, Volume 16, Issue 6, pp 1096-1101
Date: 27 Mar 2012

First Agreement Analysis and Day-to-Day Comparison of Pharyngeal pH Monitoring with pH/Impedance Monitoring in Patients with Suspected Laryngopharyngeal Reflux

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Abstract

Objective

Diagnosis of laryngopharyngeal reflux (LPR) is still challenging. Recently a diagnostic device for pH values in the aerosolized environment of the pharynx has been introduced (Dx-pH). We evaluated results of Dx-pH with objective criteria of pH/impedance monitoring (MII) and subjective reflux scoring systems and assessed day-to-day variability.

Design

This study makes use of a prospective single-center trial. Thirty patients with suspected LPR were analyzed. Upper endoscopic examination, manometry, phoniatric examination, and reflux scores were assessed. Dx-pH was performed on two consecutive days, first in combination with MII and second as single measurement. Thereafter, proton pump inhibitor (PPI) trial was performed. Patients were interviewed about symptom relief after 3 months.

Results

There were considerable differences between MII and results on Dx-pH: day 1 (agreement 11 out of 30, kappa 0.137) and day 2 (agreement 14 out of 30, kappa 0.036). Statistically significant differences were detected correlating all single reflux episodes (n = 453) of Dx-pH with MII and vice versa. Furthermore acidic reflux episodes did not result in pH drops of the pharynx. There was a fair agreement between Dx-pH measurements on subsequent days. After follow-up, 3 out of 18 patients with pathological Dx-pH results reported positive response to PPIs, in contrast to 5 out of 6 patients with pathological MII.

Conclusion

According to our data, acid pharyngeal pH levels detected with Dx-pH are not related to GERD and acid esophageal reflux episodes do not result in pharyngeal pH alterations. Hence, present etiology of LPR needs to be reconsidered since neither mixed nor gas reflux events result in pharyngeal pH alteration. Other acid-producing or retaining factors should be taken into account.

What is already known about this subject?
LPR is assumed to be connected to GERD.
Response to PPI therapy is variable.
Despite sparse data, pharyngeal pH monitoring is used in LPR diagnostics.
What are the new findings?
Acid reflux episodes do not result in pharyngeal pH drops.
Acid pharyngeal pH levels are not related to GERD.
Pharyngeal pH measurement is not a positive predictor for PPI response.