Changes in Pharyngeal Baseline Impedance in Patients With Laryngopharyngeal Reflux

Objective Few studies have investigated pharyngeal intraluminal baseline impedance (BI) levels in patients with laryngopharyngeal reflux (LPR). The aim of this study was to compare intraluminal BI levels between patients with LPR and healthy controls. Study Design Retrospective case series. Setting Tertiary care medical center. Subjects and Methods We conducted a retrospective analysis of 24-hour multichannel intraluminal impedance (MII)–pH monitoring results from patients with suspected LPR complaining of reflux symptoms. Patients with suspected LPR were divided into 2 groups according to the 24-hour MII-pH monitoring (LPR group: patients with symptoms with reflux events ≥1, symptom but no reflux [SNR] group: patients with symptoms but no reflux event). Healthy controls were recruited and also underwent 24-hour MII-pH monitoring. We compared the esophageal and pharyngeal BI levels and ratios between 3 groups. Results Pharyngeal BI levels in the LPR group were significantly higher than in the healthy controls. In addition, the pharyngeal BI levels in the SNR group were significantly higher than in the healthy controls. All ratios of pharyngeal to distal esophageal BI levels in the LPR and SNR group were significantly higher than in the healthy controls. However, there were no significant differences in esophageal BI levels and ratios between the 3 groups. Conclusion We found that the pharyngeal BI levels were higher in patients with LPR than in healthy controls. In addition, the pharyngeal BI levels measured by 24-hour MII-pH monitoring in patients with LPR symptoms, but without a reflux episode, were higher than in the healthy controls.

Validation of Peptest™ in Patients with Gastro-Esophageal Reflux Disease and Laryngopharyngeal Reflux Undergoing Impedance Testing

Background and Aims: Pepsin in the gastric refluxate is a marker for a prior reflux event and rapid detection might be achieved using the Peptest™, an in vitro diagnostic medical device. The aim of this study was to validate the use of Peptest™ to reliably diagnose reflux in patients with gastro-esophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) disease diagnosed with multichannel intraluminal impedance/ pHmetry (MII-pH). Methods: 20 reflux patients were recruited of whom 10 had classical GERD and 10 had LPR. All patients underwent MII-pH and provided expectorated saliva samples when a MII-pH reflux event was observed, or reflux symptoms were experienced, and all were tested for the presence of pepsin using the Peptest™. Results: Pepsin was detected in 31 out of 45 samples (68.9%). At least 1 positive pepsin result was seen in 16 patients (80%) and this was the same, irrespective of the GERD or LPR diagnosis. Peptest™ had a positive predictive value of 69% to detect MII-pH reflux events. Conclusions: Peptest™ is a good first-line diagnostic procedure to use in reflux sufferers to confirm the presence of reflux.

Effects of slough clearance rates post adult tonsillectomy in patients with laryngopharyngeal reflux disease

<p class="abstract"><strong>Background:</strong> Laryngopharyngeal reflux is known to be associated with multiple disease of the upper aero digestive tract and can cause serious injury to the mucosa long term.</p><p class="abstract"><strong>Methods:</strong> Patients diagnosed with chronic tonsillitis and indicated for surgery were evaluated for laryngopharyngeal reflux using reflux symptom index score. When score greater than 13 was suggestive of laryngopharyngeal reflux (LPR) and counselled for 24 hours ambulatory dual probe pH monitoring. When the reflux event was 7 or more were diagnosed having LPR. Patients were divided into two groups Group A patients with chronic tonsillitis and without LPR and Group B patients with chronic tonsillitis and LPR. Postoperatively there slough percentage was calculated as 25%, 50%, 75%, 100% on the postoperative day (POD) 7, 14 and 21. Slough clearance rates were calculated as 100- slough percentage. </p><p class="abstract"><strong>Results:</strong> There were 40 patients in Group A and 40 patients in Group B. The slough clearance rates of Group A were 46.3, 73.8 and 96.9 on post-operative days 7, 14, 21 respectively. The slough clearance rates of Group B were 30.1, 57.6, 90.1 on POD 7, 14, 21 respectively. The p values comparing slough clearance rates showed 0.00, 0.002, 0.013 on POD 7, 14, 21 which was statistically significant. Group B with laryngopharyngeal reflux had delayed healing than Group A.</p><p class="abstract"><strong>Conclusions:</strong> Laryngopharyngeal reflux seems to adversely affect healing and complication following tonsillectomy due to lowering of slough clearance rates. Hence we recommend the need for assessment and treatment pre/post operatively of laryngopharyngeal reflux disease in adult patients undergoing tonsillectomy.</p>

Assessment of the Acute Effects of Carbonated Beverage Consumption on Symptoms and Objective Markers of Gastric Reflux

Previous studies have suggested that carbonated beverages may cause gastro-oesophageal reflux. Pepsin (the major enzyme secreted by the stomach) has been suggested to be an objective, acute marker of a reflux event. This pilot study aimed to investigate whether intake of carbonated beverages could affect pepsin concentration in saliva or reflux symptoms. This was assessed by a randomised, crossover trial where participants consumed 330 mL of beverage (carbonated cola, degassed cola or water) at separate visits. Saliva samples and symptom questionnaires were collected at baseline and over the 30 min postprandial period. Pepsin was detected in all saliva samples. No difference was found in the salivary pepsin concentrations between treatments at all time points. There were significantly higher scores (p > 0.05) for feelings of fullness, heartburn, urge to belch and frequency of belches after ingestion of carbonated cola than degassed cola and water. The ingestion of carbonated beverages did not appear to increase postprandial pepsin concentration in saliva compared to other beverages but did evoke higher levels of reflux-related symptoms such as fullness, heartburn and belching. This suggests carbonated beverages may cause symptoms associated with reflux but do not drive detectable levels of gastric juice to reach the oral cavity.

Time to Stop Blaming Gastroesophageal Reflux

Objectives. Cough, pain, and desaturation episodes in infants are often ascribed to gastroesophageal reflux, and many are empirically treated with acid suppression medications. The authors hypothesize that most of these symptoms are not related to gastroesophageal reflux. Methods. Retrospective review of 186 combined pH–multichannel intraluminal impedance studies performed in infants at Cincinnati Children’s Hospital. Results. Of 4159 symptoms reported 1504 (36%) were associated with reflux events (27% nonacid and 9% acid). When total number of symptoms and reflux events were taken into consideration, nonacid reflux events were as likely to be associated with a symptom as acid reflux events ( P = .66). Conclusion. The extra-esophageal symptoms commonly attributed to gastroesophageal reflux in infants are most often not associated with a reflux event. Even though causality cannot be definitively proven, in the minority in whom a symptom association is observed, nonacid events are as likely as acid events to cause symptoms.