A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Abstract

Background and Aim: Laryngopharyngeal reflux (LPR) is caused by the reflux of gastric contents beyond the esophagus into the larynx and pharynx. However, upper esophageal sphincter (UES) motility and proximal esophagus reflux parameters are poorly studied. This study aims to explore the characteristics of UES motility and reflux parameter among LPR patients. Methods: Patients with laryngopharyngeal symptoms only (L), patients with laryngopharyngeal symptoms and typical esophageal symptoms (L + E), patients with typical esophageal symptoms only (E), and healthy controls (H) were retrospectively included. Physiological profiles were studied and compared among groups using both high-resolution manometry and pH-impedance monitoring, including UES basal pressure, residual pressure, relaxation duration time, recovery time, the time to nadir pressure, UES length, proximal contractile integral, and proximal mean nocturnal baseline impedance (MNBI). Patients' symptom outcomes were also analyzed. Results: A total of 242 patients were included. Proximal MNBI was significantly lower in patients with both laryngopharyngeal and esophageal symptoms (17 cm above low esophageal sphincter [LES]: L vs L + E vs E vs H = 3689.7 vs 2500.0 vs 3073.0 vs 3996.0; 15 cm above LES: L vs L + E vs E vs H = 3155.9 vs 2553.4 vs 3198.9 vs 2985.2; P < 0.001). Patients responded to proton pump inhibitor treatment also had lower proximal MNBI than those who did not (17 cm above LES: 1834.0 vs 3500.0; 15 cm above LES: 1946.5 vs 3432.6; P < 0.001). Conclusion: Decreased proximal MNBI can not only identify LPR patients but also predict patients' symptom outcomes.

Normative Ambulatory Reflux Monitoring Metrics for Laryngopharyngeal Reflux: A Systematic Review of 720 Healthy Individuals

“…The 95th percentile values of HRE measured by HEMII-pH ranged from 0 16 to 10. 14 The 95th percentile values of acid, weakly acidic, and nonacid HRE were 0, 0, and 2, respectively, in the study by Wang et al, 14 who were also the only authors 22 NA NA Doo, 2020 23 Individuals without LPR symptoms RFS \7 Klimara, 2019 27 Individuals without LPR symptoms Antireflux medication…”

“…15 The duration of ambulatory reflux monitoring ranged from 14 to 24 hours (Tables 1 and 2). Among the 6 studies using MII-pH without hypopharyngeal pH or impedance sensors, pH monitoring was measured using 1 (n = 4) [10][11][12]22 or 2 (n = 2) esophageal sensors (n = 2). 19,20 The location and number of impedance electrodes used in MII-pH or HEMII-pH varied substantially among studies (Table 1).…”

The Number of Interstitial Cells of Cajal Differs Among Different Subtypes of Achalasia and is Related to Patients' Prognosis

“…As a routine procedure in our hospital, patients were asked to record their demographic information before the HRM test. HRM procedure was performed as previously reported ( 11 ). Patients were required to stop swallowing for 30 seconds to record the basal pressure.…”

Mean nocturnal baseline impedance, a novel metric of multichannel intraluminal impedance-pH monitoring in diagnosing gastroesophageal reflux disease

“… 38 In addition, Sakin et al 39 displayed that proximal-to-distal BI ratio [(mean Z1 + Z2)/(mean Z5 + Z6)] can be useful in diagnosing patients with laryngopharyngeal reflux (LPR) symptoms. Moreover, Chen et al 40 found that proximal MNBI (15 or 17 cm above the LES) can not only identify patients with LPR, but also predict outcomes to anti-reflux therapy. However, some other studies noted that MNBI was not sufficient to evaluate patients with EES.…”