Impact of pH Monitoring on Laryngopharyngeal Reflux Treatment

Friedman, Michael; Maley, Alexander; Kelley, Kanwar; Pulver, Tanya; Foster, Mary H.; Fisher, Michelle; Joseph, Ninos J.

doi:10.1177/0194599811399240

Cited by 31 publications

(29 citation statements)

References 19 publications

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“…In our study, based on its current thresholds it cannot serve as a stand-alone diagnostic tool to reliably identify symptomatic patients with LPR. Smaller single center studies have suggested that oropharyngeal pH testing may have a role in predicting response to anti-reflux therapy 15, 16 and larger multicenter studies to evaluate the oropharyngeal pH probe's role in predicting treatment outcomes are needed.…”

Section: Discussionmentioning

confidence: 99%

Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

Yadlapati

Adkins

Jaiyeola

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims It has been a challenge to confirm the association between laryngeal symptoms and physiologic reflux disease. We examined the ability of oropharyngeal pH tests (with the Restech Dx-pH system) and salivary pepsin tests (with Peptest) to discriminate between asymptomatic volunteers (controls) and subjects with a combination of laryngeal and reflux symptoms (laryngeal±reflux). Methods We performed a physician-blinded prospective cohort study of 59 subjects at a single academic institution. Adult volunteers were recruited and separated into 3 groups based on GerdQ and reflux symptom index scores: controls (n=20), laryngeal symptoms (n=20), or laryngeal+reflux symptoms (n=19). Subjects underwent laryngoscopy and oropharyngeal pH tests and submitted saliva samples for analysis of pepsin concentration. Primary outcomes included abnormal acid exposure and composite (RYAN) score for oropharyngeal pH tests and abnormal mean salivary pepsin concentration based on normative data. Results Complete oropharyngeal pH data were available from 53 subjects and complete salivary pepsin data from 35 subjects. We did not observe any significant differences between groups in percent time spent below pH 4.0, 5.0, 5.5, 6.0 or RYAN scores; or percent of subjects with positive results from tests for salivary pepsin (53% vs 40% vs 75%; P=.50, respectively). The laryngeal+reflux group had a significantly higher estimated mean concentration of salivary pepsin (117.9±147.4ng/mL) than the control group (32.4±41.9ng/mL) or laryngeal symptom group (7.5±11.2ng/mL) (P=.01 and P=.04, respectively). Conclusions Using current normative thresholds, oropharyngeal pH testing and salivary pepsin analysis are not able to distinguish between healthy volunteers and subjects with a combination of laryngeal and reflux symptoms.

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Section: Discussionmentioning

confidence: 99%

Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

Yadlapati

Adkins

Jaiyeola

et al. 2016

Clinical Gastroenterology and Hepatology

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“…In a retrospective case control study of 170 patients with LPR symptoms, Friedman et al reported that PPI therapy based on a positive RYAN score compared to empiric PPI therapy resulted in significantly increased symptom response and compliance to therapy; however, in both the control and case groups the RSI significantly decreased following treatment, with mean post-treatment RSIs less than 13. 37 A prospective study of 22 patients with LPR symptoms reported a 59% response rate to PPI therapy, and described that oropharyngeal pH testing has a 69% sensitivity and 100% specificity for predicting PPI response. However, response was defined as at least a 5-point decrease in RSI; derivation of this 5-point decrease threshold is unclear.…”

