Acidic Pharyngeal Reflux Does Not Correlate with Symptoms and Laryngeal Injury Attributed to Laryngopharyngeal Reflux

Ďuríček, Martin; Bánovčin, Peter; Halickova, Tatiana; Hyrdel, Rudolf; Kollárik, Marián

doi:10.1007/s10620-018-5372-1

Cited by 15 publications

(13 citation statements)

References 38 publications

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“…13,23,31,32 Recently some authors have shown that RFS was not correlate with RSI. [39][40][41][42] These authors emphasize that the validity of RFS has to be investigated in large multicenter studies, while great care should be taken in the diagnosing LPR using only a clinical diagnosis based on symptoms or using RSI and RFS separately. [39][40][41][42] In the same vein, other authors proposed to insert new items in these scores or do not agree with the current cut-off values.…”

Section: Discussionmentioning

confidence: 99%

“…[39][40][41][42] These authors emphasize that the validity of RFS has to be investigated in large multicenter studies, while great care should be taken in the diagnosing LPR using only a clinical diagnosis based on symptoms or using RSI and RFS separately. [39][40][41][42] In the same vein, other authors proposed to insert new items in these scores or do not agree with the current cut-off values. 40,43,44 In our previous study, the differences observed among ERD/NERD, HE, no GERD patients with esophageal pathophysiological analysis (MII-pH), were not demonstrated with RSI or RFS.…”

Section: Discussionmentioning

confidence: 99%

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Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques

Nacci

Bastiani

Barillari

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: To investigate the psychometric properties of the reflux symptom index (RSI) as short screening approach for the diagnostic of laryngopharyngeal reflux (LPR) in patients with confirmed diagnosed regarding the 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH). Methods: From January 2017 to December 2018, 56 patients with LPR symptoms and 71 healthy individuals (control group) were prospectively enrolled. The LPR diagnosis was confirmed through MII-pH results. All subjects (n = 127) fulfilled RSI and the Reflux Finding Score (RFS) was performed through flexible fiberoptic endoscopy. The sensitivity and the specificity of RSI was assessed by ROC (Receiver Operating Characteristic) analysis. Results: A total of 15 LPR patients (26.8%) of the clinical group met MII-pH diagnostic criteria. Among subjects classified as positive for MII- pH diagnoses, RSI and RFS mean scores were respectively 20 (SD ± 10.5) and 7.1 (SD ± 2.5), values not significantly different compared to the negative MII-pH group. The metric analysis of the items led to the realization of a binary recoding of the score. Both versions had similar psychometric properties, α was 0.840 for RSI original version and 0.836 for RSI binary version. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without LPR pathology diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for LPR pathology were ≥ 5 for RSI binary version and ≥ 15 for RSI original version. Both version overestimated LPR prevalence. The original version had more sensitivity and the RSI Binary version had more specificity. Conclusions: It would be necessary to think about modifying the original RSI in order to improve its sensitivity and specificity (RSI binary version, adding or changing some items), or to introduce new scores in order to better frame the probably affected of LPR patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques

Nacci

Bastiani

Barillari

et al. 2020

Ann Otol Rhinol Laryngol

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“…This questionnaire needs to be prepared and validated in patient and control subjects. This area remains controversial and even using this battery of diagnostic tests is not considered to be accurate [27][28][29]. Recently, several studies have suggested that pepsin is a good biomarker for detecting LPR and that it can be considered as a reliable diagnostic marker [30][31][32][33][34][35][36][37]; this in turn has led to a valuable role for pepsin as a diagnostic test for both GERD and LPR [1,[38][39][40][41] especially as Peptest is a rapid and non-invasive diagnostic test and patient compliance has been demonstrated to be high.…”

Section: Discussionmentioning

confidence: 99%

A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients

Dettmar

Watson

McGlashan

et al. 2019

SN Compr. Clin. Med.

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Questionnaires and invasive diagnostic tests are established for diagnosing gastro-esophageal reflux disease (GERD) but shown not to be sensitive or specific for diagnosing laryngopharyngeal reflux (LPR) where vast majority of reflux events are weakly acidic or non-acidic. The research question addressed in the current multicentre study was to determine if the measurement of salivary pepsin is a sensitive, specific and reliable diagnostic test for LPR. Five UK voice clinics recruited a total of 1011 patients presenting with symptoms of LPR and a small group of subjects (n = 22) recruited as asymptomatic control group. Twenty-six patients failed to provide demographic information; the total patient group was 985 providing 2927 salivary pepsin samples for analysis. Study participants provided 3 saliva samples, the first on rising with two samples provided post-prandial (60 min) or post-symptom (15 min). The control group provided one sample on rising and two post-prandial providing a total of 66 samples. Pepsin analysis was carried out using Peptest as previously described. High prevalence of pepsin in patient groups (75%) represents a mean pepsin concentration of 131 ng/ml. The greatest prevalence for pepsin was in the post-prandial sample (155 ng/ml) and the lowest in the morning sample (103 ng/ml). The mean pepsin concentration in the control group was 0 ng/ml. Patients across all 5 clinics showed high prevalence of salivary pepsin (ranging from 69 to 86%), and the overall sensitivity was 76.4% and specificity 100%. Pepsin was shown to be an ideal biomarker for detecting airway reflux and LPR.

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“…These results indicate that the laryngopharynx may be more sensitive to the acidic and pepsin effects than the esophagus [25]. Actually, patients with a high RSI score can have at least one reflux episode for 24 h in the pH 4.0–4.5 environment [26]. Therefore, in the present study, acid exposure to pharyngeal cells was investigated at pH 4.…”

Section: Discussionmentioning

confidence: 99%

Role of Matrix Metalloproteinases 7 in the Pathogenesis of Laryngopharyngeal Reflux: Decreased E-cadherin in Acid exposed Primary Human Pharyngeal Epithelial Cells

Lee

Kim

et al. 2019

IJMS

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Cleavage of E-cadherin and the resultant weakness in the cell-cell links in the laryngeal epithelium lining is induced by exposure to acidic contents of the refluxate. Herein, we aimed to evaluate the role of matrix metalloproteinases (MMPs) in inducing E-cadherin level changes following acid exposure to the human pharyngeal mucosal cells. E-cadherin levels were inversely correlated with the duration of acid exposure. Treatment with actinonin, a broad MMP inhibitor, inhibited this change. Immunocytochemical staining and transepithelial permeability test revealed that the cell surface staining of E-cadherin decreased and transepithelial permeability increased after acid exposure, which was significantly inhibited by the MMP inhibitor. Among the various MMPs analyzed, the mRNA for MMP-7 in the cellular component was upregulated, and the secretion and enzymatic activity of MMP-7 in the culture media increased with the acid treatment. Consequently, MMP-7 plays a significant role in the degradation of E-cadherin after exposure to a relatively weak acidic condition that would be similar to the physiologic condition that occurs in Laryngopharyngeal reflux disease patients.

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Acidic Pharyngeal Reflux Does Not Correlate with Symptoms and Laryngeal Injury Attributed to Laryngopharyngeal Reflux

Cited by 15 publications

References 38 publications

Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques

Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques

A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients

Role of Matrix Metalloproteinases 7 in the Pathogenesis of Laryngopharyngeal Reflux: Decreased E-cadherin in Acid exposed Primary Human Pharyngeal Epithelial Cells

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