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Elkalawy H, Abosena W, Elnagger M, Allison H. Wake up to gastro-oesophageal reflux disease: The interplay between arousal and night-time reflux. J Sleep Res 2024:e14158. [PMID: 38356205 DOI: 10.1111/jsr.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
This review examines the temporal association between nocturnal gastro-oesophageal reflux and sleep-arousal cycles. Most nocturnal gastro-oesophageal reflux events occur during the awake cycle, and arousals precede most nocturnal gastro-oesophageal reflux events, indicating that arousal from sleep predisposes to nocturnal gastro-oesophageal reflux. This sheds light on the complex relationship between nocturnal gastro-oesophageal reflux and sleep, and has implications for managing nocturnal gastro-oesophageal reflux symptoms. The appearance of symptoms and the pathophysiology of nocturnal gastro-oesophageal reflux are influenced by sleep hygiene, sleep disturbances and the misalignment of circadian rhythms. Nocturnal gastro-oesophageal reflux and its related sleep disorders are prevalent and negatively impact the quality of life. There is conflicting evidence on whether nocturnal gastro-oesophageal reflux and sleep disturbances are causally linked, and whether sleep disturbances drive nocturnal gastro-oesophageal reflux. Poor sleep quality increases oesophageal hypersensitivity and overall acid exposure. The nocturnal gastro-oesophageal reflux is linked to the more severe forms of gastro-oesophageal reflux disease, especially with atypical/extra-oesophageal manifestations and complications of mucosal damage such as oesophagitis and stricture, Barret's oesophagus, and oesophageal adenocarcinoma. This review highlights the role of sleep problems in presenting nocturnal gastro-oesophageal reflux, and the potential benefits of treating sleep disturbances in enhancing patient care and quality of life.
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Affiliation(s)
- Hanan Elkalawy
- Department of Anesthesiology and Perioperative Care, Tufts Medical Center, Boston, Massachusetts, USA
| | - Wael Abosena
- Department of Surgery, Faculty of Medicine, Tanta University, Gharbeya, Egypt
| | - Mohamed Elnagger
- Department of Internal Medicine, Hartford Health Care, Hartford, Connecticut, USA
| | - Harmony Allison
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Wang G, Wang L, Sun Z, Li L, Guo Y, Wu J, Wang Q, Fang J, Lv Q, Li G, Han H, Zhong C, Qu C, Li B, Sui X, Zhou Y, Liu H, Sataloff RT, Wu W. A Comparison Between W Score and RYAN Score in Diagnosing Laryngopharyngeal Reflux Disease. J Voice 2023:S0892-1997(23)00174-1. [PMID: 37429810 DOI: 10.1016/j.jvoice.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To assess the diagnostic value of the W score in differentiating laryngopharyngeal reflux disease (LPRD) patients from the normal population by pharyngeal pH (Dx-pH) monitoring, compared with the RYAN score. METHODS One hundred and eight patients with suspected LPRD and complete follow-up results after more than 8 weeks of anti-reflux therapy were enrolled from the Department of Otolaryngology-Head and Neck Surgery, Gastroenterology and Respiratory Medicine of seven hospitals. Their Dx-pH monitoring data before treatment were reanalyzed to obtain the W score in addition to the RYAN score and then the diagnostic sensitivity and specificity were compared and evaluated with reference to the result of anti-reflux therapy. RESULTS In eighty-seven (80.6%) cases, anti-reflux therapy was effective, and in 21 patients (19.4%), therapy was ineffective. Twenty-seven patients (25.0%) had a positive RYAN score. The W score was positive in 79 (73.1%) patients. There were 52 patients who had a negative RYAN score, but a positive W score. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of the RYAN score were 28.7%, 90.5%, 92.6%, and 23.5%, respectively (kappa = 0.092, P = 0.068), whereas those of the W score for LPRD was 83.9%, 71.4%, 92.4%, and 51.7%, respectively (kappa = 0.484, P < 0.001). CONCLUSIONS W score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve diagnostic efficacy. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1800014931.
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Affiliation(s)
- Gang Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Lei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Zhezhe Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Lianyong Li
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yuzhu Guo
- Department of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Jimin Wu
- Department of Gastroesophageal Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Qi Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital of the Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital of the Capital Medical University, Beijing, China
| | - Qiuping Lv
- Department of Otorhinolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Gelin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital of the Capital Medical University, Beijing, China
| | - Haolun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Changqing Zhong
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Changmin Qu
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Baowei Li
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Xinke Sui
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Ying Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Hongdan Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Robert T Sataloff
- Department of Otorhinolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China.
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Salgado S, Borges LF, Cai JX, Lo WK, Carroll TL, Chan WW. Symptoms classically attributed to laryngopharyngeal reflux correlate poorly with pharyngeal reflux events on multichannel intraluminal impedance testing. Dis Esophagus 2022; 36:6627278. [PMID: 35780323 DOI: 10.1093/dote/doac041] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 03/17/2022] [Indexed: 01/11/2023]
Abstract
Laryngopharyngeal reflux (LPR) is thought to be a common etiology of throat and airway symptoms. Diagnosis of LPR is challenging, given the variable symptomatology and response to therapy. Identifying symptoms that better correlate with LPR may inform management strategies. We aimed to examine the association between patient-reported symptoms and objectively identified LPR on ambulatory reflux monitoring. This was a retrospective cohort study of consecutive adults with suspected LPR undergoing combined hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing (HEMII-pH) at a tertiary center. All patients completed standardized symptom surveys for presenting symptoms, reflux symptom index (RSI), and voice handicap index (VHI). LPR was defined as >1 full-column pharyngeal reflux event on HEMII-pH over 24 hours. Univariate and multivariable analyses were performed. A total of 133 patients were included (mean age = 55.9 years, 69.9% female). Of this 83 (62.4%) reported concomitant esophageal symptoms. RSI and VHI did not correlate with proximal esophageal or pharyngeal reflux events (Kendall's tau correlations P > 0.05), although the mean RSI was higher in the LPR group (21.1 ± 18.9 vs. 17.1 ± 8.3, P = 0.044). Cough, but not other laryngeal symptoms, was more common among patients with esophageal symptoms (58% vs. 36%, P = 0.014). Neither laryngeal symptoms nor esophageal symptoms of reflux predicted LPR on univariate or multivariable analyses (all P > 0.05). Neither laryngeal symptoms classically attributed to LPR nor typical esophageal symptoms correlated with pharyngeal reflux events on HEMII-pH. Clinical symptoms alone are not sufficient to make an LPR diagnosis. Broad evaluation for competing differential diagnoses and objective reflux monitoring should be considered in patients with suspected LPR symptoms.