Section: Discussionmentioning

confidence: 99%

Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms

Yadlapati

Pandolfino

Lidder

et al. 2016

American Journal of Gastroenterology

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Introduction Predicting response to proton-pump inhibitor (PPI) therapy in patients with laryngeal symptoms is challenging. The Restech Dx-pH probe is a transnasal catheter that measures oropharyngeal pH. In this study, we aimed to investigate the prognostic potential of oropharyngeal pH monitoring to predict responsiveness to PPI therapy in patients with laryngeal symptoms. Methods We conducted a physician blinded prospective cohort study at a single academic institution between 1/2013–10/2014. Adult patients with Reflux Symptom Index scores (RSI) ≥13 off PPI therapy were recruited. Patients underwent video laryngoscopy and 24-hour oropharyngeal pH monitoring, followed by an 8–12 week trial of omeprazole 40 mg daily. Prior to, and following PPI therapy, patients completed various symptom questionnaires. The primary outcome was the association between PPI response and oropharyngeal pH metrics. PPI response was separated into three subgroups based on post-treatment RSI score and % RSI response: Non-response = RSI ≥ 13; Partial response = post-treatment RSI < 13 and change in RSI < 50%; and Complete response = post-treatment RSI < 13 and change in RSI ≥ 50%. The primary analysis utilized a multinomial logistic regression controlling for pre-treatment RSI score. A secondary analysis assessed the relationship between change in RSI (post-pre) and oropharyngeal pH metrics via ordinary least square regression. Results Thirty-four patients completed the study and were included in final analysis. Symptom response to PPI therapy was as follows: 50% no response, 15% partial-response and 35% complete-response. Non-responders had a higher pre-treatment RSI (P < 0.01). There were no significant differences in oropharyngeal acid exposure (below pH of 4.0, 5.0, 5.5, 6.0 and RYAN scores) between responder types. The secondary analysis noted a trend between lower PPI response and greater total percent time below pH of 5.0 (P = 0.03), upright percent time below pH of 5.0 (p = .07) and RYAN supine (corrected) (P = 0.03), as well as an association between PPI response and greater decreases in the Anxiety Sensitivity Inventory (P < 0.01), Brief Symptom Inventory-18 (P < 0.01), and Negative Affect Scale (P < 0.01). Discussion Oropharyngeal pH testing did not predict laryngeal symptom response to PPI therapy. Contrary to hypothesis, our study signaled that the degree of oropharyngeal acid exposure is inversely related to PPI response. In addition, reduction in negative affect and psychological distress parallels PPI response.

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“…Rarer but more serious manifestations or complications associated with LPRD include laryngospasm and laryngeal cancer (14,18). Several tests have been used to diagnose LPRD and these include: Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Double probe pH monitoring, Pepsin (sputum) as a marker of LPR, Sensory testing; Laryngopharyngeal sensory descrimination testing (FEESST), Esophagoscopy, Barium esophagography and Bernstein acid perfusion (19)(20)(21)(22)(23). The reflux symptoms Index was described by Belfaski as a compilation of nine reflux related laryngeopharyngeal symptoms.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Laryngopharyngeal Reflux Disease in Patients Diagnosed with Hypothyroidism

Hamdan¹

2012

Acta Endo (Buc)

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Objective. To examine the prevalence of laryngopharyngeal reflux disease (LPRD) in patients with hypothyroidism.Materials and Methods. A total of 85 patients with hypothyroidism vs 31 matched controls were recruited. Demographic data was collected and an RSI questionnaire filled. A score > 10 was considered diagnostic of LPRD. The average score of every question was computed for all patients and compared to the corresponding average score in controls.Results. Mean age of hypothyroidism patients was 44.92 ± 13.77 years (83% females). One third of subjects were smokers and 10% had allergy. In 78.8% of the cases Hashimoto's disease was the etiological factor and 22.4% patients had history of thyroidectomy. At the time of examination, only 30% had a TSH > 4.2 mU/L. There was a borderline significance where more patients than controls had a RSI > 10 (24.7% patients vs. 9.1% controls), but with non-significant difference (p = 0.077). Similarly, closer examination of those with TSH > 4.2mU/L compared to those with controls revealed a higher prevalence in the former group, but statistically non-significant (p = 0.275). A comparison between those with TSH > 4.2 mU/L and cases diagnosed with hypothyroidism and normal TSH revealed no significant difference in the prevalence of LPRD. All laryngopharyngeal questions had a score higher in the hypothyroid group than controls.Conclusion. LPRD is more prevalent in hypothyroidism patients compared to normal individuals, but with nonstatistically significant difference. The prevalence of symptoms should alert physicians to the possibility of LPRD and prompt further diagnostic tests and therapeutic intervention.

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Impact of pH Monitoring on Laryngopharyngeal Reflux Treatment

Abstract: Among our patient population, treatment of LPR based on pH monitoring resulted in greater compliance, as well as greater symptom improvement, compared with empirical therapy alone.

Cited by 31 publications

References 19 publications

Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms

Prevalence of Laryngopharyngeal Reflux Disease in Patients Diagnosed with Hypothyroidism

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