Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

2021 ◽  
pp. 019459982110268
Author(s):  
Jiasen Wang ◽  
Jinrang Li ◽  
Qian Nie ◽  
Ran Zhang
Keyword(s):  
Cohort Study ◽  
Prospective Cohort ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
True Positive ◽  
Multiple Tests ◽  
Kappa Value ◽  
Negative Findings ◽  
Tertiary Hospitals ◽  
Positive Results

Objectives To evaluate the necessity of multiple salivary pepsin tests within a day when diagnosing laryngopharyngeal reflux. Study Design Prospective cohort study. Setting Tertiary hospitals. Methods A total of 138 patients with signs and/or symptoms associated with laryngopharyngeal reflux were included. Salivary pepsin was detected on the day of 24-hour pH monitoring, and the results of salivary pepsin detected once in the morning and multiple times in 1 day were compared with the results of pH monitoring. Results Among the 138 patients, pH monitoring results were positive in 112. Salivary pepsin was positive in 47 cases in the morning, which was not consistent with the results of pH monitoring (kappa value = 0.117). With the pH monitoring results as the standard, the salivary pepsin detected once in the morning had a sensitivity of 38.4% (43/112) and a specificity of 84.6% (22/26) for the diagnosis of laryngopharyngeal reflux. When salivary pepsin was detected multiple times per day, 102 patients tested positive. The consistency with pH monitoring was moderate (kappa value = 0.587). The sensitivity was 86.6% (97/112), and the specificity was 80.8% (21/26). Of the 97 patients with positive results from pH monitoring and salivary pepsin detected multiple times a day, 54 had negative findings for a single detection in the morning, indicating that 55.7% (54/97) of the true positive cases were missed. Conclusion Although a single detection of salivary pepsin in the morning is more economical, the sensitivity is too low, and it is necessary to detect it multiple times a day.

scholarly journals Characteristics of 24-h multichannel intraluminal impedance-pH monitoring in patients with laryngopharyngeal reflux refractory to proton pump inhibitor therapy: A prospective cohort study

2020 ◽  
Author(s):  
Su Il Kim ◽  
Su Jin Jeong ◽  
Oh Eun Kwon ◽  
Jung Min Park ◽  
Young Chan Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Proton Pump Inhibitor ◽  
Prospective Cohort Study ◽  
Proton Pump ◽  
Prospective Cohort ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Multichannel Intraluminal Impedance ◽  
Reflux Time ◽  
Intraluminal Impedance

Objectives: This study evaluated the characteristics of reflux in patients with laryngopharyngeal reflux (LPR) refractory to proton pump inhibitor (PPI) therapy using the 24-h multichannel intraluminal impedance (MII)-pH monitoring. Design: Prospective cohort study. Setting: A tertiary care otolaryngology clinic. Participants: Patients with suspected LPR underwent 24-hour MII-pH monitoring and were prescribed high-dose PPI twice daily. One-hundred and eight patients followed up for at least 2 months were enrolled. Main outcome measures: Patients with suspected LPR showing more than one proximal reflux episode were considered to have LPR. Patients with LPR showing ≥50% decrease in the follow-up reflux symptom index (RSI) score compared to the pre-treatment RSI score during treatment periods were defined as responders; others were defined as non-responders. Various parameters in the 24-h MII-pH monitoring between non-responders and responders with LPR were compared using Student’s t-test. Results: Of 108 patients with suspected LPR, 80 were diagnosed with LPR. Patients with LPR were categorized as non-responders (n = 19) and responders (n = 61). Proximal all reflux time and proximal longest reflux time in MII parameters were significantly higher in responders than in non-responders (p = 0.0040 and 0.0216, respectively). The proximal all reflux time >0.000517% was a better cut-off value to predict responders with LPR compared to the proximal longest reflux time >0.61 min (sensitivity + specificity: 1.317 vs. 1.291). Conclusions: The proximal all reflux time can be helpful to predict the response to PPI therapy and establish a personalized therapeutic scheme in patients with LPR.

scholarly journals Deep Venous Thrombosis Recurrence and Its Predictors at Selected Tertiary Hospitals in Ethiopia: A Prospective Cohort Study