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Affiliation(s)
- Sanjay Salgado
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lawrence F Borges
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer X Cai
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Wai-Kit Lo
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas L Carroll
- Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA, USA
| | - Walter W Chan
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
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Włodarczyk E, Jetka T, Miaśkiewicz B, Skarzynski PH, Skarzynski H. Validation and Reliability of Polish Version of the Reflux Symptoms Index and Reflux Finding Score. Healthcare (Basel) 2022; 10:healthcare10081411. [PMID: 36011068 PMCID: PMC9408310 DOI: 10.3390/healthcare10081411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To confirm the credibility, consistency, and replicability of the Polish versions of the Reflux Symptoms Index (PL-RSI) and the Reflux Finding Score (PL-RFS). (2) Methods: The translation followed the WHO recommendations. The study group included 100 volunteers (age 15−87) with hoarseness and pharyngolaryngeal complaints. The control group comprised 55 healthy volunteers (age 20−75). Study participants completed the PL-RSI; then, two independent otolaryngologists completed the PL-RFS based on pharyngeal videostroboscopy. Questionnaires were repeated after 7 days, with no treatment before the second round. Additionally, patients underwent 24 h pH-metry. The control group had a single round of questionnaires followed by pH-metry. (3) Results: The PL-RSI is consistent, reliable (Cronbach’s alpha 0.77−0.83; test−retest reliability 0.83), and significantly correlated with other patient-filled tools (p < 0.001). The PL-RFS intra-rater reliability is 0.84−0.91, and inter-rater is 0.88. Both questionnaires strongly correlate with pH-metry (PL-RSI upright Ryan Score 0.35, PL-RFS—0.60). Both clearly distinguish (i) healthy from persons with voice disorders, but without acid LPR (p < 0.0001), and (ii) within patient group between subjects with and without acid LPR (p = 0.0002). (4) Conclusions: The PL-RSI and PL-RFS are reliable and can be recommended to Polish-speaking otolaryngologists. Our findings confirm the role of country-specific factors in RSI results and that practitioners should always use a proper control group.
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Affiliation(s)
- Elżbieta Włodarczyk
- Rehabilitation Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland
- Correspondence:
| | - Tomasz Jetka
- World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
| | - Beata Miaśkiewicz
- Audiology and Phoniatric Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
| | - Piotr Henryk Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
- Institute of Sensory Organs, 05-830 Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Henryk Skarzynski
- Otorhinolaryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
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Wlodarczyk E, Domeracka-Kolodziej A, Miaskiewicz B, Skarzynski H, Skarzynski PH. A simple qualitative scale for diagnosis of laryngopharyngeal reflux: high correlations with pH measurements and disease severity. The usefulness of the Warsaw Scale in LPR diagnostics compared to other diagnostic tools. Eur Arch Otorhinolaryngol 2021; 278:4883-4892. [PMID: 34357461 PMCID: PMC8553686 DOI: 10.1007/s00405-021-06989-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 12/26/2022]
Abstract
Purpose Diagnosis and monitoring of laryngopharyngeal reflux (LPR) is a constant challenge in otolaryngological practice, chiefly because there are no specific symptoms characteristic of the disease. In this paper, we present the validation of a simple, 6-level qualitative scale to gauge the clinical findings of LPR. It has been previously published in Polish as the Warsaw Scale. Methods In the study, we enrolled 100 patients with voice problems who had registered in our clinic, and we performed an extended battery of diagnostic tests for LPR, together with 24-h pH monitoring. Results The Warsaw Scale significantly outperformed other instruments in both predicting LPR status and correlating with pH measurements. Moreover, the rating provided by the scale showed a strong association with patient-reported symptoms. Conclusion The data indicate that the Warsaw Scale could be used as an affordable, consistent, and effective diagnostic and monitoring tool for LPR.
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Affiliation(s)
- E Wlodarczyk
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - A Domeracka-Kolodziej
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - B Miaskiewicz
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
- Institute of Sensory Organs, Kajetany, Poland
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - P H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.
- Institute of Sensory Organs, Kajetany, Poland.
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
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6
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姜 允, 李 丹, 李 田, 吴 蓓, 尹 冰, 李 爱. [Value of airway pH monitoring in determining the association between chronic cough and laryngopharyngeal reflux in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:713-717. [PMID: 34266529 PMCID: PMC8292663 DOI: 10.7499/j.issn.1008-8830.2102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To study the value of airway pH monitoring in determining the association between chronic cough and laryngopharyngeal reflux (LPR) in children. METHODS A total of 274 children with chronic cough who were treated from January 2016 to December 2019 were enrolled. The DX-pH detection system was used to conduct 24-hour airway pH monitoring. The association between chronic cough and LPR was analyzed. RESULTS Among the 274 children, there were 168 boys and 106 girls, with a median age of 62.8 months and a median airway pH value of 7.3. Of all the 274 children, 99 (36.1%) had LPR, and the incidence rate of LPR was 36.9% (62/168) in boys and 34.9% (37/106) in girls (P=0.737). The comparison of the incidence rate of LPR among children aged < 1 year, 1-6 years, and > 6 years showed that the younger children had a significantly higher incidence rate of LPR than the older ones (P=0.003). There was no significant difference in the incidence of LPR between the two groups with chronic cough of unknown etiology and definite etiology. The incidence of chronic cough was positively correlated with that of LPR (rs=0.861, P < 0.01). Among the 99 children with positive RYAN index, 65 (66%) suffered from simple LPR. CONCLUSIONS LPR is highly associated with the development of chronic cough, and airway pH monitoring may be a safe and effective method for the diagnosis of LPR.
