Pharyngeal reflux episodes in patients with suspected laryngopharyngeal reflux versus healthy subjects: a prospective cohort study

Kim, Su Il; Jeong, Su Jin; Kwon, Ohseong; Park, Jung Min; Doo, Jeon Gang; Park, Sang‐In; Kim, Bo‐Hyung; Lee, Young Chan; Eun, Young‐Gyu; Ko, Seong‐Gyu

doi:10.1007/s00405-021-06865-8

Cited by 14 publications

(17 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In another recent study, these authors reported that 43.3% of patients with >1 HREs reported abnormal findings at the high-resolution manometry; the most common abnormality being the ineffective esophageal motility, whereas most patients having reduced proximal esophageal contractibility [77]. The findings of these recent studies support the observations of studies conducted over the past decade [61,74]. Regarding GERD, the patient profile at the HEMII-pH is mostly characterized by upright(daytime)/supine(nighttime) liquid acid esophageal events, with an esophageal distal acid exposure time >6% of testing according to Lyon consensus [29].…”

Section: Profiles Of Reflux Patients At the Hypopharyngeal-esophageal...supporting

confidence: 57%

“…A few studies investigated the HEMII-pH findings in healthy individuals (Table 3) [58 ▪▪ ,59,60–73]. Kim et al [74] observed that the consideration of ≥1 HRE was associated with sensitivity and specificity of 76.0% and 81.5%, respectively, whereas others reported a normal range of 1–10 HREs [58 ▪▪ ,68]. The diagnosis criteria may vary regarding the type of pH study device used.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

See 1 more Smart Citation

The role of pH-impedance monitoring in swallowing disorders

Bobin¹,

Lechien

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

View full text Add to dashboard Cite

Purpose of reviewTo review the current evidence about the usefulness and the place of pH study in the management of patients with swallowing disorders.Recent findingsGastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are found in approximately 30% of patients with esophageal or oropharyngeal dysphagia. Patients with suspected GERD may benefit from gastrointestinal endoscopy and proton pump inhibitors according to guidelines. The diagnosis of LPR in patients with oropharyngeal dysphagia is more controversial because there are no gold standard and diagnostic guidelines. The clinical diagnosis based on empirical therapeutic trial is a reasonable first-line strategy, but many dysphagic patients should not respond to treatment. These patients require hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH), which is the most effective examination providing important information on GERD and LPR features. At the HEMII-pH, GERD patients often report upright (daytime) and supine (nighttime) liquid acid esophageal events with significant esophageal distal acid exposure time. LPR patients have more frequently upright (daytime) gaseous weakly acid or nonacid pharyngeal reflux events without distal esophageal acid exposure abnormalities in many times. The features of reflux at the HEMII-pH may indicate a personalized treatment for dysphagic patients combining proton pump inhibitors, alginate/magaldrate or gastroprokinetic in cases of esophageal dysmotility.SummaryGERD and LPR are prevalent causes of dysphagia. The large number of reflux patients who do not respond to empirical treatment makes important the awareness of otolaryngologists about pH-impedance monitoring indication, features, and interpretation.

show abstract

Section: Profiles Of Reflux Patients At the Hypopharyngeal-esophageal...supporting

confidence: 57%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

The role of pH-impedance monitoring in swallowing disorders

Bobin¹,

Lechien

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

View full text Add to dashboard Cite

show abstract

“…The same team reported in another publication that 43.3% of patients with LPR at the HEMII-pH had abnormal findings at the high-resolution manometry, with the ineffective esophageal motility being the most common diagnosis [ 54 ]. Interestingly, recent findings reported that most HREs are weakly or nonacid [ 6 , 38 , 41 , 55 ], which supports the consideration of alginate or magaldrate in the therapeutic strategy [ 32 , 55 ]. Moreover, in practice, the pH of the reflux event may increase from the distal to the proximal esophagus.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 88%

“…To date, there is no international consensus guidelines determining HRE threshold for the LPR diagnosis. In a recent study, Kim et al observed that the consideration of ≥1 HRE at the HEMIII-pH was associated with sensitivity and specificity of 76.0% and 81.5%, respectively [ 38 ]. According to the type of pH-impedance monitoring used for the diagnosis, the diagnosis criteria may vary.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…Ryan score is calculated according to three components: the percent time pH < 5.5 upright or <5.0 supine; the number of episodes in which the pH dropped below threshold; and the duration of the longest episode. The low consideration of HRE with pH > 7.0 in the Ryan score is a controversial issue because many studies demonstrated that there are significant proportions of HREs with pH > 7 in LPR patients [ 22 , 37 , 38 ]. At alkaline pH, the bile salts and some potential other enzymes may injury the laryngopharyngeal mucosa.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

See 1 more Smart Citation

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

Lechien

2022

JCM

View full text Add to dashboard Cite

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.

show abstract

Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux

Zhang

Wang

et al. 2022

The Laryngoscope

View full text Add to dashboard Cite

Objective To investigate the optimal time point for diagnosing laryngopharyngeal reflux (LPR) through combining 24‐h hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH (24‐h HEMII‐pH) monitoring and the multi‐time point salivary pepsin test (MTPSPT). Study Design Prospective uncontrolled trial. Method Patients with and without LPR symptoms were included as the test group and the control group, respectively. The patients in the test group underwent 24‐h HEMII‐pH and MTPSPT. The results of 24‐h HEMII‐pH were used as a diagnostic criterion for LPR, and the diagnostic value of salivary pepsin tests performed at different time points was compared by receiver operating characteristic (ROC) analysis. Results A total of 153 patients were included. Based on 24‐h HEMII‐pH, the positive rate of LPR in the test group of patients was 84.00%. In the control group, only one person (3.57%) had a positive salivary pepsin test result. The area under the curve (AUC) of the MTPSPT was 0.827. In addition, we separately calculated the AUC of the combined salivary pepsin test at different time points, and found good diagnostic value (AUC = 0.799) when the test was combined with the waking, 1 and 2 h after breakfast and lunch, and 1 h after dinner tests. However, when the number of tests were further increased, the diagnostic value did not improve significantly. Conclusion Salivary pepsin testing combined with waking, 1 h and 2 h after breakfast and lunch, and 1 h after dinner has almost the same diagnostic value as MTPSPT, and testing at these time points can be an effective method for diagnosing LPR. Level of Evidence 3 Laryngoscope, 133:1706–1711, 2023

show abstract

Pharyngeal reflux episodes in patients with suspected laryngopharyngeal reflux versus healthy subjects: a prospective cohort study

Cited by 14 publications

References 22 publications

The role of pH-impedance monitoring in swallowing disorders

The role of pH-impedance monitoring in swallowing disorders

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

Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux

Contact Info

Product

Resources

About