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Diagnostic Value of the Peptest TM in Detecting Laryngopharyngeal Reflux. J Clin Med 2021; 10:jcm10132996. [PMID: 34279479 PMCID: PMC8268930 DOI: 10.3390/jcm10132996] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The PeptestTM is a non-invasive diagnostic test for measuring the pepsin concentration in saliva, which is thought to correlate with laryngopharyngeal reflux (LPR). The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR. METHODS Patients with suspected LPR were examined with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), fasting Peptest, and MII-pH monitoring. We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Peptest, RSI, and RFS based on the threshold of one and six hypopharyngeal reflux episodes. RESULTS Altogether, the data from 46 patients were analyzed. When one hypopharyngeal reflux episode was used as a diagnostic threshold for LPR, the accuracy, sensitivity, specificity, PPV, and NPV were, respectively, as follows: 35%, 33%, 100%, 100%, and 3%, for the Peptest; 39%, 40%, 0%, 95%, and 0%, for the RSI; and 57%, 58%, 0%, 96%, and 0%, for the RFS. The accuracy, sensitivity, specificity, PPV, and NPV of the Peptest for diagnosing gastroesophageal reflux disease (GERD) were 46%, 27%, 63%, 40.0%, and 48%, respectively. CONCLUSIONS A positive Peptest is highly supportive of a pathological LPR diagnosis. However, a negative test could not exclude LPR.
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Van Daele DJ. Esophageal Manometry, pH Testing, Endoscopy, and Videofluoroscopy in Patients With Globus Sensation. Laryngoscope 2019; 130:2120-2125. [DOI: 10.1002/lary.28289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Douglas J. Van Daele
- Department of Otolaryngology–Head and Neck SurgeryRoy J. and Lucille A. Carver College of Medicine, University of Iowa Iowa City Iowa U.S.A
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The effects of paroxetine and amitriptyline on the upper esophageal sphincter (UES) pressure and its natural history in globus pharyngeus. Dig Liver Dis 2017; 49:757-763. [PMID: 28258931 DOI: 10.1016/j.dld.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antidepressant agents have been shown to be an effective and safe treatment method for patients with globus. However, there are few clinical trials dedicated to studying the effects of antidepressant agents on the natural history and upper oesophageal sphincter (UES) pressure of treated globus patients. AIMS To evaluate the effect of paroxetine and amitriptyline to prevent relapses in patients with globus, the simultaneous relationship between changes in UES pressure and improvement of globus symptoms were measured. METHODS Globus patients were randomised into amitriptyline, paroxetine and lansoprazole groups for a 6-week treatment period, and follow-up was extended to 12 additional months. Efficacy was evaluated in terms of the Glasgow-Edinburgh Throat Scale (GETS), and UES pressure was measured by standard oesophageal manometry. RESULTS Paroxetine therapy resulted in a higher withdrawal rate due to symptom relapse (15.9% vs 44.1%, P=0.01; 15.9% vs 64.7, P=0.001) than amitriptyline and lansoprazole. Furthermore, globus symptoms were alleviated with the decrease of UES pressure after paroxetine and amitriptyline treatment (r=0.620, P=0.02; r=0.575, P=0.03) CONCLUSIONS: This follow-up study indicates that paroxetine may alter the natural history of globus and can effectively be used for the long-term management of patients with the disease. Apart from the clinical benefits, paroxetine and amitriptyline can potentially decrease UES pressure.
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Zeleník K, Formánek M, Matoušek P, Komínek P. Chronic Rhinosinusitis and Extraesophageal Reflux: Who is the Candidate for Antireflux Treatment? Am J Rhinol Allergy 2016; 30:e5-9. [DOI: 10.2500/ajra.2016.30.4286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background During the past decade, extraesophageal reflux (EER) has been hypothesized to be one of the possible factors that contribute to the worsening of chronic rhinosinusitis (CRS). However, the relationship remains indeterminate due to its complexity, and it is not clear whether antireflux treatment is indicated for patients with recurrent CRS and who would benefit from it. Objective The aim of the study was to determine the severity of EER in patients with variable durations of CRS and different numbers of previous endoscopic endonasal surgeries (EES). Methods Ninety patients with CRS were recruited for the prospective case series. The age, sex, body mass index, reflux symptom index, duration of treatment of CRS with corticosteroids, and the number of ESS within the previous 5 years were ascertained. The severity of EER was evaluated by oropharyngeal pH monitoring by using the Restech system (the presence of EER, value of the RYAN score) and compared among the groups with varying durations of treatment of CRS (≤10 years, 11–20 years, >20 years) and different numbers of ESS within the previous 5 years (no ESS, 1–2 ESS, >2 ESS). Results Pathologic EER was present significantly more often in patients with CRS treated for >10 years (p = 0.0054) and in patients who underwent >2 ESS within the previous 5 years (p = 0.0001). Conclusion Patients with CRS treated for >10 years and those who had undergone >2 ESS within the previous 5 years had significant EER. Antireflux therapy (e.g., proton pump inhibitors) can be recommended for these patients. However, its effect has to be confirmed in further studies.