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Affiliation(s)
- 允丽 姜
- />上海市儿童医院/上海交通大学附属儿童医院呼吸科, 上海 200040Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - 丹 李
- />上海市儿童医院/上海交通大学附属儿童医院呼吸科, 上海 200040Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - 田田 李
- />上海市儿童医院/上海交通大学附属儿童医院呼吸科, 上海 200040Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - 蓓蓉 吴
- />上海市儿童医院/上海交通大学附属儿童医院呼吸科, 上海 200040Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - 冰如 尹
- />上海市儿童医院/上海交通大学附属儿童医院呼吸科, 上海 200040Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - 爱求 李
- />上海市儿童医院/上海交通大学附属儿童医院呼吸科, 上海 200040Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
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7
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Alves JR. Importance of esophageal pH monitoring and manometry in indicating surgical treatment of gastroesophageal reflux disease. ACTA ACUST UNITED AC 2021; 67:131-139. [PMID: 34161486 DOI: 10.1590/1806-9282.67.01.20200354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To demonstrate the need of performing esophageal pH monitoring and manometry in patients with clinical suspicion of Gastroesophageal reflux disease, as more accurate and practical complementary exams in the indication of surgical treatment. METHODS A systematic review was carried out in the PubMed/Medline database, based on the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, selecting studies in humans, published in Portuguese, Spanish, and English, from January 1, 2009 to August 5, 2020. The following descriptors were used: "reflux gastroesophageal" AND "surgery" AND "surgical treatment" AND "esophageal manometry" OR "pH monitoring". After that, retrospective or prospective observational studies with a sample of less than 100 individuals, or with limited access, reports or case series, review articles, letters, comments, or book chapters were excluded. To facilitate the application of the exclusion criteria, the Rayyan management base was used. RESULTS Out of the 676 studies found, 19 valid and eligible studies were selected to make inferences. CONCLUSIONS Based on the best evidence, currently, considering national particularities, performing a 24-hour esophageal pH monitoring and esophageal manometry for all patients undergoing anti-reflux surgery.
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Affiliation(s)
- José Roberto Alves
- Universidade Federal de Santa Catarina, Curso de Medicina, Departamento de Cirurgia - Florianópolis (SC), Brasil
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8
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Wang H, Fu Z, Xu P, Gu X, Chen X, Yu W. Proton pump inhibitor treatment improves pulmonary function in acute exacerbations of COPD patients with 24-hour Dx-pH monitoring-diagnosed laryngopharyngeal reflux. CLINICAL RESPIRATORY JOURNAL 2021; 15:558-567. [PMID: 33751792 DOI: 10.1111/crj.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/04/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) patients have higher laryngopharyngeal reflux (LPR)-related symptom incidence. But LPR treatment is empirical. We aimed to determine the frequency of LPR, diagnosed by 24-hour Dx-pH monitoring, among acute exacerbations of COPD (AECOPD) patients with Reflux Symptom Index (RSI) ≥13 and investigate proton pump inhibitor (PPI) treatment effect on LPR, COPD symptoms, and pulmonary function. METHODS From January 2016 to September 2017, 102 AECOPD patients with RSI ≥13 were enrolled. COPD assessment test (CAT), mMRC dyspnea scale, pulmonary function tests, and 24-hour Dx-pH monitoring were performed. The Ryan score was evaluated by using the Dx-pH DataView Lite software, which identifies patients with abnormal pharyngeal pH environments. Associations among RSI, pulmonary function test results, and Ryan score parameters were evaluated. The abovementioned assessments were reperformed after treatment, and pre- and posttreatment data were compared. RESULTS Of the 102 eligible patients, 49 (48.04%) were diagnosed with LPR based on Ryan score. Percentage of the forced expiratory volume at 1 second (FEV1%) was significantly worse in Ryan-positive than in Ryan-negative AECOPD patients. There were significant negative correlations between FEV1% and Ryan score (r = -0.394, P < 0.001), FEV1% and % time below pH threshold (r = -0.371, P < 0.001) in upright position but not in supine position. There was no significant correlation between RSI and Ryan score parameters. There were significant improvements in RSI, mMRC, CAT, and FEV1% in Ryan-positive AECOPD patients after PPI and basic treatments. CONCLUSION Study results indicate unreliability of RSI threshold for LPR diagnosis. Combination of symptoms, endoscopic findings, and 24-hour Dx-pH monitoring is recommended for LPR diagnosis and PPI treatment decisions, especially in difficult-to-control or severe COPD patients.
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Affiliation(s)
- Huaying Wang
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Zhongming Fu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Peihong Xu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Xiao Gu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Xiaofei Chen
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Wanjun Yu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
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Zikos TA, Triadafilopoulos G, Kamal A, Podboy A, Sonu IS, Regalia KA, Nandwani MC, Nguyen LA, Fernandez-Becker NQ, Clarke JO. Baseline impedance via manometry and ambulatory reflux testing are not equivalent when utilized in the evaluation of potential extra-esophageal gastroesophageal reflux disease. J Thorac Dis 2020; 12:5628-5638. [PMID: 33209395 PMCID: PMC7656325 DOI: 10.21037/jtd-20-1623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Esophageal baseline impedance (BI) shows promise for the diagnosis of gastroesophageal reflux disease (GERD), but means of acquisition and relevance to extra-esophageal manifestations of GERD (EE-GERD) remain unclear. In this study we aim to (I) evaluate concordance between BI as measured by 24-hour pH-impedance (pH-MII) and high-resolution impedance manometry (HRIM), and (II) assess relationship to potential EE-GERD symptoms. Methods In this prospective open cohort study, patients presenting for outpatient HRIM and pH-MII studies were prospectively enrolled. All patients completed the GERD-HRQL, NOSE, and respiratory symptom index questionnaire (RSI), plus questions regarding wheezing and dental procedures. HRIM and pH-MII were evaluated with calculation of BI. Correlations were assessed using either Pearson’s correlation or Spearman’s rank coefficients. Results 70 HRIM patients were enrolled, 35 of whom underwent pH-MII. There was no correlation between BI measurements as assessed by HRIM and pH-MII proximally, but there was moderate-weak correlation distally (r=0.34 to 0.5). Distal acid exposure time correlated with distal BI only for measurements by pH-MII (rho= −0.5 to −0.65), and not by HRIM. There was no relationship between proximal acid exposure time and proximal BI. There were no correlations when comparing proximal or distal BI measurements, acid exposure times, and impedance events to symptoms. Conclusions Concordance between BI as measured by HRIM and pH-MII is poor, especially proximally, suggesting that these two methods are not interchangeable. There is no correlation between BI both distally/proximally and symptoms of either GERD/EE-GERD, suggesting that many symptoms are unrelated to acid or that BI is not an adequate marker to assess EE-GERD symptoms.
