708 A NEW DIAGNOSTIC PARADIGM FOR LARYNGOPHARYNGEAL REFLUX DISEASE: CORRELATION OF IMPEDANCE-PH MONITORING AND DIGITAL REFLUX SCINTIGRAPHY RESULTS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jin-soo Park ◽  
Oleksandr Khoma ◽  
Hans Van Der Wall ◽  
Gregory Falk
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
High Rate ◽  
High Yield ◽  
Time Activity ◽  
Proximal Esophagus ◽  
Laryngopharyngeal Reflux Disease ◽  
High Level ◽  
No Gold Standard

Abstract   No gold-standard investigation exists for laryngopharyngeal reflux (LPR). Multichannel intraluminal impedance (MII)-pH testing has uncertain utility in LPR. Meanwhile, reflux scintigraphy allows immediate and delayed visualisation of tracer reflux in the esophagus, pharynx, and lungs. The present study aimed to correlate MII-pH and scintigraphic reflux results in patients with primary LPR. Methods Consecutive patients with LPR underwent MII-pH and scintigraphic reflux studies. Abnormal values for MII-pH results were defined from existing literature. MII-pH and scintigraphic data were correlated. Results 105 patients with LPR (31 males (29.5%), median age 60 years (range: 20–87)) were studied. Scintigraphic reflux was seen in the pharynx in 94 (90.4%), and in the proximal esophagus in 94 (90.4%). Delayed scintigraphic contamination of the pharynx was seen in 101 patients (96.2%) and in the lungs of 56 patients (53.3%). Abnormal reflux was seen in the distal esophagus in 12.4%, proximal esophagus in 25.7%, and in the pharynx in 82.9%. Patients with poor scintigraphic clearance had higher Demeester scores (p = 0.043), more proximal reflux episodes (p = 0.046), more distal acid reflux episodes (p = 0.023), and longer bolus clearance times (p = 0.002). Conclusion Reflux scintigraphy has a high yield in LPR patients. Scintigraphic time-activity curves correlated with validated MII-pH results. A high rate of pulmonary microaspiration was found in LPR patients. This study demonstrated a high level of pharyngeal contamination by scintigraphy and MII-pH, which supports the use of digital reflux scintigraphy in diagnosing LPR.

M1525 Acid Reflux to the Proximal Esophagus Predicts Postoperative Success in Patients with Laryngopharyngeal Reflux Disease

2008 ◽  
Vol 134 (4) ◽  
pp. A-866
Author(s):  
Carlos Godinez ◽  
Stephen M. Kavic ◽  
George T. Fantry ◽  
Paul F. Castellanos ◽  
J. Scott Roth ◽  
...  
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Acid Reflux ◽  
Proximal Esophagus ◽  
Laryngopharyngeal Reflux Disease

Patterns of laryngopharyngeal and gastroesophageal reflux

2009 ◽  
Vol 123 (S31) ◽  
pp. 42-47 ◽  
Author(s):  
K Sato ◽  
H Umeno ◽  
S Chitose ◽  
T Nakashima
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Gold Standard ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Lower Oesophageal Sphincter ◽  
Percentage Time ◽  
Laryngopharyngeal Reflux Disease ◽  
Time Periods ◽  
Ph Level

AbstractObjectives:Double-probe, 24-hour pH monitoring remains the ‘gold standard’ for the diagnosis of laryngopharyngeal reflux disease, even though there is no consensus on how to interpret the data collected.Methods:Tetra-probe, 24-hour pH monitoring was performed in 56 patients with suspected laryngopharyngeal reflux, in order to investigate patterns of laryngopharyngeal and gastroesophageal reflux.Results:The number of reflux episodes and the total and percentage time periods spent with pH < 4.0 were correlated with the distance of the probe from the lower oesophageal sphincter. The number of reflux episodes and the total and percentage time periods with pH < 4.0 were greater when patients were upright (i.e. during the daytime). There were few laryngopharyngeal reflux events recorded for pH levels of <4.0; however, there were a significant number of laryngopharyngeal reflux events recorded for pH levels of <5.0, a level capable of causing laryngopharyngeal reflux disease. When a pH level of <5.0 was used, the number, total time and percentage time of laryngopharyngeal reflux episodes was greater during the supine period (i.e. during sleeping) in a quarter of the cases, compared with results when a pH of <4.0 was used.Conclusions:It is valid to use a pH level of 5.0 as indicative of laryngopharyngeal reflux in the hypopharynx.

