Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study
Patients with otorhinolaryngologic (ear, nose, and throat—ENT) symptoms attributed to gastroesophageal reflux disease (GERD) are usually treated with medication based on the findings of nasal endoscopy and laryngoscopy only. This study aims to determine sensitivity and specificity of symptoms, nasal endoscopy, and laryngoscopy for the diagnosis of GERD as compared to pH monitoring.
We studied 79 patients (mean age 53 years, 38 % males) in whom ENT symptoms were assumed to be secondary to GERD. All patients underwent a transnasal laryngoscopy by the ENT team and upper endoscopy and esophageal function tests by the surgical team. GERD was defined by a pathological pH monitoring.
Pathologic reflux by pH monitoring was documented in 36 of the 79 patients (46 %), with a mean DeMeester score of 44. In 25 of the 36 patients (69 %), distal and proximal reflux was present. Among patients with negative pH monitoring, one patient was diagnosed with achalasia. ENT symptom sensitivity for globus, hoarseness and throat clearing was respectively 11, 58, and 33 %; specificity was respectively 77, 42, and 58 %. Positive predictive value for nasal endoscopy and laryngoscopy was 46 %. Among patients with positive pH monitoring, 13 (36 %) had a hypotensive lower esophageal sphincter (p < 0.01) and 27 (34 %) had abnormal peristalsis (p < 0.01).
In conclusion, the results of this study showed that (a) ENT symptoms were unreliable for the diagnosis of GERD and (b) laryngoscopy had a low positive predictive value for the diagnosis of GERD. These data confirm the importance of esophageal manometry and pH monitoring in any patient with suspected ENT manifestations of GERD before starting empiric therapy with acid-reducing medications since pathologic reflux by pH monitoring was confirmed in less than half of the patients with suspected GERD.
KeywordsGastroesophageal reflux disease Globus Hoarseness Throat clearing Laryngoscopy Esophageal manometry Esophageal pH monitoring
FAMH: acquisition of data, analysis and interpretation of data, drafting the article, final approval of the version to be published
CA: acquisition of data, analysis and interpretation of data, final approval of the version to be published
YV: acquisition of data, analysis and interpretation of data, final approval of the version to be published
MGP: conception and design, review for intellectual content, final approval of the version to be published
BRP: review for intellectual content, final approval of the version to be published
Compliance with Ethical Standards
The study was approved by the IRB of each Institution. Informed consent was waived due to the retrospective format of the study.
- 1.Herbella FA, Dubecz A. Extraesophageal manifestation of gastroesophageal reflux disease. In. P. Marco Fisichella, Marco E. Allaix, Mario Morino, Marco G. Patti Editors. Esophageal Diseases. Evaluation and Treatment. Springer. 2014, pp 95–108Google Scholar
- 4.Ahmed TF, Khandwala F, Abelson TI, Hicks DM, Richter JE, Milstein C, Vaezi MF. Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am J Gastroenterol. 2006;101(3):470–8.CrossRefPubMedGoogle Scholar
- 14.de Bortoli N, Nacci A, Savarino E, Martinucci I, Bellini M, Fattori B, Ceccarelli L, Costa F, Mumolo MG, Ricchiuti A, Savarino V, Berrettini S, Marchi S. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related? World J Gastroenterol. 2012;18(32):4363–70.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Benati CD, Herbella FA, Patti MG. Manometric parameters in patients with suspected gastroesophageal reflux disease and normal pH monitoring. GED gastroenterol. Endosc. Dig. 2014; 33(2):52–57.Google Scholar
- 20.Becker V, Bajbouj M, Waller K, Schmid RM, Meining A. Clinical trial: persistent gastro-oesophageal reflux symptoms despite standard therapy with proton pump inhibitors—a follow-up study of intraluminal-impedance guided therapy. Aliment Pharmacol Ther. 2007;26(10):1355–60.CrossRefPubMedGoogle Scholar