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, 1 (6), 438-44

Pharyngeal pH Alone Is Not Reliable for the Detection of Pharyngeal Reflux Events: A Study With Oesophageal and Pharyngeal pH-impedance Monitoring

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Pharyngeal pH Alone Is Not Reliable for the Detection of Pharyngeal Reflux Events: A Study With Oesophageal and Pharyngeal pH-impedance Monitoring

Marie Desjardin et al. United European Gastroenterol J.

Abstract

Background: Pharyngeal pH probes and pH-impedance catheters have been developed for the diagnosis of laryngo-pharyngeal reflux.

Objective: To determine the reliability of pharyngeal pH alone for the detection of pharyngeal reflux events.

Methods: 24-h pH-impedance recordings performed in 45 healthy subjects with a bifurcated probe for detection of pharyngeal and oesophageal reflux events were reviewed. Pharyngeal pH drops to below 4 and 5 were analysed for the simultaneous occurrence of pharyngeal reflux, gastro-oesophageal reflux, and swallows, according to impedance patterns.

Results: Only 7.0% of pharyngeal pH drops to below 5 identified with impedance corresponded to pharyngeal reflux, while 92.6% were related to swallows and 10.2 and 13.3% were associated with proximal and distal gastro-oesophageal reflux events, respectively. Of pharyngeal pH drops to below 4, 13.2% were related to pharyngeal reflux, 87.5% were related to swallows, and 18.1 and 21.5% were associated with proximal and distal gastro-oesophageal reflux events, respectively.

Conclusions: This study demonstrates that pharyngeal pH alone is not reliable for the detection of pharyngeal reflux and that adding distal oesophageal pH analysis is not helpful. The only reliable analysis should take into account impedance patterns demonstrating the presence of pharyngeal reflux event preceded by a distal and proximal reflux event within the oesophagus.

Keywords: Gastro-oesophageal reflux; laryngo-pharyngeal reflux; oesophageal impedance; pharyngeal pH.

Figures

Figure 1.
Figure 1.
Bifurcated oesophageal and pharyngeal pH-impedance catheter. The long arm branch has two impedance electrode pairs positioned 3 and 5 cm above the oesophagogastric junction (OGJ) and a pH sensor positioned 5 cm above the OGJ. The short arm branch has four impedance electrode pairs positioned 2 and 4 cm below the upper oesophageal sphincter (UOS) and 0 and 1 cm above the UOS; a pH sensor is located 0.5 cm above the UOS.
Figure 2.
Figure 2.
Examples of pharyngeal pH drops. (a) Pharyngeal drop to below 4 related to a gastro-oesophageal and pharyngeal reflux event; there is a drop in impedance starting distally (at the level of the oesophagogastric junction) and reaching the more proximal pharyngeal impedance site (arrow). (b) Pharyngeal pH drop to below 4 associated with a distal acid gastro-oesophageal reflux event without any evidence of proximal oesophageal nor pharyngeal extent. (c) Successive pharyngeal pH drops to below 4 and 5 related to swallows as confirmed by the impedance patterns (antegrade drop in impedance values within the oesophagus) (arrow); note that there is a simultaneous pH drop to below 4 in the distal oesophagus.

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