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Affiliation(s)
- Thomas A Zikos
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - George Triadafilopoulos
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Afrin Kamal
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander Podboy
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Irene S Sonu
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kirsten A Regalia
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Monica C Nandwani
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Linda A Nguyen
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nielsen Q Fernandez-Becker
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - John O Clarke
- Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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The application of 24-hour pharyngeal pH-monitoring and Reflux Finding Score and Reflux Symptom Index questionnaires in the diagnostics of laryngopharyngeal reflux. GASTROENTEROLOGY REVIEW 2019; 14:274-282. [PMID: 31988674 PMCID: PMC6983756 DOI: 10.5114/pg.2019.90253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/14/2019] [Indexed: 11/17/2022]
Abstract
Introduction Twenty-four-hour oesophageal pH-monitoring is a gold standard in the diagnostics of gastroesophageal reflux (GERD); however, this examination does not always perform well in patients in whom laryngeal symptoms of reflux are observed. Aim To test the effectiveness of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in confirming the occurrence of laryngopharyngeal reflux (LPR). Material and methods Eighty-two patients with symptoms suggesting the occurrence of LPR were studied. The mean age of the participants amounted to 48.79 ±12.02. The patients were asked to fill in the RSI. The pharynx was assessed using videolaryngostroboscopy and then the RSF was filled in. Next, 24-hour pharyngeal pH-monitoring was performed with the use of a Dx pH – Restech System device. All the statistical analyses were conducted with the use of the R computational environment. Results The authors attempted to determine the reference values of the RSI and RFS questionnaires for the Polish population. For a very general approximation, normality of the distributions of the results in the RSI and RFS questionnaire can be done and an approximation mean + 2 SD can be used as a reference value. Then, for RSI the recommended cut-off limit of LPR would fluctuate, depending on the study, between 8 and 17, whereas for RFS it would be between 8 and 14. Conclusions When used alone, RSI/RFS questionnaires do not allow an unambiguous diagnosis of LPR assessed by 24-hour pharyngeal pH-monitoring.
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Diagnosis of laryngopharyngeal reflux in children with voice disorders using 24-hour pharyngeal pH monitoring. Int J Pediatr Otorhinolaryngol 2019; 121:188-196. [PMID: 30925396 DOI: 10.1016/j.ijporl.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the usefulness of 24-h pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux (LPR) in children with voice disorders. METHODS The study was conducted on 68 children aged 3-18 years old. In all cases, pH monitoring was successful; no child removed the probe from the nasal cavity or reported discomfort or other complaints. The following definitions were adopted: LPR in the upright position if Ryan Score upright >9.41; LPR in the supine position if there was at least one supine episode below pH 5.0 (equal to a Ryan Score supine >2.91). RESULTS In 43 children (63%), vocal fold edema was strongly related to recorded reflux episodes, especially in the upright position. In 18 children (26%), vocal nodules were observed, but their occurrence did not significantly affect the Ryan Score, either upright or supine. The selected potential LPR markers were significantly correlated to all the pH monitoring variables and individual elements on the Reflux Symptoms Index and the Reflux Finding Score questionnaire. CONCLUSION Our findings indicate that, together with vocal fold edema, laryngeal edema and posterior commissure mucosal hypertrophy are important determinants of paediatric LPR. In fact, if LPR is suspected in a child, 24-h pharyngeal pH monitoring appears to be a valuable and welltolerated diagnostic tool. Vocal fold edema observed in laryngeal endoscopy can be considered a probable sign of LPR. The Reflux Finding Score appears to be helpful in diagnosing LPR in children, especially if a cut-off value of 4/5 is adopted.
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Duricek M, Banovcin P, Halickova T, Hyrdel R, Kollarik M. Acidic Pharyngeal Reflux Does Not Correlate with Symptoms and Laryngeal Injury Attributed to Laryngopharyngeal Reflux. Dig Dis Sci 2019; 64:1270-1280. [PMID: 30430298 PMCID: PMC10694844 DOI: 10.1007/s10620-018-5372-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laryngopharyngeal reflux (LPR) is suspected when the symptoms are attributed to the penetration of acidic gastroesophageal reflux (GER) into the larynx. However, the relationships between the intensity of LPR and symptoms and laryngeal injury have not been elucidated. Several factors confound the study of LPR, namely pH is monitored in the pharynx (pharyngeal reflux) but the pharyngeal acidity (pH) required to induce laryngeal injury is unknown, the GER origin of pharyngeal acid is not always established, and a recent treatment with proton pump inhibitors (PPI) confounds the analysis. AIMS We aimed to limit these confounding factors to analyze the relationship between LPR and symptoms and laryngeal injury. METHODS We used dual pharyngeal and distal esophageal 24-h pH/impedance monitoring to establish GER origin of pharyngeal reflux, we used an unbiased approach to analysis by evaluating a whole range of acidity (pH < 6, pH < 5.5, pH < 5.0, pH < 4.5 and pH < 4.0) in patients with suspected LPR without PPI for > 30 days. RESULTS Pharyngeal reflux was (median[IQR]) 14[8-20.5] and 4[1.5-6.5] pharyngeal reflux episodes with pH < 6.0 and pH < 5.5, respectively. Pharyngeal reflux with pH < 5.0 was rare. Comprehensive analysis did not reveal any correlation between symptoms (reflux symptom index) or laryngeal injury (reflux finding score) and the number of pharyngeal reflux episodes or duration of pharyngeal acid exposure at any pH level. CONCLUSION Unbiased comprehensive approach did not reveal any relationship between acidic pharyngeal reflux and the symptoms or laryngeal injury attributed to LPR. Limited clinical usefulness of pharyngeal monitoring reported by others is unlikely due to confounding factors.