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Affiliation(s)
- Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic, and
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic, and
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petr Matoušek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic, and
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic, and
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Zeleník K, Matoušek P, Formánek M, Urban O, Komínek P. Patients with chronic rhinosinusitis and simultaneous bronchial asthma suffer from significant extraesophageal reflux. Int Forum Allergy Rhinol 2015; 5:944-9. [PMID: 26046448 DOI: 10.1002/alr.21560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/26/2015] [Accepted: 05/02/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to determine the severity of extraesophageal reflux (EER) in patients with various degrees of chronic rhinosinusitis (CRS), and particularly in patients with simultaneous bronchial asthma. METHODS Patients with different severity of CRS were invited to participate in the study. Group I consisted of patients with CRS without nasal polyps or bronchial asthma; group II consisted of patients with CRS with nasal polyps but without bronchial asthma; group III consisted of patients with CRS with nasal polyps and bronchial asthma. The age, gender, Reflux Symptom Index, severity of EER evaluated using the Restech system, and number of previous functional endoscopic sinus surgeries (FESSs) were compared between groups. RESULTS A total of 90 patients (30 in each group) were recruited for the study. Pathological EER was significantly often present in group III when compared with group I and group II in all parameters analyzed (RYAN score, number of EER episodes, total percentage of time below pH 5.5). Furthermore, patients from group III had undergone more surgeries in the past. CONCLUSION Patients with CRS with nasal polyps and simultaneous bronchial asthma suffer from significant EER. Antireflux therapy can be recommended for these patients. However, the effect has to be confirmed in further studies.
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Affiliation(s)
- Karol Zeleník
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petr Matoušek
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Martin Formánek
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Gastroenterology, Vítkovice Hospital, Ostrava, Czech Republic
| | - Ondřej Urban
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Gastroenterology, Vítkovice Hospital, Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Comparison of Three Methods Used in the Diagnosis of Extraesophageal Reflux in Children with Chronic Otitis Media with Effusion. Gastroenterol Res Pract 2015; 2015:547959. [PMID: 26064092 PMCID: PMC4438165 DOI: 10.1155/2015/547959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 04/23/2015] [Indexed: 02/07/2023] Open
Abstract
Objectives. Detection of extraesophageal reflux (EER) in children with chronic otitis media with effusion (OME) using three different diagnostic methods. Methods. Children between 1 and 7 years with OME who underwent adenoidectomy and myringotomy with insertion of a ventilation tube were included in this prospective study. EER was detected using three methods: oropharyngeal pH was monitored for 24 hours using the Restech system; detection of pepsin in middle ear fluid obtained during myringotomy was done using Peptest, and detection of pepsin in an adenoid specimen was done immunohistochemically. Results. Altogether 21 children were included in the study. Pathological oropharyngeal pH was confirmed in 13/21 (61.9%) children. Pepsin in the middle ear fluid was present in 5/21 (23.8%) children; these 5 patients were diagnosed with the most severe EER established through monitoring of oropharyngeal pH. No specimen of adenoids tested was positive for pepsin upon immunohistochemical examination. Conclusions. Diagnosis of EER in patients with OME using Restech is sensitive but less specific when compared to the detection of pepsin in middle ear fluid using Peptest. Pepsin in the middle ear was consistently present in patients with RYAN score above 200, and these patients in particular could potentially profit from antireflux therapy.
