using Chicago Classification v3.0. Results: Abnormal findings on HRM were identified in 84 (43.3%) patients, with ineffective esophageal motility (n = 60, 30.9%) as the most common diagnosis. A disorder of esophagogastric junction outflow or a major disorder of peristalsis was identified in 26 (13.4%) patients, including 2 (1%) with achalasia and 7 (3.6%) with jackhammer esophagus. Reflux burden (distal, proximal, or pharyngeal) on combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing did not differ across HRM findings. Patients reporting esophageal symptoms were more likely to have a primary motility disorder (odds ratio 2.34, P = 0.04). However, no significant differences in Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, or 12-Item Short-Form Health Survey were noted across HRM diagnoses. Conclusion: Esophageal motility disorders are prevalent among patients with LPR symptoms, including up to one in seven with esophagogastric junction outflow or major peristaltic disorder. Patients with abnormal motility more likely report esophageal symptoms. Clinicians should be aware of these coexisting conditions, particularly in those with refractory symptoms.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 80%

Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Sikavi

Cai

Carroll

et al. 2021

J of Gastro and Hepatol

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“…In studies that performed two Peptest examinations (one fasting and one an hour after the main meal), the Peptest showed 95% specificity and 48% sensitivity compared to the RSI. However, studies have shown that the RSI was not specific for LPR, and its diagnostic weaknesses have been discussed repeatedly [1,13]. Therefore, a comparison between the Peptest and the RSI cannot be taken as sufficient evidence of the diagnostic value of the Peptest.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux

Zeleník

Hránková

Vrtková

et al. 2021

JCM

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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.

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“…The use of inadequate treatment, the chronic course of some LPR disease presentations, and the patient adherence are all factors that may underly the low empirical therapeutic success rate [ 18 ]. According to recent reviews [ 18 , 19 ], most authors used proton pump inhibitors (PPIs) for the empirical treatment, even though most hypopharyngeal reflux events (HREs) are weakly or nonacid at the hypopharyngeal-esophageal multichannel intraluminal impedance–pH monitoring (HEMII-pH) [ 20 , 21 , 22 ]. The use of PPIs with alginate or magaldrate makes further sense [ 18 ], but this combination remains infrequently used [ 23 , 24 ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…Interestingly, Harrel et al observed that adding a hypopharyngeal pH sensor in pH study increased the detection of abnormal pH values and supported the diagnosis of LPR more often than traditional dual-sensor esophageal monitoring [ 34 ]. Nowadays, the accuracy of single, dual-, or triple-probe pH-study devices is called into question regarding the lack of correlation between distal/proximal esophageal events and HREs and the lack of consideration of weakly acid or nonacid HREs [ 20 , 21 , 22 , 37 ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Lechien

2022

JCM

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Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

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Does the Reflux Symptom Index Predict Increased Pharyngeal Events on HEMII-pH Testing and Correlate with General Quality of Life?

Cited by 7 publications

References 36 publications

Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

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