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. 2017 Aug;5(5):632-640.
doi: 10.1177/2050640616675040. Epub 2016 Oct 12.

The Diagnostic Value of 24-hour Ambulatory Intraesophageal pH-impedance in Patients With Laryngopharyngeal Reflux Symptoms Comparable With Typical Symptoms

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Free PMC article

The Diagnostic Value of 24-hour Ambulatory Intraesophageal pH-impedance in Patients With Laryngopharyngeal Reflux Symptoms Comparable With Typical Symptoms

Yusuf S Sakin et al. United European Gastroenterol J. .
Free PMC article

Abstract

Background: The diagnosis of laryngopharyngeal reflux is currently based on a combination of the patient history of multichannel intraluminal impedance and ambulatory pH (MII-pH); however, none of these findings alone is specific for the diagnosis of laryngopharyngeal reflux. We aimed to compare the baseline characteristics and esophageal baseline impedance values between patients with and without laryngopharyngeal reflux symptoms.

Methods: We retrospectively analyzed data from two groups of patients with laryngopharyngeal reflux according to their reflux finding score (RFS) as scored by ENTs. Control patients were nonerosive reflux disease patients without laryngopharyngeal reflux. All MII-pH parameters and baseline impedance were analyzed from six levels and the proximal and distal baseline impedance and the ratio of the proximal to distal baseline impedance levels was calculated.

Results: Altogether 123 patients with laryngopharyngeal reflux and 49 control patients were included. A total of 81 of 123 patients had RFS ≥ 7, and 42 of 123 patients had RFS < 7. Baseline impedance analysis showed that patients with laryngopharyngeal reflux symptoms had significantly lower proximal baseline impedance values (1997 ± 51 vs 2245 ± 109, p < 0.05) than the control group. Additionally, patients with laryngopharyngeal reflux symptoms had a significantly lower proximal-to-distal ratio (1.28 ± 0.05 vs 1.53 ± 0.09, p < 0.05). In the subgroup analysis, patients with RFS < 7 were found to have a significantly lower acid exposure time than either the patients with RFS ≥ 7 (3.85 ± 0.65 vs 8.2 ± 1.52, p < 0.05) or the control group (3.85 ± 0.65 vs 6.1 ± 0.81, p < 0.05). Additionally, patients with RFS ≥ 7 had significantly lower proximal baseline impedance levels than the control group (1970 ± 63 vs 2245 ± 109, p < 0.05).

Conclusions: Patients with pathologic laryngopharyngeal reflux symptom scores had lower proximal baseline impedance levels and lower proximal-to-distal ratios, which may reflect the proximal mucosal noxious effect of the refluxate. These results may indicate that laryngopharyngeal reflux symptoms may be due to chronic acid exposure in the proximal segments of the esophagus, and the proximal-to-distal ratio may be used as a new metric for diagnosis.

Keywords: Baseline impedance; gastroesophageal reflux; laryngopharyngeal reflux; proximal to distal ratio; reflux finding score.

Figures

Figure 1.
Figure 1.
Schematic presentation of the data analysis. LPR: laryngopharyngeal reflux; MII-pH: multichannel intraluminal impedance and ambulatory pH; RFS: reflux finding score; Sx: symptoms; UGE: upper gastrointestinal endoscopy.
Figure 2.
Figure 2.
The comparison of baseline impedance (BI) values of (a) proximal esophagus, (b) distal esophagus and (c) proximal to distal ratio between patients with and without laryngopharyngeal reflux (LPR). The BI of proximal esophagus and the proximal-to-distal ratio were significantly lower in patients with LPR symptoms (data are expressed as the mean ± standard error of the mean (SEM)). *p < 0.05, βp < 0.01; proximal esophagus: mean BI of 15 and 17 cm above lower esophageal sphincter (LES); distal esophagus: mean BI of 3 and 5 cm above LES; proximal to distal ratio: proximal BI/distal BI. GERD: gastroesophageal reflux disease symptoms.

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