scholarly journals A Comparison between W score and Ryan score in diagnosing of Laryngopharyngeal reflux disease

2021 ◽  
Author(s):  
Gang Wang ◽  
Lei Wang ◽  
Zhezhe Sun ◽  
Yuzhu Guo ◽  
Hongdan Liu ◽  
...  
Keyword(s):  
Reflux Disease ◽  
Predictive Value ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Normal Population ◽  
Neck Surgery ◽  
Diagnostic Value ◽  
Diagnostic Sensitivity ◽  
Clinical Trial Registry ◽  
Laryngopharyngeal Reflux Disease

Abstract ObjectiveTo assess the diagnostic value of W score which was supposed to identify laryngopharyngeal reflux disease (LPRD) patients from the normal population by Dx-pH monitoring, comparing with Ryan score.MethodsOne 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 besides Ryan score and then the diagnostic sensitivity and specificity were compared according to the result of anti-reflux therapy.ResultsEighty-seven (80.6%) cases were anti-reflux therapy effective, and 21 patients (19.4%) were 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 were 83.9%, 71.4%, 92.4% and 51.7%, respectively (kappa = 0.484, p < 0.001).ConclusionsW score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve the new diagnostic criteria.Trial RegistrationChinese Clinical Trial Registry: ChiCTR1800014931.

720 CONVENTIONAL AND SIMPLE METHODS OF MEASURING MEAN NOCTURNAL BASELINE IMPEDANCE SHOW EXCELLENT AGREEMENT

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jin-soo Park ◽  
Hans Van der Wall ◽  
Gregory Falk
Keyword(s):  
Excellent Agreement ◽  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Measurement Methods ◽  
Distal Esophagus ◽  
Simple Method ◽  
Proximal Esophagus ◽  
Predominant Symptom ◽  
Symptom Profile

Abstract   Mean nocturnal baseline impedance (MNBI) is a measurement that shows promise in investigating reflux disease by reflecting esophageal mucosal integrity. The conventional method of measuring MNBI is time-consuming and operator-dependent. A new, simple method of measuring MNBI has been suggested. This study aimed to report MNBI measurements by both conventional and simple methods in a cohort of laryngopharyngeal reflux (LPR) and gastro-esophageal reflux disease (GERD) patients to validate the simple measurement method. Methods 187 patients were divided into LPR (n = 105) or GERD (n = 82) groups by predominant symptom profile, and underwent off-therapy impedance-pH monitoring. MNBI was blindly measured by both conventional and simple methods, and values were correlated. Bland–Altman plots were constructed to assess mean differences and to identify bias between the two measurement methods. Results For the two measurement methods, mean difference in the distal esophagus was −89 (±328) ohms, in the proximal esophagus was −6 (±653) ohms, and in the pharynx was 128 (±577) ohms. There was strong correlation between conventional and simple MNBI values, with r = 0.940 in the distal esophagus, r = 0.463 in the proximal esophagus, and r = 0.712 in the pharynx (all p &lt; 0.001). Conclusion There was excellent agreement between conventional and simple methods of measuring MNBI, with no evidence of proportional bias. Conventional and simple MNBI values correlated excellently in the distal esophagus, and moderately well in the proximal esophagus and pharynx. This study supports the use of the simple method of measuring MNBI to enhance diagnosis of reflux disease.

scholarly journals Pendekatan Diagnostik Refluks Laring Faring

e-CliniC ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 457
Author(s):  
Karin I. Rompas ◽  
Steward K. Mengko ◽  
Ora Et Labora I. Palandeng
Keyword(s):  
Literature Review ◽  
Symptom Score ◽  
Reflux Disease ◽  
Fiber Optic ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Lifestyle Changes ◽  
Reflux Symptom ◽  
Laryngopharyngeal Reflux Disease ◽  
And Behavior