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Abstract
Globus is a topic of interest for many specialties including otorhinolaryngology, gastroenterology and psychiatry/psychosomatic medicine, but, although many hypotheses have been suggested, key questions about its aetiology remain. This Review provides an overview of the extensive literature concerning this topic and discusses the quality of the evidence to date. Globus has been associated with oropharyngeal structural lesions, upper oesophageal sphincter disorders, oesophageal disorders, GERD, psychosocial factors and psychiatric comorbidity. However, findings are often contradictory and the literature remains highly inconclusive. Indeed, with the exception of patients with structural-based globus, the Rome III criteria for functional globus only apply to a subgroup of patients with idiopathic globus. In clinical reality, there exists a group of patients who present with idiopathic (nonstructural) globus, but nevertheless have dysphagia, odynophagia or GERD-exclusion criteria for globus diagnosis according to Rome III. The symptomatology of patients with globus might be broader than previously thought. It is therefore crucial to approach globus not from one single perspective, but from a multifactorial point of view, with focus on the coexistence and/or interactions of different mechanisms in globus pathogenesis. This approach could be translated to clinical practice by adopting a multidisciplinary method to patients presenting with globus.
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Schindler A, Mozzanica F, Alfonsi E, Ginocchio D, Rieder E, Lenglinger J, Schoppmann SF, Scharitzer M, Pokieser P, Kuribayashi S, Kawamura O, Kusano M, Zelenik K. Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus. Ann N Y Acad Sci 2013; 1300:250-260. [PMID: 24117647 DOI: 10.1111/nyas.12251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The following discussion of upper esophageal sphincter dysfunction includes commentaries on the role of the cricopharyngeus muscle in reflux disease; the etiology and treatment of Zenker diverticulum; the use of videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus; the role of pH-impedance monitoring in globus evaluation; and treatment for reflux-associated globus.
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Affiliation(s)
- Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco,", University of Milan, Milan, Italy
| | - Francesco Mozzanica
- Department of Biomedical and Clinical Sciences "L. Sacco,", University of Milan, Milan, Italy
| | - Enrico Alfonsi
- Spinal and Cranial Reflexes Laboratory, Fondazione Istituto Neurologico C Mondino IRCCS, Pavia, Italy
| | - Daniela Ginocchio
- Department of Audiology, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Erwin Rieder
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Peter Pokieser
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Shiko Kuribayashi
- Department of Gastroenterology, Gunma University Hospital, Gunma, Japan
| | - Osamu Kawamura
- Department of Gastroenterology, Gunma University Hospital, Gunma, Japan
| | - Motoyasu Kusano
- Department of Gastroenterology, Gunma University Hospital, Gunma, Japan
| | - Karol Zelenik
- Department of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic
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Choi WS, Kim TW, Kim JH, Lee SH, Hur WJ, Choe YG, Lee SH, Park JH, Sohn CI. High-resolution Manometry and Globus: Comparison of Globus, Gastroesophageal Reflux Disease and Normal Controls Using High-resolution Manometry. J Neurogastroenterol Motil 2013; 19:473-8. [PMID: 24199007 PMCID: PMC3816181 DOI: 10.5056/jnm.2013.19.4.473] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Globus is a foreign body sense in the throat without dysphagia, odynophagia, esophageal motility disorders, or gastroesophageal reflux. The etiology is unclear. Previous studies suggested that increased upper esophageal sphincter pressure, gastroesophageal reflux and hypertonicity of esophageal body were possible etiologies. This study was to quantify the upper esophageal sphincter (UES) pressure, contractile front velocity (CFV), proximal contractile integral (PCI), distal contractile integral (DCI) and transition zone (TZ) in patient with globus gastroesophageal reflux disease (GERD) without globus, and normal controls to suggest the correlation of specific high-resolution manometry (HRM) findings and globus. Methods Fifty-seven globus patients, 24 GERD patients and 7 normal controls were studied with HRM since 2009. We reviewed the reports, and selected 5 swallowing plots suitable for analysis in each report, analyzed each individual plot with ManoView. The 5 parameters from each plot in 57 globus patients were compared with that of 24 GERD patients and 7 normal controls. Results There was no significant difference in the UES pressure, CFV, PCI and DCI. TZ (using 30 mmHg isobaric contour) in globus showed significant difference compared with normal controls and GERD patients. The median values of TZ were 4.26 cm (interquartile range [IQR], 2.30-5.85) in globus patients, 5.91 cm (IQR, 3.97-7.62) in GERD patients and 2.26 cm (IQR, 1.22-2.92) in normal controls (P = 0.001). Conclusions HRM analysis suggested that UES pressure, CFV, PCI and DCI were not associated with globus. Instead increased length of TZ may be correlated with globus. Further study comparing HRM results in globus patients within larger population needs to confirm their correlation.
