Is ambulatory 24-h dual-probe pH monitoring useful in suspected ENT manifestations of GERD?

Sermon, Filip; Brande, S Vanden; Roosens, Bart; Mana, Fazia; Deron, Philippe; Urbain, Daniël

doi:10.1016/j.dld.2003.07.008

Cited by 18 publications

(9 citation statements)

References 26 publications

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“…These issues are compounded by the lack of agreement on normative values and variability in testing methods, especially relating to the positioning of the upper pH probe. In some studies, for example, the proximal probe was placed below the upper esophageal sphincter, whereas in others placement was in the hypopharynx which, although considered closer to the site of injury, is also subject to spurious drops in pH related to intermittent probe drying [24].…”

Section: Establishing a Diagnosis Of Laryngopharyngeal Reflux Diseasementioning

confidence: 99%

Chronic rhinosinusitis and bacterial biofilms

Ramadan

2006

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Section: Establishing a Diagnosis Of Laryngopharyngeal Reflux Diseasementioning

confidence: 99%

Chronic rhinosinusitis and bacterial biofilms

Ramadan

2006

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…The pathophysiological mechanisms causing esophago-pharyngeal regurgitation, that can potentially lead to injury of supra-esophageal structures, are largely unknown. Factors leading to the development of gastro-esophageal reflux disease may not play a central role, as a large proportion of patients with laryngitis that is believed to be acid-related, have normal esophageal motility and physiological levels of esophageal acid exposure [2], [4], [5]. Low basal UES pressure is an unlikely cause, as in healthy individuals UES tone falls to very low levels during sleep without causing regurgitation [6] and UES hypotonia following cricopharyngeal myotomy, even in established refluxers, does not predispose to regurgitation [7].…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Esophago-Pharyngeal Acid Regurgitation in Human Subjects

2011

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Esophago-pharyngeal regurgitation is implicated in various otolaryngologic and respiratory disorders. The pathophysiological mechanisms causing regurgitation are still largely unknown.AimTo determine the principal mechanisms behind esophago-pharyngeal regurgitation.MethodsWe studied 11 patients with extra-esophageal GORD symptoms in whom esophago-pharyngeal acid regurgitation had previously been demonstrated using ambulatory, dual (pharyngo-esophageal) pH metry (>2 episodes/day using previously validated pH-metric criteria). Patients underwent continuous, 24 hr, stationary monitoring of pharyngo-esophageal manometry and dual (pharyngeal and esophageal) pH recordings. They were intubated with a 14-channel manometric assembly incorporating 2 sleeve sensors monitoring the upper and lower esophageal sphincters simultaneously. A dual pH catheter recorded pH signals 2 cm above the UES midpoint and 7 cm above the LES midpoint.ResultsA total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded. All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium. All regurgitation events were associated with a relaxation of the UES, which were classified as transient non-swallow related relaxations in 29 (91%) and swallow-related in the remaining 3 (9%). Straining was an additional associated factor in 41% of regurgitation events, but strain alone was not sufficient to cause esophago-pharyngeal regurgitation.ConclusionSome form of active UES relaxation is necessary for regurgitation to occur. The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.Level of EvidenceN/A

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“…Patients with laryngitis may have minimal or no esophageal symptoms and frequently have normal esophageal acid exposure on traditional ambulatory esophageal pH testing. [10][11][12][13] However, the laryngeal mucosa is exquisitely sensitive to acid and pepsin. 5 Hence, it is possible that very infrequent acid exposure has the potential to cause laryngeal injury.…”

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confidence: 99%