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Affiliation(s)
- Martin Duricek
- Gastroenterology Clinic JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovakia
| | - Peter Banovcin
- Gastroenterology Clinic JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovakia.
| | - Tatiana Halickova
- Clinic of ENT and Head and Neck Surgery, Central Military and Faculty Hospital in Ružomberok, Považská 1380/2, 034 01, Ružomberok, Slovakia
| | - Rudolf Hyrdel
- Gastroenterology Clinic JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovakia
| | - Marian Kollarik
- Department of Pathophysiology JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Ružomberok, Slovakia
- Department of Molecular Pharmacology & Physiology, University of South Florida, Tampa, FL, USA
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Affiliation(s)
- Steven R DeMeester
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic and The Foundation for Surgical Innovation and Education, 4805 NE Glisan Street, Suite 6N60, Portland, OR, 97213, USA.
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Agrawal N, Yadlapati R, Shabeeb N, Price CP, Lidder A, Shintani-Smith S, Bové M, Pandolfino J, Tan B. Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux. Dis Esophagus 2019; 32:5067901. [PMID: 30101358 DOI: 10.1093/dote/doy072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/23/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Laryngopharyngeal reflux (LPR) is a clinical entity diagnosed by history laryngoscopic findings that has a variable response to empiric proton-pump inhibitor (PPI) therapy. While the reflux finding score (RFS), an endoscopic scoring scheme, has been advanced as a measure of LPR, it has not been externally validated against symptom severity in practice. Extralaryngeal pharyngeal endoscopic findings may have diagnostic utility but remain underexplored. This study assesses the correlation between extralaryngeal findings and (1) 24-hour oropharyngeal pH & (2) PPI response in patients with suspected LPR. Subjects presented to a tertiary care center with laryngeal symptoms ≥1 month and reflux symptom index (RSI) ≥13. Following baseline questionnaires, laryngoscopy, and a 24-hour oropharyngeal pH probe study, subjects were prescribed 8-12 week omeprazole trials. Baseline endoscopic findings were scored in a blinded fashion using the RFS and extralaryngeal score criteria, summatively the 'ELS.' PPI response was defined as ≥50% improvement in RSI. Thirty-three subjects with flexible endoscopic recordings completed baseline and follow-up questionnaires. The cohort's baseline mean RSI was 23.0 ± 7.2 with a ΔRSI = 9.8 after PPI therapy. The baseline RFS score averaged 5.3 ± 2.7. 45% of our subjects was found to be PPI responsive. The Cohen's kappa for the ELS but not the RFS was significant. There were no significant differences between the RFS (P = 0.10) or ELS (P = 0.07) for PPI responders & nonresponders. Oropharyngeal pH measures did not correlate with the RFS or ELS. In conclusion, endoscopic scores of laryngeal and extralaryngeal findings did not predict PPI response or oropharyngeal acid exposure in suspected LPR.
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Affiliation(s)
- N Agrawal
- Department of Otolaryngology - Head and Neck Surgery
| | - R Yadlapati
- Division of Medicine - Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - N Shabeeb
- Indiana University School of Medicine, Indianapolis, Indiana
| | - C Pe Price
- Department of Otolaryngology - Head and Neck Surgery
| | - A Lidder
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - M Bové
- Department of Otolaryngology - Head and Neck Surgery
| | - J Pandolfino
- Division of Medicine - Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Tan
- Department of Otolaryngology - Head and Neck Surgery
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Wang G, Qu C, Wang L, Liu H, Han H, Xu B, Zhou Y, Li B, Zhang Y, Sun Z, Gong J, Li L, Wu W. Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease. Acta Otolaryngol 2019; 139:299-303. [PMID: 31056040 DOI: 10.1080/00016489.2019.1571280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND pH monitoring can reflect the changes in H+ in the airway. OBJECTIVES To explore the utility of pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease (LPRD). MATERIAL AND METHODS Clinical data from 956 suspected LPRD patients from February 2016 to March 2018 were analyzed retrospectively. RESULTS One hundred forty-one patients had positive Ryan score. The positive rates of reflux symptom index (RSI), reflux finding score (RFS), RSI and RFS and RSI or RFS were 14.7%, 32.5%, 21.9%, 7.8% and 46.5%, respectively. The RFS in the positive Ryan score group was higher than that in the negative Ryan score group [(6 ± 3.5) vs. (4.8 ± 2.9)], while the RSI was not significantly different from that in the negative Ryan score group [(10.9 ± 8) vs. (11.3 ± 7.1)]. Regarding Ryan score as the gold standard in the diagnosis of LPRD, the sensitivity, specificity, positive and negative predictive value of identifying LPRD by RSI/RFS were 15.9%, 86.3%, 50.4% and 54%, respectively. CONCLUSIONS Ryan score, RSI and RFS have poor correlation in detecting LPRD. Some patients may be missed with the Ryan score as a diagnostic criterion. SIGNIFICANCE Pharyngeal pH monitoring is useful and more appropriate index is expected.
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Affiliation(s)
- Gang Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Changmin Qu
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Lei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Hongdan Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Haolun Han
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Bingxin Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Ying Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Baowei Li
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Yiyan Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Zhezhe Sun
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Jing Gong
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Lianyong Li
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Wei Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
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Barona-Lleo L, Barona-De Guzman R, Krstulovic C. The Diagnostic Usefullness of the Salivary Pepsin Test in Symptomatic Laryngopharyngeal Reflux. J Voice 2018; 33:923-928. [PMID: 30314932 DOI: 10.1016/j.jvoice.2018.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue alterations in the aero-digestive upper tract as a consequence of the gastric contents retrograde movement. In most cases diagnosis is clinical and it is established by the presence of symptoms and endoscopic laryngeal signs. The aim of the study was to determine the sensitivity, specificity, positive and negative Likelihood Ratio (LR) of the salivary pepsin assay (PEP-test, RD Biomed, Hull, UK) as diagnostic tool of LPR. STUDY DESIGN Diagnostic Accuracy Study. METHOD 221 subjects aged between 26 and 68 years were recruited. All subjects completed the Reflux Symptom Index scale. PEP-test was carried out on fasting subjects, and a second test was performed one hour after the main meal, only on those subjects with a fasting negative result. RESULTS Fasting PEP-test showed a 98% specificity, 40% sensitivity, positive LR of 16.4 and negative LR of 0.61. The use of both PEP-test showed a 95% specificity, 48% sensitivity, positive LR of 9.61 and negative LR of 0.55. CONCLUSIONS The PEP-test is a simple, inexpensive, non-invasive and easily reproducible test that should be considered as an alternative diagnosis tool for LPR diagnosis. When there is a clinical suspicion of LPR disease, a positive result on the test could be considered diagnostic, but on subjects with negative results it should be complemented with more complex tests such as the 24-hour dual-channel pH-metry.
