OFR-3 Extended wireless pH monitoring increases GERD diagnoses in patients with a normal pH impedance study

Zeki, Sebastian; Miah, Ismail; Wolak, Anna; deSilva, Minerva; Dunn, Jason; Davies, Andrew; Botha, Abrie; Sui, Guiping; Jafari, Jafar; Wong, Terry

doi:10.1136/gutjnl-2021-bsg.20

Cited by 2 publications

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“…These findings suggest that prolonged wireless pH monitoring has a higher diagnostic value than catheter-based 24-hour pH-impedance monitoring in the evaluation of chronic laryngeal symptoms without prior GERD evidence and that 24-hour pH-impedance may risk a high false negative rate. The higher yield of prolonged wireless pH monitoring has been well demonstrated in patients with typical GERD symptoms, mostly attributed to the ability to capture variability in daily acid exposure (10)(11)(12)(13)(14)(15)(16). Although wireless pH monitoring is preferred for the evaluation of esophageal GERD symptom (17), there is debate whether 24-hours pH-impedance monitoring, with its ability to detect nonacid reflux and proximal extent of refluxate, yields a diagnostic advantage in the evaluation of chronic laryngeal symptoms (2,3,5,18).…”

Section: Discussionmentioning

confidence: 99%

“…The higher yield of prolonged wireless pH monitoring has been well demonstrated in patients with typical GERD symptoms, mostly attributed to the ability to capture variability in daily acid exposure (10–16). Although wireless pH monitoring is preferred for the evaluation of esophageal GERD symptom (17), there is debate whether 24-hours pH-impedance monitoring, with its ability to detect nonacid reflux and proximal extent of refluxate, yields a diagnostic advantage in the evaluation of chronic laryngeal symptoms (2,3,5,18).…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms

Krause,

Greytak,

Kaizer

et al. 2023

Am J Gastroenterol

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INTRODUCTION: Among patients with chronic laryngeal symptoms, ambulatory reflux monitoring off acid suppression is recommended to evaluate for laryngopharyngeal reflux (LPR). However, reflux monitoring systems are diverse in configuration and monitoring capabilities, which present a challenge in creating a diagnostic reference standard in these patients. This study aimed to compare diagnostic yield and performance between reflux monitoring systems in patients with chronic laryngeal symptoms. METHODS: This multicenter, international study of adult patients referred for evaluation of LPR over a 5-year period (March 2018–May 2023) assessed and compared diagnostic yield of pathologic gastroesophageal reflux (GER+) on ambulatory reflux monitoring off acid suppression. RESULTS: Of 813 patients, 296 (36%) underwent prolonged wireless pH, 532 (65%) underwent 24-hour pH-impedance monitoring, and 15 (2%) underwent both tests. Overall diagnostic yield for GER+ was 36% and greater for prolonged wireless pH compared with that for 24-hour pH-impedance monitoring (50% vs 27%; P < 0.01). Among 15 patients who underwent both prolonged wireless pH and 24-h pH-impedance monitoring, concordance between systems for GER+ was 40%. The most common source of discordance was strong evidence of GER+ across multiple days on prolonged wireless pH compared with no evidence of GER+ on pH-impedance. DISCUSSION: In this multicenter international study of patients with chronic laryngeal symptoms referred for LPR evaluation, diagnostic yield of ambulatory reflux monitoring off acid suppression was 36% and rose to 50% when using wireless pH monitoring. In patients referred for chronic laryngeal symptoms, 24-hour pH-impedance monitoring may risk a low negative predictive value in patients with unproven GER+ disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms

Krause,

Greytak,

Kaizer

et al. 2023

Am J Gastroenterol

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“…The two main ambulatory reflux monitoring systems used are prolonged wireless pH monitoring and 24 h impedance‐pH monitoring. Prolonged wireless reflux monitoring has a higher diagnostic yield and is better tolerated when compared to 24 h impedance‐pH monitoring 26–28 . On the other hand, 24 h impedance‐pH monitoring measures flow of liquid or gas and quantifies non‐acid or weakly acidic reflux events, in addition to acidic reflux events.…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

“…Wireless pH monitoring consists of a pH capsule that is affixed to the oesophageal mucosa, generally during a sedated EGD. The battery life of the wireless pH recorder enables prolonged reflux monitoring for up to 96 h. Prolonged monitoring is associated with higher diagnostic yield, ability to capture variability in daily acid exposure in patients with GERD, as well as associated with treatment outcomes 28,40–45 . Wireless pH capsule placement is also better tolerated than transnasal catheter placement 26,27 .…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Review article: Diagnosis and management of laryngopharyngeal reflux

Krause,

Yadlapati

2024

Aliment Pharmacol Ther

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SummaryBackgroundLaryngopharyngeal reflux has classically referred to gastroesophageal reflux leading to chronic laryngeal symptoms such as throat clearing, dysphonia, cough, globus sensation, sore throat or mucus in the throat. Current lack of clear diagnostic criteria significantly impairs practitioners' ability to identify and manage laryngopharyngeal reflux.AimsTo discuss current evidence‐based diagnostic and management strategies in patients with laryngopharyngeal reflux.MethodsWe selected studies primarily based on current guidelines for gastroesophageal reflux disease and laryngopharyngeal reflux, and through PubMed searches.ResultsWe assess the current diagnostic modalities that can be used to determine if laryngopharyngeal reflux is the cause of a patient's laryngeal symptoms, as well as review some of the common treatments that have been used for these patients. In addition, we note that the lack of a clear diagnostic gold‐standard, as well as specific diagnostic criteria, significantly limit clinicians' ability to determine adequate therapies for these patients. Finally, we identify areas of future research that are needed to better manage these patients.ConclusionsPatients with chronic laryngeal symptoms are complex due to the heterogenous nature of symptom pathology, inconsistent definitions and variable response to therapies. Further outcomes data are critically needed to help elucidate ideal diagnostic workup and therapeutic management for these challenging patients.

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OFR-3 Extended wireless pH monitoring increases GERD diagnoses in patients with a normal pH impedance study

Cited by 2 publications

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Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms

Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms

Review article: Diagnosis and management of laryngopharyngeal reflux

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