2020 ◽  
Vol 26 ◽  
pp. 107602962094107
Author(s):  
Abera Mulatu ◽  
Tsegaye Melaku ◽  
Legese Chelkeba
Keyword(s):  
Pulmonary Embolism ◽  
Cohort Study ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Recurrent Event ◽  
Incidence Density ◽  
Proximal Site ◽  
Tertiary Hospitals

Deep venous thrombosis (DVT) is a common clinical problem associated with substantial morbidity and mortality. Knowledge of the global burden of DVT recurrence is deficient in Africa, including Ethiopia. The objective of the study was to assess deep venous thrombosis recurrence and its predictors at selected tertiary hospitals in Ethiopia. Prospective cohort study was conducted among hospitalized DVT patients. Data were analyzed using SPSS version 21.0. To identify the independent predictors of DVT-recurrence, multiple stepwise-backward Cox-regression analysis was done. Statistical significance was considered at P value < .05. A total of 129 participants were included (65.1% females) with mean ± SD age of 38.63 ± 17.67 years. About 26.4% of patients developed recurrent venous thromboembolism. Pulmonary embolism accounted for 17.60% of recurrent event. The overall incidence density of DVT recurrence was 2.99 per 1000 person-days. The mean ± SD survival time to DVT recurrence was 42.03 ± 22.371 days. Age ≥ 50 years (adjusted hazard ratio [AHR]: 5.566; 95% CI: 1.587-19.518; P = .007), occasional alcohol consumption (AHR: 2.011; 95% CI: 1.307-6.314; P = .019), surgical history (AHR: 6.218; 95% CI: 1.540-25.104; P = .010), pregnancy (AHR: 2.0911; 95% CI: 1.046-4.179; P = .037), diabetes mellitus (AHR: 8.048; 95% CI: 2.494-25.966; P < .001), unmet activated partial thromboplastin time target after 24 hours of heparin (AHR: 1.129; 95% CI: 0.120-10.600; P = .011), proximal site involvement (AHR: 5.937; 95% CI: 1.300-27.110; P = .022), and previous history of DVT (AHR: 2.48; 95% CI: 1.085-11.20; P = .0002) were independent predictors of DVT recurrence. The DVT recurrence rate was high in the study area, which is even complicated with pulmonary embolism as well as death. Efforts are needed to prevent and reduce the development of DVT recurrence.

scholarly journals Cognition in pregnancy and motherhood: prospective cohort study

2010 ◽  
Vol 196 (2) ◽  
pp. 126-132 ◽  
Author(s):  
Helen Christensen ◽  
Liana S. Leach ◽  
Andrew Mackinnon
Keyword(s):  
Cohort Study ◽  
Prospective Cohort ◽  
Late Pregnancy ◽  
Cognitive Change ◽  
Biased Sampling ◽  
Cognitive Deterioration ◽  
Negative Findings ◽  
In Pregnancy

BackgroundResearch has reported that pregnant women and mothers become forgetful. However, in these studies, women are not recruited prior to pregnancy, samples are not representative and studies are underpowered.AimsThe current study sought to determine whether pregnancy and motherhood are associated with brief or long-term cognitive deterioration using a representative sample and measuring cognition during and before the onset of pregnancy and motherhood.MethodWomen aged 20–24 years were recruited prospectively and assessed in 1999, 2003 and 2007. Seventy-six women were pregnant at follow-up assessments, 188 became mothers between study waves and 542 remained nulliparous.ResultsNo significant differences in cognitive change were found as a function of pregnancy or motherhood, although late pregnancy was associated with deterioration on one of four tests of memory and cognition.ConclusionsThe hypothesis that pregnancy and motherhood are associated with persistent cognitive deterioration was not supported. Previous negative findings may be a result of biased sampling.