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Affiliation(s)
- Luz Barona-Lleo
- Barona and Associates Otolaryngology Clinic, Casa de Salud Hospital, Valencia, Spain.
| | | | - Claudio Krstulovic
- Barona and Associates Otolaryngology Clinic, Casa de Salud Hospital, Valencia, Spain
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Lim KG, Morgenthaler TI, Katzka DA. Sleep and Nocturnal Gastroesophageal Reflux: An Update. Chest 2018; 154:963-971. [PMID: 29859888 DOI: 10.1016/j.chest.2018.05.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 05/09/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023] Open
Abstract
Nocturnal gastroesophageal reflux has been associated with poor sleep quality. Normal physiological adaptations of the aerodigestive system to sleep prolong and intensify nocturnal reflux events. This occurrence leads to sleep disruption, as well as to esophageal, laryngeal, and laryngopharyngeal reflux. Controversy exists on whether OSA and nocturnal reflux are causally linked or merely associated because of shared risk factors. Advances in diagnostic technology have provided new insights into gastroesophageal reflux and the mechanisms of nocturnal reflux during sleep. This update reviews new data on causal links between sleep and gastroesophageal reflux disease.
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Affiliation(s)
- Kaiser G Lim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Division of Allergic Diseases, Mayo Clinic, Rochester, MN.
| | | | - David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Salivary Pepsin Test: Useful and Simple Tool for the Laryngopharyngeal Reflux Diagnosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zalvan CH, Hu S, Greenberg B, Geliebter J. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg 2017; 143:1023-1029. [PMID: 28880991 DOI: 10.1001/jamaoto.2017.1454] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Laryngopharyngeal reflux (LPR) is a common disorder with protean manifestations in the head and neck. In this retrospective study, we report the efficacy of a wholly dietary approach using alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions compared with that of the traditional treatment approach of proton pump inhibition (PPI) and standard reflux precautions. Objective To determine whether treatment with a diet-based approach with standard reflux precautions alone can improve symptoms of LPR compared with treatment with PPI and standard reflux precautions. Design, Setting, and Participants This was a retrospective medical chart review of 2 treatment cohorts. From 2010 to 2012, 85 patients with LPR that were treated with PPI and standard reflux precautions (PS) were identified. From 2013 to 2015, 99 patients treated with alkaline water (pH >8.0), 90% plant-based, Mediterranean-style diet, and standard reflux precautions (AMS) were identified. The outcome was based on change in Reflux Symptom Index (RSI). Main Outcomes and Measures Recorded change in the RSI after 6 weeks of treatment. Results Of the 184 patients identified in the PS and AMS cohorts, the median age of participants in each cohort was 60 years (95% CI, 18-82) and 57 years (95% CI, 18-93), respectively (47 [56.3%] and 61 [61.7%] were women, respectively). The percentage of patients achieving a clinically meaningful (≥6 points) reduction in RSI was 54.1% in PS-treated patients and 62.6% in AMS-treated patients (difference between the groups, 8.05; 95% CI, -5.74 to 22.76). The mean reduction in RSI was 27.2% for the PS group and 39.8% in the AMS group (difference, 12.10; 95% CI, 1.53 to 22.68). Conclusions and Relevance Our data suggest that the effect of PPI on the RSI based on proportion reaching a 6-point reduction in RSI is not significantly better than that of alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions, although the difference in the 2 treatments could be clinically meaningful in favor of the dietary approach. The percent reduction in RSI was significantly greater with the dietary approach. Because the relationship between percent change and response to treatment has not been studied, the clinical significance of this difference requires further study. Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR. This approach may effectively improve symptoms and could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet.
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Affiliation(s)
- Craig H Zalvan
- Department of Otolaryngology, New York Medical College, Valhalla
| | - Shirley Hu
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Barbara Greenberg
- Department of Epidemiology and Community Health, New York Medical College, Valhalla
| | - Jan Geliebter
- Department of Otolaryngology, New York Medical College, Valhalla.,Department of Microbiology and Immunology, New York Medical College, Valhalla
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Salivary Pepsin Test: Useful and simple tool for the laryngopharyngeal reflux diagnosis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:80-85. [PMID: 28522132 DOI: 10.1016/j.otorri.2017.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/09/2017] [Accepted: 03/19/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue damage caused by retrograde flow of gastric contents to the upper aerodigestive tract. It represents up to 10% of otolaryngology consultations. The aim of the study is to describe the findings obtained by applying the salivary pepsin test (PEP-test) in a sample of patients with the clinical suspicion of LPR. MATERIAL AND METHODS Our descriptive clinical study included 142 subjects with symptoms suggestive of LPR and a score above 13 on the RSI scale. The subjects underwent laryngeal endoscopy to rule out other pathologies that could justify the symptoms and the salivary pepsin test (PEP-test). The latter was carried out on fasting subjects and a second test one hour after eating, only on those with negative results. RESULTS The results obtained in the tests performed on the 142 patients included in the study were: 105 (73.94%) presented positive results in some of the salivary pepsin tests and the results of both tests were negative in 37 subjects (26.06%). CONCLUSION The salivary pepsin test is a simple, low-cost, non-invasive and easily repeatable tool which could minimize empirical treatments and invasive tests for LPR diagnosis, although further research is needed for its validation.
