Gastrointestinal function testing model using a new laryngopharyngeal pH probe (Restech) in patients after Ivor-Lewis esophagectomy

Abstract

BACKGROUND There is no established correlation between 24-h esophageal pH-metry (Eso-pH) and the new laryngopharyngeal pH-monitoring system (Restech) as only small case series exist. Eso-pH was not designed to detect laryngopharyngeal reflux (LPR) and Restech may detect LPR better. We have previously published a dataset using the two techniques in a large patient collective with gastroesophageal reflux disease. Anatomically, patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists. AIM To use a human reflux model to examine our previously published correlation in these patients. METHODS Patients after Ivor Lewis esophagectomy underwent our routine follow-up program with surveillance endoscopies, computed tomography scans and further exams following surgery. Only patients with a complete check-up program and reflux symptoms were offered inclusion into this prospective study and evaluated using Restech and simultaneous Eso-pH. Subsequently, the relationship between the two techniques was evaluated RESULTS A total of 43 patients from May 2016 - November 2018 were included. All patients presented with mainly typical reflux symptoms such as heartburn (74%), regurgitation (84%), chest pain (58%), and dysphagia (47%). Extraesophageal symptoms such as cough, hoarseness, asthma symptoms, and globus sensation were also present. Esophageal 24-hour pH-metry was abnormal in 88% of patients with a mean DeMeester Score of 229.45 [range 26.4-319.5]. Restech evaluation was abnormal in 61% of cases in this highly selective patient cohort. All patients with abnormal supine LPR were also abnormal for supine esophageal reflux measured by conventional Eso-pH. CONCLUSION Patients following esophagectomy and reconstruction with gastric interposition can ideally serve as a human reflux model. Interestingly, laryngopharyngeal reflux phases occur mainly in the upright position. In this human volume-reflux model, results of simultaneous esophageal and laryngopharyngeal (Restech) pH-metry showed 100% correlation as being explicable by one of our reflux scenarios.

Review of Classical and New Diagnostic Methods Reflux-Associated Ent Pathology: Proton Pump Inhibitor Test, Oropharyngeal Ph-Monitoring

“…with the results of simultaneous pH-metry of the esophagus [25,26]. Many authors have advocated the use of hypopharyngeal pH monitoring to confirm the role of GERD in patients with ENT signs and symptoms.…”

“…In the last decade, much attention has been paid to the diagnostic algorithms of LPR and this has exacerbated the distrust of the classical strategy of empirical treatment of LPR with subsequent diagnosis [6]. Many authors call the proven clinical tools, such as reflux symptom index in combination with reflux detection scale, as well as an empirical course of treatment with proton pump inhibitors and daily pH monitoring the "gold standard" for the diagnosis of extraesophageal manifestations of GERD [7,8,9].. In 2023, Kazakhstan introduced a methodology for the management of patients with laryngopharyngeal reflux for differential diagnosis and treatment, where the authors proposed a systematic standardized approach to the diagnosis of LPR at an outpatient appointment with an oto-rhinolaryngologist [10].…”