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

Lechien, Jérôme R.; Chan, Walter W.; Akst, Lee M.; Hoppo, Toshitaka; Jobe, Blair A.; Chiesa‐Estomba, Carlos Miguel; Muls, Vinciane; Bobin, François; Saussez, Sven; Carroll, Thomas L.; Vaezi, Michael F.; Bock, Jonathan M.

doi:10.1177/01945998211029831

Cited by 34 publications

(53 citation statements)

References 38 publications

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“…LPR was nonacid or weakly acid in more than half patients, and they had only upright and daytime HREs in 59% of cases [ 22 ]. The findings of this study corroborated those summarized in the systematic review of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies [ 37 ]. The occurrence of daytime, upright, and gaseous HREs involved esophageal dysmotility, especially transient relaxations of the lower and upper esophageal sphincters.…”

Section: Diagnosis Of Reflux and Place Of Ph Studysupporting

confidence: 88%

“…Interestingly, Harrel et al observed that adding a hypopharyngeal pH sensor in pH study increased the detection of abnormal pH values and supported the diagnosis of LPR more often than traditional dual-sensor esophageal monitoring [ 34 ]. Nowadays, the accuracy of single, dual-, or triple-probe pH-study devices is called into question regarding the lack of correlation between distal/proximal esophageal events and HREs and the lack of consideration of weakly acid or nonacid HREs [ 20 , 21 , 22 , 37 ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…According to the type of pH-impedance monitoring used for the diagnosis, the diagnosis criteria may vary. Many differences across studies make difficult the establishment of consensual normative criteria for LPR on ambulatory reflux monitoring, e.g., impedance/pH sensor placements or configurations, definition of HRE, definition of composition (gas, liquid, mixed), or type (acid/weakly acid/nonacid) events ( Table 1 and Table 2 ) [ 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. These differences may involve the various devices available on the market.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…These differences may involve the various devices available on the market. Thus, in a recent systematic review including the pH study findings of 720 healthy individuals, authors observed that the 95th percentile thresholds were 0 to 10 HREs for HEMII-pH and 40 to 128 for events with pH < 6.0 on oropharyngeal pH monitoring, respectively [ 37 ]. These differences between HEMII-pH and oropharyngeal pH monitoring may be related to different sensitivities and precisions of pH study devices in the HRE detection.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…Oropharyngeal pH monitoring (Restech Dx–pH monitoring) was specifically developed for the diagnosis of LPR [ 48 ]. As for HEMII-pH studies, there are several diagnostic criteria in the literature [ 37 ]m but many authors agreed to consider a positive Ryan score (upright score ≥ 9.41 or supine score ≥ 6.8) for the presence of LPR [ 46 , 48 , 49 , 56 , 57 ]. Ryan score is calculated according to three components: the percent time pH < 5.5 upright or <5.0 supine; the number of episodes in which the pH dropped below threshold; and the duration of the longest episode.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

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Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Lechien

2022

JCM

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Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

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Section: Diagnosis Of Reflux and Place Of Ph Studysupporting

confidence: 88%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

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Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Lechien

2022

JCM

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Laryngopharyngeal Reflux Disease is More Severe in Obese Patients: A Prospective Multicenter Study

Lechien

Bobin²,

Muls

et al. 2021

The Laryngoscope

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Objectives/Hypothesis To investigate whether there is an impact of obesity and overweight on the clinical findings and therapeutic responses of patients with laryngopharyngeal reflux (LPR). Study Design Prospective uncontrolled. Methods Patients with LPR‐related symptoms and positive LPR diagnosis at the hypopharyngeal‐esophageal multichannel intraluminal impedance pH‐monitoring (HEMII‐pH) were recruited from December 2017 to December 2020. Patients were treated with a combination of diet, proton pump inhibitors, and alginate for 3 to 6 months. The following outcomes were studied according to the weight of patients: HEMII‐pH, gastrointestinal endoscopy features, symptoms, findings, and therapeutic response. Results A total of 262 patients completed the study, accounting for 134, 85, and 43 patients with normal weight (body mass index [BMI] <25), overweight (BMI = 25–29.99), and obesity (BMI >30). Obese patients reported significant higher prevalence of gastroesophageal reflux disease (GERD), acid LPR, and a more severe LPR disease regarding the number of pharyngeal reflux events, reflux symptom score (RSS), and reflux sign assessment (RSA). RSS and RSA scores significantly improved from baseline to 3‐month posttreatment irrespective of the patient weight group. Symptoms and signs continued to improve from 3 to 6‐month posttreatment only in patients with a normal weight. Conclusion Obesity is associated with a more severe LPR disease and a higher proportion of GERD and acid LPR. Obese LPR patients may require more frequently PPI‐therapy regarding the higher prevalence of GERD. Level of Evidence 3 Laryngoscope, 131:E2742–E2748, 2021

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Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification

et al. 2022

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Objective: To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients. Methods: Patients with LPR diagnosed by hypopharyngeal-esophageal impedance-pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3-to 9-month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated.Results: One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life-RSS (QoL-RSS) and RSS total scores were significantly higher in chronic LPR patients. The post-treatment decrease of QoL-RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL-RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL-RSS thresholds defined acute (QoL-RSS = 6-25), recurrent (QoL-RSS = 26-38), and chronic (QoL-RSS > 38) LPR.Conclusion: Baseline QoL-RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR.

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

Cited by 34 publications

References 38 publications

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Laryngopharyngeal Reflux Disease is More Severe in Obese Patients: A Prospective Multicenter Study

Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification

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