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Jiang N, Sung CK, Damrose EJ. Improvement in the Reflux Symptom Index Following Surgery for Cricopharyngeal Dysfunction. J Voice 2017; 31:86-89. [DOI: 10.1016/j.jvoice.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/08/2016] [Indexed: 11/16/2022]
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Emre Dinc M, Dalgic A, Avincsal MO, Ulusoy S, Celik A, Develioglu ON. An assessment of olfactory function in patients with laryngopharyngeal reflux disease. Acta Otolaryngol 2017; 137:71-77. [PMID: 27472044 DOI: 10.1080/00016489.2016.1211318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSIONS The results reported here indicate that there was a statistically significant difference in the olfactory functions of laryngopharyngeal reflux patients vs the healthy group. To the best of the authors' knowledge, this study is the first to evaluate the olfactory function of patients diagnosed with laryngopharyngeal reflux using an objective method, 24-h pH monitoring. OBJECTIVES/HYPOTHESIS The aim of this study was to investigate olfactory functions in laryngopharyngeal reflux (LPR) patients and compare the results with healthy controls. METHODS A total of 60 participants; 30 men and women with a diagnosis of laryngopharyngeal reflux and 30 healthy controls, were included in the study. Patients in the laryngopharyngeal reflux group were evaluated by the Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and finally 24-h pH monitoring to confirm the diagnosis of laryngopharyngeal reflux. The Sniffin' Sticks olfactory test results of the laryngopharyngeal reflux and control groups were compared, and the relationship between the study findings and the olfactory parameters were evaluated. RESULTS The odor threshold, odor discrimination, odor identification, and TDI scores of the laryngopharyngeal reflux group were significantly lower than those of the control group. Also there was a statistically significant negative correlation detected between the olfactory test and some symptom and finding scores.
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Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms. Am J Gastroenterol 2016; 111:1517-1524. [PMID: 27091320 PMCID: PMC5071144 DOI: 10.1038/ajg.2016.145] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES 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 January 2013 and October 2014. Adult patients with Reflux Symptom Index scores (RSI) ≥13 off PPI therapy were recruited. Patients underwent video laryngoscopy and 24-h oropharyngeal pH monitoring, followed by an 8- to 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 the 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 the pre-treatment RSI score. A secondary analysis assessed the relationship between the 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 a greater total percent time below pH of 5.0 (P=0.03), upright percent time below pH of 5.0 (P=0.07), 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). CONCLUSIONS 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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Patel DA, Harb AH, Vaezi MF. Oropharyngeal Reflux Monitoring and Atypical Gastroesophageal Reflux Disease. Curr Gastroenterol Rep 2016; 18:12. [PMID: 26908280 DOI: 10.1007/s11894-016-0486-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of gastroesophageal reflux disease (GERD) has been increasing since the 1990 s, with up to 27.8 % of people in North America affected by this disorder. The healthcare burden of patients who primarily have extra-esophageal manifestations of GERD (atypical GERD) is estimated to be 5 times that of patients with primarily heartburn and regurgitation due to lack of a gold standard diagnostic test, poor responsiveness to PPI therapy, and delay in recognition. Empiric twice daily PPI therapy for 1-2 months is currently considered the best diagnostic test, but due to poor responsiveness to PPIs in patients with atypical GERD in multiple randomized controlled trials, newer modes of diagnostic procedures such as oropharyngeal pH monitoring have gained significantly more traction. The utility of oropharyngeal pH monitoring systems such as Restech Dx-pH is currently limited due to lack of consensus on normal and abnormal cutoff values. Recent studies suggest its utility as a prognostic tool and its ability to predict responsiveness to medical and surgical therapy. However, routine use of oropharyngeal pH monitoring is still not widespread due to the lack of well-controlled prospective studies.
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Affiliation(s)
- Dhyanesh A Patel
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ali H Harb
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
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Halitosis associated volatile sulphur compound levels in patients with laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2016; 273:1515-20. [DOI: 10.1007/s00405-016-3961-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/01/2016] [Indexed: 01/06/2023]
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Mesallam TA, Malki KH, Farahat M, Bukhari M, Alharethy S. Voice problems among laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. Folia Phoniatr Logop 2014; 65:280-7. [PMID: 24861352 DOI: 10.1159/000362835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of consensus regarding the clinical presentation and diagnosis of laryngopharyngeal reflux (LPR). The aim of this study was to explore voice-related abnormalities in a group of LPR patients, diagnosed with a 24-hour oropharyngeal pH monitoring. PATIENTS AND METHODS Eighty-two patients with voice-related problems participated in the study. Diagnosis of LPR was made using a 24-hour oropharyngeal pH monitoring. Patients were divided accordingly into positive and negative pH groups. Comparisons between the two groups were done, including results of clinical presentation, Voice Handicap Index-10 (VHI-10), reflux symptom index (RSI), reflux finding score (RFS), and acoustic measurements. The correlation was conducted between Ryan scores and other variables including VHI-10, RSI, and RFS. RESULTS Significant differences were found between the two groups for RSI and VHI-10. No significant differences were found between the two groups regarding clinical presentation, RFS or acoustic measures. Significant positive correlations were found between the Ryan composite measurements and both severity ratings (VHI-10, RSI). CONCLUSION LPR clinical presentation appears to be non-specific in terms of symptoms and laryngeal findings. LPR appears to have an effect on the patients' self-perception of voice problems. Further studies are needed to clarify the effect of LPR on acoustic measurements.
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Affiliation(s)
- Tamer A Mesallam
- Department of Otolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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Wan Y, Yan Y, Ma F, Wang L, Lu P, Maytag A, Jiang JJ. LPR: how different diagnostic tools shape the outcomes of treatment. J Voice 2014; 28:362-8. [PMID: 24491501 DOI: 10.1016/j.jvoice.2013.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/06/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To seek a deeper and more comprehensive understanding of two major diagnostic methods for laryngopharyngeal reflux by exploring whether and how differences exist before and after treatment between patients diagnosed by either Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) or 24-hour pH monitoring. MATERIALS AND METHODS Two groups of patients who confirmed laryngopharyngeal reflux disease (LPRD) by either a combination of RSI and RFS (Questionnaire group, 35 patients) or 24-hour multichannel intraluminal impedance (MII) pH monitoring (pH Group, 23 patients) were recruited. All patients were prescribed esomeprazole 20 mg twice a day for 1 month. RSI, RFS, and acoustic parameters before and after treatment were compared between the two groups. Intrinsic correlations involving multiple parameters were investigated as well. RESULTS Except for excess throat mucus (P = 0.019) and subglottic edema (P = 0.042), most RSI and RFS items before treatment were not significantly different between the Questionnaire and pH Groups, and nearly all such items in both groups exhibited distinct remission after therapy (P < 0.05). Absolute value of remission in RSI after treatment was more prominent in pH Group than in the Questionnaire group (P = 0.007). Jitter (P = 0.252), shimmer (P = 0.815), and harmonics-to-noise ratio (P = 0.117) descended to normal value after treatment. Moderate to high levels of correlation were found between the patient's original status and the absolute value of remission in most items of RSI and RFS as well as voice parameters. CONCLUSION The 24-hour MII pH monitoring and a combination of RSI and RFS are quite competitive with each other in selecting LPRD patients. Although treatment worked out on nearly all the symptoms, laryngeal images and voice parameters, 24-hour MII pH seems to be more promising in a greater symptom relief. The extent of relief that can take place in most of the measurements is considerably determined by their initial status.