Maternal Anxiety and the Second-Trimester Prenatal Screening: A Prospective Cohort Study

2015 ◽  
Vol 38 (4) ◽  
pp. 269-275 ◽  
Author(s):  
Sanaz Mousavi ◽  
Sedigheh Hantoushzadeh ◽  
Mahdi Sheikh ◽  
Mamak Shariat
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Trait Anxiety ◽  
Prospective Cohort ◽  
Prenatal Screening ◽  
Maternal Anxiety ◽  
Inhibin A ◽  
Anxiety Levels ◽  
Positive Results ◽  
Prenatal Visits

Objective: Assessing the effects of maternal anxiety on the markers and results of quadruple screening and on maternal anxiety after receiving positive results. Methods: This prospective cohort study evaluated 1,595 pregnant women referred for prenatal visits. Maternal state/trait anxiety levels were measured, then quadruple screening was performed by measuring serum α-fetoprotein (AFP), β-human chorionic gonadotropin, inhibin A, and unconjugated estriol (UE3). After receiving the results, the state/trait anxiety was remeasured. Amniocentesis was performed for screening-positive mothers. Results: High prescreening maternal anxiety was associated with lower rates of elevated AFP (OR, 0.27; 95% CI, 0.1-0.74) and elevated inhibin A (OR, 0.38; 95% CI, 0.15-0.98). High maternal anxiety was associated with higher rates of decreased UE3 (OR, 1.8; 95% CI, 1.06-3.08). There were no significant associations between prescreening maternal anxiety and the final screening or amniocentesis results. Among the screening-positive mothers, those who had high state/trait anxiety before screening had higher anxiety scores after receiving positive results compared to those with low prescreening anxiety levels (52.9 ± 10.8 vs. 43.7 ± 10.3). Conclusion: High prescreening maternal anxiety is associated with lower rates of elevated AFP and inhibin A and higher rates of decreased UE3. However, maternal anxiety does not affect the final screening or amniocentesis result. High maternal state/trait anxiety before screening is associated with significantly higher maternal anxiety after the receipt of positive results.

Treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study

2017 ◽  
Vol 38 (5) ◽  
pp. 603-607 ◽  
Author(s):  
William S. Tierney ◽  
Scott L. Gabbard ◽  
Claudio F. Milstein ◽  
Michael S. Benninger ◽  
Paul C. Bryson
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Laryngopharyngeal Reflux ◽  
Positioning Device ◽  
Sleep Positioning

scholarly journals Evaluation of Oropharyngeal pH-Monitoring in the Assessment of Laryngopharyngeal Reflux

2021 ◽  
Vol 10 (11) ◽  
pp. 2409
Author(s):  
Lukas Horvath ◽  
Patricia Hagmann ◽  
Emanuel Burri ◽  
Marcel Kraft
Keyword(s):  
Cohort Study ◽  
Diagnostic Tests ◽  
Retrospective Cohort ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Transnasal Esophagoscopy ◽  
Sensitivity Specificity

Background: Laryngopharyngeal reflux (LPR) is a prevalent disorder. The aim of the present retrospective cohort study was to evaluate oropharyngeal pH-monitoring using a novel scoring system for LPR. Methods: In a total of 180 consecutive patients with possible LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring and transnasal esophagoscopy were carried out for further investigation. Results: In our series, 99 (55%) patients had severe LPR, 29 (16%) cases presented with moderate and 23 (13%) with mild severity, 9 (5%) subjects revealed neutral values, and 7 (4%) individuals were alkaline, while 13 (7%) patients had no LPR. In detecting LPR, the sensitivity, specificity and accuracy of oropharyngeal pH-monitoring was 95%, 93% and 94%, respectively. Conclusion: Oropharyngeal pH-monitoring is a reliable tool in the assessment of LPR, but the pH graphs have to be precisely analyzed and interpreted in context with other validated diagnostic tests.

Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study

2020 ◽  
Vol 34 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Jérôme R. Lechien ◽  
Camille Finck ◽  
Kathy Huet ◽  
Anne-Françoise Fourneau ◽  
Mohamad Khalife ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Reflux Disease ◽  
Prospective Cohort ◽  
Laryngopharyngeal Reflux ◽  
Voice Quality ◽  
Therapeutic Outcome ◽  
Laryngopharyngeal Reflux Disease
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