First Agreement Analysis and Day-to-Day Comparison of Pharyngeal pH Monitoring with pH/Impedance Monitoring in Patients with Suspected Laryngopharyngeal Reflux

Becker, Valentin; Graf, Simone; Schlag, Christoph; Schuster, Tibor; Feußner, H.; Schmid, Roland M.; Bajbouj, Monther

doi:10.1007/s11605-012-1866-x

Cited by 55 publications

(57 citation statements)

References 21 publications

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“…18 This is somehow concordant with previous results of our study group detecting acid environment in the oropharynx in LPR patients without any correlation to gastroesophageal reflux episodes assessed by pH/impedance measurement. 12 Reason and etiology therefore remain unclear. Interestingly in our data, most pathological results were found in upright position, whereas in others report a drop of pharyngeal pH was more frequent and prolonged in the supine position.…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal pH monitoring in gastrectomy patients – what do we really measure?

Wilhelm

Jell

Feußner

et al. 2016

United European Gastroenterology Journal

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Aim: Diagnosis of laryngopharyngeal reflux (LPR) has dramatically increased over the last years. For diagnosis of gastroesophageal reflux, a newly designed pharyngeal probe (Dx-pH) was recently introduced. It is also recommended to guide therapy decision in antireflux surgery. However, diagnostic results are questionable. Therefore, we establish a reliable reference group with asymptomatic patients after total gastrectomy and, thus, complete extinction of gastric acid production. Methods: Pharyngeal pH monitoring was performed in 10 consecutive patients with history of total gastrectomy. All patients were off proton pump inhibitor (PPI) therapy and followed a non-acid diet during the complete measurement period. Results: All procedures were performed without any complication. Six of the 10 asymptomatic gastrectomy patients (60%) had pathological results derived from the validated reference values (Ryan score) in pharyngeal pH monitoring. Conclusion: Pathological pH values assessed by the Dx-pH device, usually interpreted as pathological aerosolized acidic gastroesophageal and/or laryngopharyngeal reflux, are obviously dissociated from gastric acid production. Further studies are required to determine diagnostic value of the new system. Therefore, the pharyngeal pH monitoring system seems currently not to be useful to guide any diagnostic or therapeutic decisions, in particular if surgical therapy is considered.

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Section: Discussionmentioning

confidence: 99%

Pharyngeal pH monitoring in gastrectomy patients – what do we really measure?

Wilhelm

Jell

Feußner

et al. 2016

United European Gastroenterology Journal

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“…We verified a pathologic, acidic environment in the oropharynx in most of the examined LPR-patients without any correlation with the objectified gastroesophageal reflux episodes [9] . This finding supports the theory of laryngeal acid production.…”

Section: Discussionmentioning

confidence: 75%

“…However, the correlation between GERD, LPR symptoms and the response to PPI is comparatively poor, and an interventional antireflux therapy (e.g., Fundoplication) might harbor significant risks. In a recently published study, we were able to demonstrate that a pathological acidic environment in the oropharynx in LPR-patients was not correlated to objectified gastroesophageal reflux episodes [9] . These results were reconfirmed in another study with the same design [10] .…”

Section: Introductionmentioning

confidence: 74%

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New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease

Becker¹,

Drabner²,

Graf³

et al. 2015

WJG

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AIM:To determine the laryngeal H+K+-ATPase and pharyngeal pH in patients with laryngopharyngeal reflux (LPR)-symptoms as well as to assess the symptom scores during PPI therapy. METHODS:Endoscopy was performed to exclude neoplasia and to collect biopsies from the posterior cricoid area (immunohistochemistry and PCR analysis).Immunohistochemical staining was performed with monoclonal mouse antibodies against human H+K+-ATPase. Quantitative real-time RT-PCR for each of the H+K+-ATPase subunits was performed. The pH values were assessed in the aerosolized environment of the oropharynx (DxpH Catheter) and compared to a subsequently applied combined pH/MII measurement. RESULTS:Twenty patients with LPR symptoms were included. In only one patient, the laryngeal H+K+-ATPase was verified by immunohistochemical staining. In another patient, real-time RT-PCR for each H+K+-ATPase subunit was positive. Fourteen out of twenty patients had pathological results in DxpH, and 6/20 patients had pathological results in pH/MII. Four patients had pathological results in both functional tests. Nine out of twenty patients responded to PPIs. CONCLUSION:The laryngeal H+K+-ATPase can only be sporadically detected in patients with LPR symptoms and is unlikely to cause the LPR symptoms. Alternative hypotheses for the pathomechanism are needed. The role of pharyngeal pH-metry remains unclear Prospective Study ORIGINAL ARTICLEBecker V et al . Pathomechansim and diagnosis of LPR and its use can only be recommended for patients in a research study setting. Core tip: The pathophysiology and objective diagnosis of laryngopharyngeal reflux (LPR) is still unclear. The response to standard therapy (proton pump inhibitors) is poor. Laryngeal proton pumps (H+K+-ATPase) are often considered to be potential causes of LPR. The clinical significance of laryngeal proton pumps (H+K+-ATPase) is unclear. We present the first prospective series evaluating the laryngeal H+K+-ATPase, pharyngeal pH and symptom scores in patients with LPR symptoms. Laryngeal H+K+-ATPases can only be sporadically detected, and they are unlikely to cause LPR symptoms. The role of pharyngeal pH-metry remains unclear and its use can only be recommended for patients in the research study setting.Becker V, Drabner R, Graf S, Schlag C, Nennstiel S, Buchberger AM, Schmid RM, Saur D, Bajbouj M. New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease. World J Gastroenterol 2015; 21(3): 982-987 Available from:

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“…In contrast, Ummarino et al [114] did not show any correlation, although chronic coughing was the only symptom reported by patients, and when they compared MII-pH and Restech, the superiority of the first technique seemed clear. Similarly, Becker et al [115] evaluated, in a prospective, single-center trial, the differences between MII-pH and Dx-pH. They demonstrated that acid pharyngeal pH levels detected with Dx-pH were not correlated with GERD, and acid esophageal reflux episodes did not result in pharyngeal pH alterations.…”

Section: Dx-ph (Restech)mentioning

confidence: 99%

Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

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Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry.

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First Agreement Analysis and Day-to-Day Comparison of Pharyngeal pH Monitoring with pH/Impedance Monitoring in Patients with Suspected Laryngopharyngeal Reflux

Cited by 55 publications

References 21 publications

Pharyngeal pH monitoring in gastrectomy patients – what do we really measure?

Pharyngeal pH monitoring in gastrectomy patients – what do we really measure?

New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease

Esophageal testing: What we have so far

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