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Affiliation(s)
- Yichen Wan
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China; Department of Otolaryngology- Head and Neck Surgery, Peking University, International Hospital, Beijing, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Furong Ma
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China.
| | - Li Wang
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Peiquan Lu
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Allison Maytag
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Rafii B, Taliercio S, Achlatis S, Ruiz R, Amin MR, Branski RC. Incidence of underlying laryngeal pathology in patients initially diagnosed with laryngopharyngeal reflux. Laryngoscope 2013; 124:1420-4. [DOI: 10.1002/lary.24483] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 09/03/2013] [Accepted: 10/18/2013] [Indexed: 01/17/2023]
Affiliation(s)
- Benjamin Rafii
- New York University Voice Center; Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Salvatore Taliercio
- New York University Voice Center; Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Stratos Achlatis
- New York University Voice Center; Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Ryan Ruiz
- New York University Voice Center; Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Milan R. Amin
- New York University Voice Center; Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Ryan C. Branski
- New York University Voice Center; Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
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Evaluating the Incidence, Clinical Significance and Predictors for Vocal Cord Palsy and Incidental Laryngopharyngeal Conditions before Elective Thyroidectomy: Is There a Case for Routine Laryngoscopic Examination? World J Surg 2013; 38:385-91. [DOI: 10.1007/s00268-013-2259-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gómez-Puerta JA, Cisternas A, Hernández MV, Ruiz-Esquide V, Vilaseca I, Sanmartí R. Laryngeal assessment by videolaryngostroboscopy in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 10:32-6. [PMID: 23830735 DOI: 10.1016/j.reuma.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/27/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the larynx involvement in patients with rheumatoid arthritis (RA) in a clinical setting and correlate with the different clinical features related to more aggressive disease. METHODS Cross-sectional study including 36 consecutive patients with RA. Reflux symptoms were evaluated by the Reflux Symptom Index (RSI) and vocal cord impairment by the Voice Handicap Index-10 (VHI-10). Laryngeal involvement was done by videolaryngostroboscopy (VLS). RESULTS The mean age was 56,3 ± 14 years with a mean disease duration of 2,6 ± 3,1 years (range 0-16 years). Voice use was considered as professional users in 33%. Twenty-four (67%) out of 36 patients had abnormal findings of VLS. One patient had larynx nodules (bamboo nodules). Eleven patients (31%) were diagnosed with muscle tension dysphonia, and there were symptoms and signs of pharyngeal-laryngeal reflux in 23 (64%) patients. No signs of cricoarytenoid joint impairment was found. CONCLUSIONS Organic larynx involvement was uncommon in patients with RA. However symptoms and signs of pharyngeal-laryngeal reflux were seen in around 60% of patients. There was no correlation between the clinical phenotype, severity of disease, immunological profile or treatment with VLS findings.
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Affiliation(s)
- José A Gómez-Puerta
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España; División de Reumatología, Brigham and Women's Hospital, Boston, EE. UU..
| | - Ariel Cisternas
- Servicio de Otorrinolaringología, Hospital San Juan de Dios, Santiago, Chile; Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, España
| | - M Victoria Hernández
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Virginia Ruiz-Esquide
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Isabel Vilaseca
- Servicio de Otorrinolaringología, Hospital San Juan de Dios, Santiago, Chile
| | - Raimon Sanmartí
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
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Vailati C, Mazzoleni G, Bondi S, Bussi M, Testoni PA, Passaretti S. Oropharyngeal pH monitoring for laryngopharyngeal reflux: is it a reliable test before therapy? J Voice 2012; 27:84-9. [PMID: 23159026 DOI: 10.1016/j.jvoice.2012.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/09/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Current methods of measuring pharyngeal pH are problematic. The aim of the study was to assess the ability of the oropharyngeal pH monitoring (Restech) in predicting the response to proton pump inhibitor (PPI) therapy in patients with gastroesophageal reflux disease-related laryngopharyngeal symptoms. STUDY DESIGN The study design is prospective and uncontrolled. METHODS Twenty-two consecutive naive patients with chronic laryngeal symptoms were enrolled. Reflux symptom index, fibrolaryngoscopy, and 24-hour oropharyngeal pH monitoring were performed. Both patients and laryngoscopist were blinded by the results of Restech. All the patients were given a 3-month therapy with pantoprazole of 40mg twice a day and then repeated both the reflux symptom index and fibrolaryngoscopic evaluation. Patients were considered as responders if a five-point decrease in symptom score was recorded. RESULTS Thirteen of the 22 patients (59.1%) responded to therapy. Laryngoscopic findings did not correlate with the clinical improvement after the 3 months of PPI. Nine patients (40.9%) had a pathologic Restech study, and all resulted responsive to PPI; nine patients (40.9%) with a negative Restech were nonresponsive to PPI, and four patients (18.2%) despite a negative Restech resulted responsive to therapy. Responsive patients showed both a higher oropharyngeal acid exposure in orthostatic position and a higher Ryan score, compared with nonresponders (49.74±58.11 vs 2.12±0.0, P=0.002). Considering responsiveness to medical therapy as the gold standard of laryngopharyngeal reflux (LPR) for the diagnosis of LPR, Restech showed a sensitivity of 69% and a specificity of 100%. CONCLUSIONS The high specificity and reasonable sensitivity of this technique make the Restech an interesting tool before therapy of patients with pharyngoesophageal reflux.
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Affiliation(s)
- Cristian Vailati
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
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