Abstract: Lifestyle and behavior changes can have bad impacts on our health. One of the diseases that can be caused by lifestyle changes is pharyngeal larynx reflux. Pharyngeal laryngeal reflux is a state of return of the contents of the stomach to the larynx and pharynx causing an inflammatory reaction to the mucous membranes of the larynx and pharynx. In an attempt to diagnose pharyngeal larynx reflux, a follow-up examination is required. In this case there are several examinations that can be done to confirm the diagnosis of pharyngeal larynx reflux. This study was aimed to obtain the diagnostic approaches in laringopharyngeal reflux cases. This was a literature review study using two databases namely PubMed and ClinicalKey. The keywords used were laringophaingeal reflux and laryngopharyngeal reflux disease. After being selected based on inclusion and exclusion criteria, nine literatures using experimental research methods. were obtained. The results showed that several examinations that could be performed in diagnosing laringofaringeal reflux, as follows: anamnesis, physical examination, pH-monitoring, reflux findings score, reflux symptom score, PEP-test, reflux sign assessment, reflux symptom score, immunohistochemistry, and fiber-optic laryngoscopy. In conclusion, supporting examinations are needed to confirm the diagnosis of pharyngeal larynx reflux.Keywords: refluks laring faring; laryngopharyngeal reflux disease. Abstrak: Perubahan gaya hidup dan perilaku dapat berdampak pada kesehatan tubuh. Salah satu penyakit yang dapat diakibatkan oleh perubahan gaya hidup yaitu refluks laring faring. Refluks laring faring merupakan keadaan kembalinya isi lambung ke laring dan faring sehingga menyebabkan reaksi inflamasi pada selaput lendir laring dan faring. Untuk menegakkan diagnosis refluks laring faring dibutuhkan pemeriksaan lanjutan. Penelitian ini bertujuan untuk mengetahui pendekatan diagnosis yang dapat dilakukan dalam pemeriksaan kasus refluks laring faring. Jenis penelitian ialah literature review dengan pencarian data menggunakan dua database yaitu PubMed dan ClinicalKey. Kata kunci yang digunakan yaitu refluks laring faring and laryngopharyngeal reflux disease. Setelah diseleksi berdasarkan kriteria inklusi dan eksklusi, didapatkan sembilan literatur yang menggunakan metode penelitian eksperimental. Hasil peneli-tian mendapatkan pemeriksaan-pemeriksaan yang dilakukan dalam menegakkan diagnosis refluks laring faring ialah: anamnesis, pemeriksaan fisik, pH-monitoring, skor temuan refluks, skor gejala refluks, PEP-test, reflux sign assessment, reflux symptom score, immunohistochemistry, dan fiber-optic laryngoscopy. Simpulan penelitian ini ialah pemeriksaan penunjang perlu dilakukan untuk menegakkan diagnosis refluks laring faring.Kata kunci: refluks laring faring; laryngopharyngeal reflux disease

scholarly journals Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad

2020 ◽  
Author(s):  
Shilpa Divakaran ◽  
Sivaa Rajendran ◽  
Roshan Marie Thomas ◽  
Jaise Jacob ◽  
Mary Kurien
Keyword(s):  
Positive Response ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Tertiary Care ◽  
Acid Reflux ◽  
Response To Treatment ◽  
Care Hospital ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Chi Squared

Abstract Introduction Twenty-four-hour multichannel intraluminal impedance with double probe pH monitoring (MII-pH), though considered the most sensitive tool for the diagnosis of gastroesophageal reflux disease (GERD), is invasive, time consuming, not widely available, and unable to detect non-acid reflux. In contrast, the presence of pepsin in the saliva would act as a marker for reflux, considering that pepsin is only produced in the stomach. Objective To evaluate the predictive value of salivary pepsin in diagnosing laryngopharyngeal reflux (LPR) as suggested by the results of reflux symptom index (RSI > 13), reflux finding score (RFS > 7), and positive response to treatment with a 4-week course of proton-pump inhibitors. Methods This prospective study was done at a tertiary care hospital on 120 adult patients attending ENT OPD with clinical diagnosis of LPR. The presence of pepsin in their pharyngeal secretions and saliva using a lateral flow device, the Peptest, was compared with RSI, RFS, and with the response to medical treatment using the Chi-squared test. Results Salivary pepsin was found to be positive in 68% of the patients, with 87.5% of them showing positive response to treatment. Chi-squared analysis showed a significant association between positive salivary pepsin and RFS > 7, RSI >13, a combination of RFS > 7 and RSI > 13 as well as with response to treatment (p < 0.0001). Conclusion When considered along with the clinical indicators of RFS and RSI of more than 7 and 13, respectively, and/or with a response to treatment, a positive salivary pepsin test indicates statistically significant chance of presence of LPR.

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