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Affiliation(s)
- Won Seok Choi
- Division of Gastroenterology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi WS, Kim TW, Kim JH, Lee SH, Hur WJ, Choe YG, Lee SH, Park JH, Sohn CI. High-resolution Manometry and Globus: Comparison of Globus, Gastroesophageal Reflux Disease and Normal Controls Using High-resolution Manometry. J Neurogastroenterol Motil 2013. [PMID: 24199007 DOI: 10.5056/jnm.2013.19.4.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS Globus is a foreign body sense in the throat without dysphagia, odynophagia, esophageal motility disorders, or gastroesophageal reflux. The etiology is unclear. Previous studies suggested that increased upper esophageal sphincter pressure, gastroesophageal reflux and hypertonicity of esophageal body were possible etiologies. This study was to quantify the upper esophageal sphincter (UES) pressure, contractile front velocity (CFV), proximal contractile integral (PCI), distal contractile integral (DCI) and transition zone (TZ) in patient with globus gastroesophageal reflux disease (GERD) without globus, and normal controls to suggest the correlation of specific high-resolution manometry (HRM) findings and globus. METHODS Fifty-seven globus patients, 24 GERD patients and 7 normal controls were studied with HRM since 2009. We reviewed the reports, and selected 5 swallowing plots suitable for analysis in each report, analyzed each individual plot with ManoView. The 5 parameters from each plot in 57 globus patients were compared with that of 24 GERD patients and 7 normal controls. RESULTS There was no significant difference in the UES pressure, CFV, PCI and DCI. TZ (using 30 mmHg isobaric contour) in globus showed significant difference compared with normal controls and GERD patients. The median values of TZ were 4.26 cm (interquartile range [IQR], 2.30-5.85) in globus patients, 5.91 cm (IQR, 3.97-7.62) in GERD patients and 2.26 cm (IQR, 1.22-2.92) in normal controls (P = 0.001). CONCLUSIONS HRM analysis suggested that UES pressure, CFV, PCI and DCI were not associated with globus. Instead increased length of TZ may be correlated with globus. Further study comparing HRM results in globus patients within larger population needs to confirm their correlation.
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Affiliation(s)
- Won Seok Choi
- Division of Gastroenterology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hawkshaw MJ, Pebdani P, Sataloff RT. Reflux Laryngitis: An Update, 2009–2012. J Voice 2013; 27:486-94. [DOI: 10.1016/j.jvoice.2013.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/07/2013] [Indexed: 02/07/2023]
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Extraesophageal Reflux: What Is the Best Parameter for pH-Monitoring Data Analysis from the Perspective of Patient Response to Proton Pump Inhibitors? Gastroenterol Res Pract 2013; 2013:736486. [PMID: 23401677 PMCID: PMC3562676 DOI: 10.1155/2013/736486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 12/15/2012] [Accepted: 12/19/2012] [Indexed: 12/14/2022] Open
Abstract
Objectives. To analyze the pH-monitoring records of patients with suspected extraesophageal reflux (EER) using three different parameters (number of refluxes (NOR), acid exposure time (AET), and reflux area index (RAI)), with a view to determining which type of analysis is best at selecting the patients who will respond to a proton pump inhibitor (PPI). Methods. Demographic data were obtained and the level of the complaint was assessed using the Visual Analogue Scale. A dual probe pH-monitoring study was conducted. NOR greater than six, AET more than 0.1%, and RAI higher than 6.3 mpH were taken to be the thresholds for EER. Subsequently the response to a 12-week PPI trial was analyzed. Results. A total of 81 patients were analyzed. The percentages of patients with substantial EER based on NOR, AET, and RAI were 36%, 28% and 26%, respectively. Statistically significant, often positive PPI trials were confirmed in the group identified as having substantial EER using all three types of analysis. When using AET and RAI, the significance was more pronounced (P = 0.012 and P = 0.013, resp.) in comparison with NOR (P = 0.033). Conclusions. Patients with EER diagnosed using AET or RAI will respond to PPI significantly often.
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