Histologic versus pH probe results in pediatric laryngopharyngeal reflux

Andrews, Thomas M.; Orobello, Nicklas C.

doi:10.1016/j.ijporl.2013.02.017

Cited by 21 publications

(15 citation statements)

References 15 publications

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“…The questionnaire set included the RSI, a validated patient-reported laryngeal symptom questionnaire, 6, 25 GerdQ, a validated instrument for evaluating GERD symptoms, 26 Visceral Sensitivity Index (VSI), a validated instrument for gastrointestinal symptom-specific anxiety, 27 and the Brief Symptom Inventory (BSI-18), a validated psychosocial self-report symptom scale. 17 In addition, the Heartburn Vigilance Scale (HVS), adapted from the validated Pain Vigilance and Awareness Questionnaire, and the Heartburn Catastrophizing Scale (HCS), adapted from the Pain Catastrophizing Scale were used to examine reflux-specific thought and discomfort. 28, 29 The Anxiety Sensitivity Inventory (ASI), a validated instrument that assesses beliefs about the social and somatic consequences of anxiety symptoms, and the Discomfort Intolerance Scale (DIS), a self-report measure of the ability to tolerate uncomfortable sensations, were used to evaluate gastrointestinal symptom-specific anxiety.…”

Section: Methodsmentioning

confidence: 99%

“…13, 14 Studies demonstrate that oropharyngeal pH monitoring is highly sensitive in detecting acid reflux in the posterior oropharynx and more quickly reaches pH equilibrium compared to a standard pH catheter. 13–16 However, data evaluating the agreement between esophageal pH impedance and oropharyngeal pH are mixed 17–20 , and unified normative values for oropharyngeal pH monitoring are lacking, limiting its current role as a diagnostic tool. 21–24 In addition, whether oropharyngeal pH testing is a reliable prognostic tool for medical therapy and surgical outcomes is of great interest.…”

Section: Introductionmentioning

confidence: 99%

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Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms

Yadlapati

Pandolfino

Lidder

et al. 2016

American Journal of Gastroenterology

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Introduction Predicting response to proton-pump inhibitor (PPI) therapy in patients with laryngeal symptoms is challenging. The Restech Dx-pH probe is a transnasal catheter that measures oropharyngeal pH. In this study, we aimed to investigate the prognostic potential of oropharyngeal pH monitoring to predict responsiveness to PPI therapy in patients with laryngeal symptoms. Methods We conducted a physician blinded prospective cohort study at a single academic institution between 1/2013–10/2014. Adult patients with Reflux Symptom Index scores (RSI) ≥13 off PPI therapy were recruited. Patients underwent video laryngoscopy and 24-hour oropharyngeal pH monitoring, followed by an 8–12 week trial of omeprazole 40 mg daily. Prior to, and following PPI therapy, patients completed various symptom questionnaires. The primary outcome was the association between PPI response and oropharyngeal pH metrics. PPI response was separated into three subgroups based on post-treatment RSI score and % RSI response: Non-response = RSI ≥ 13; Partial response = post-treatment RSI < 13 and change in RSI < 50%; and Complete response = post-treatment RSI < 13 and change in RSI ≥ 50%. The primary analysis utilized a multinomial logistic regression controlling for pre-treatment RSI score. A secondary analysis assessed the relationship between change in RSI (post-pre) and oropharyngeal pH metrics via ordinary least square regression. Results Thirty-four patients completed the study and were included in final analysis. Symptom response to PPI therapy was as follows: 50% no response, 15% partial-response and 35% complete-response. Non-responders had a higher pre-treatment RSI (P < 0.01). There were no significant differences in oropharyngeal acid exposure (below pH of 4.0, 5.0, 5.5, 6.0 and RYAN scores) between responder types. The secondary analysis noted a trend between lower PPI response and greater total percent time below pH of 5.0 (P = 0.03), upright percent time below pH of 5.0 (p = .07) and RYAN supine (corrected) (P = 0.03), as well as an association between PPI response and greater decreases in the Anxiety Sensitivity Inventory (P < 0.01), Brief Symptom Inventory-18 (P < 0.01), and Negative Affect Scale (P < 0.01). Discussion Oropharyngeal pH testing did not predict laryngeal symptom response to PPI therapy. Contrary to hypothesis, our study signaled that the degree of oropharyngeal acid exposure is inversely related to PPI response. In addition, reduction in negative affect and psychological distress parallels PPI response.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms

