Gastroesophageal reflux evaluation in patients affected by chronic cough: Restech versus multichannel intraluminal impedance/pH metry

Ummarino, Dario; Vandermeulen, Liv; Roosens, Bart; Urbain, Daniël; Hauser, Bruno; Vandenplas, Yvan

doi:10.1002/lary.23738

Cited by 56 publications

(37 citation statements)

References 21 publications

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“…In a recently published study, we were able to demonstrate that a pathological acidic environment in the oropharynx in LPR-patients was not correlated to objectified gastroesophageal reflux episodes [9] . These results were reconfirmed in another study with the same design [10] . Based on these data, the generally accepted pathomechanism of the direct alteration of the laryngeal epithelium by gastric contents, resulting in LPR-symptoms, needs to be reconsidered and alternative mechanisms should be discussed.…”

Section: Introductionsupporting

confidence: 54%

“…As reported in previous trials, Dx-pH more often detects pathological acid pH levels than the standard pH/MII. On the other hand, the pharyngeal system regularly misses proximal pH exposure that is documented in regular pH/MII [9,10] . Hence, the clinical significance of this Dx-pH system is not clear.…”

Section: Discussionmentioning

confidence: 99%

“…However, the concentration of the laryngeal H+K+-ATPase proton pumps is much lower than the concentration in the stomach [26] . Compared to the distal esophagus, relatively low acid levels might result in relevant symptoms because the larynx area is extremely sensitive to pH alterations [10] . This might explain the need for high dose, long-term PPI therapy in LPR patients to terminate proton secretion and resolve symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…H+K+-ATPase proton pumps were identified by immunohistochemistry in pathologic specimens of the larynx. Hence, local laryngeal acid production might be responsible for LPR symptoms because the laryngeal area is very sensitive to acid [10] . To objectively evaluate the laryngeal acid levels, selective pH values in the aerosolized environment can continuously be assessed with a pH measurement system.…”

Section: Introductionmentioning

confidence: 99%

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New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease

Becker¹,

Drabner²,

Graf³

et al. 2015

WJG

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AIM:To determine the laryngeal H+K+-ATPase and pharyngeal pH in patients with laryngopharyngeal reflux (LPR)-symptoms as well as to assess the symptom scores during PPI therapy. METHODS:Endoscopy was performed to exclude neoplasia and to collect biopsies from the posterior cricoid area (immunohistochemistry and PCR analysis).Immunohistochemical staining was performed with monoclonal mouse antibodies against human H+K+-ATPase. Quantitative real-time RT-PCR for each of the H+K+-ATPase subunits was performed. The pH values were assessed in the aerosolized environment of the oropharynx (DxpH Catheter) and compared to a subsequently applied combined pH/MII measurement. RESULTS:Twenty patients with LPR symptoms were included. In only one patient, the laryngeal H+K+-ATPase was verified by immunohistochemical staining. In another patient, real-time RT-PCR for each H+K+-ATPase subunit was positive. Fourteen out of twenty patients had pathological results in DxpH, and 6/20 patients had pathological results in pH/MII. Four patients had pathological results in both functional tests. Nine out of twenty patients responded to PPIs. CONCLUSION:The laryngeal H+K+-ATPase can only be sporadically detected in patients with LPR symptoms and is unlikely to cause the LPR symptoms. Alternative hypotheses for the pathomechanism are needed. The role of pharyngeal pH-metry remains unclear Prospective Study ORIGINAL ARTICLEBecker V et al . Pathomechansim and diagnosis of LPR and its use can only be recommended for patients in a research study setting. Core tip: The pathophysiology and objective diagnosis of laryngopharyngeal reflux (LPR) is still unclear. The response to standard therapy (proton pump inhibitors) is poor. Laryngeal proton pumps (H+K+-ATPase) are often considered to be potential causes of LPR. The clinical significance of laryngeal proton pumps (H+K+-ATPase) is unclear. We present the first prospective series evaluating the laryngeal H+K+-ATPase, pharyngeal pH and symptom scores in patients with LPR symptoms. Laryngeal H+K+-ATPases can only be sporadically detected, and they are unlikely to cause LPR symptoms. The role of pharyngeal pH-metry remains unclear and its use can only be recommended for patients in the research study setting.Becker V, Drabner R, Graf S, Schlag C, Nennstiel S, Buchberger AM, Schmid RM, Saur D, Bajbouj M. New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease. World J Gastroenterol 2015; 21(3): 982-987 Available from:

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Section: Introductionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease

Becker¹,

Drabner²,

Graf³

et al. 2015

WJG

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“…Vailati et al [113] showed the high specificity and reasonable sensitivity of the Restech technique, which could be considered an interesting tool that can be used before therapy in patients with pharyngoesophageal reflux. In contrast, Ummarino et al [114] did not show any correlation, although chronic coughing was the only symptom reported by patients, and when they compared MII-pH and Restech, the superiority of the first technique seemed clear. Similarly, Becker et al [115] evaluated, in a prospective, single-center trial, the differences between MII-pH and Dx-pH.…”

Section: Dx-ph (Restech)mentioning

confidence: 82%

Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

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Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry.

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New Diagnostic Tests for GERD

Kavitt

Vaezi

2021

The Esophagus

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Gastroesophageal reflux evaluation in patients affected by chronic cough: Restech versus multichannel intraluminal impedance/pH metry

Abstract: OP pH metry detected less reflux episodes than MII/pH; 35% of the OP events were swallows according to impedance. Time correlation between cough and reflux could not be demonstrated with OP pH metry.

Cited by 56 publications

References 21 publications

New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease

New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH metry in extraesophageal gastroesophageal reflux disease

Esophageal testing: What we have so far

New Diagnostic Tests for GERD

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