Yadlapati

Pandolfino

Lidder

et al. 2016

American Journal of Gastroenterology

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“…Bu incelemenin laringofaringeal reflü tanısında verimliliği arttıracağı ileri sürülmüştür. Boğaz temizleme, nazal konjesyon, öksürük, radyolojik bulguları olmayan tekrarlayıcı sinüzit öyküsü, halitozis, kültür negatif boğaz ağrısı ve postnazal akıntı gibi semptomları olan çocuklarda laringeal biyopsi ve nazofaringeal pH ölçümü ile yapılan bir çalışmada %80 oranında reflü pozitifliği saptanmıştır (32). Buna göre Restech kateterinin laringofaringeal reflü tanısında yararlı bir araç olduğu ileri sürülmüştür.…”

Section: Nazofaringeal Ph İzlemiunclassified

Respiratory Manifestations and Diagnosis of Gastroesophageal Reflux Disease in Children

Kasırga¹,

Gülen²

2014

jpr

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“…Therefore, it is regarded as the best evidence for diagnosis of LPR[10]. Some studies have documented LPR using a new pH sensor[9,11] and others have investigated the pH threshold for identifying patients with an abnormal pharyngeal pH environment[12,13]. However, few studies have shown the therapeutic outcome in patients with LPR who were diagnosed by oropharyngeal pH-monitoring.…”

Section: Introductionmentioning

confidence: 99%

Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

Zhang¹,

Hu²,

Chen³

et al. 2017

WJG

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AIMTo compare the outcomes between laparoscopic Nissen fundoplication (LNF) and proton pump inhibitors (PPIs) therapy in patients with laryngopharyngeal reflux (LPR) and type I hiatal hernia diagnosed by oropharyngeal pH-monitoring and symptom-scale assessment.METHODSFrom February 2014 to January 2015, 70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment, oropharyngeal pH-monitoring, manometry, and gastrointestinal endoscopy were enrolled in this study. All of the patients met the inclusion criteria. All of the patients underwent LNF or PPIs administration, and completed a 2-year follow-up. Patients’ baseline characteristics and primary outcome measures, including comprehensive and single symptoms of LPR, PPIs independence, and satisfaction, and postoperative complications were assessed. The outcomes of LNF and PPIs therapy were analyzed and compared.RESULTSThere were 31 patients in the LNF group and 39 patients in the PPI group. Fifty-three patients (25 in the LNF group and 28 in the PPI group) completed reviews and follow-up. Oropharyngeal pH-monitoring parameters were all abnormal with high acid exposure, a large amount of reflux, and a high Ryan score, associated reflux symptom index (RSI) score. There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups (P < 0.05), as well as typical symptoms of gastroesophageal reflux disease. Improvement in the RSI (P < 0.005) and symptom scores of cough (P = 0.032), mucus (P = 0.011), and throat clearing (P = 0.022) was significantly superior in the LNF group to that in the PPI group. After LNF and PPIs therapy, 13 and 53 patients achieved independence from PPIs therapy (LNF: 44.0% vs PPI: 7.14%, P < 0.001) during follow-up, respectively. Patients in the LNF group were more satisfied with their quality of life than those in the PPI group (LNF: 62.49 ± 28.68 vs PPI: 44.36 ± 32.77, P = 0.004). Body mass index was significantly lower in the LNF group than in the PPI group (LNF: 22.2 ± 3.1 kg/m2 vs PPI: 25.1 ± 2.9 kg/m2, P = 0.001).CONCLUSIONDiagnosis of LPR should be assessed with oropharyngeal pH-monitoring, manometry, and the symptom-scale. LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

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Histologic versus pH probe results in pediatric laryngopharyngeal reflux

Cited by 21 publications

References 15 publications

Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms

Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms

Respiratory Manifestations and Diagnosis of Gastroesophageal Reflux Disease in Children

Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

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