Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2024, Vol. 38 ›› Issue (6): 115-119.doi: 10.6040/j.issn.1673-3770.0.2024.057

• Clinical Research • Previous Articles    

Impact of acid reflux event thresholds on the diagnosis and management of oesophageal reflux disease

DU Chen, YAN Yan, WANG Li, LU Peiquan   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
  • Published:2024-12-13

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Abstract: Objective To compare the similarities and differences of 24-hour multichannel intraluminal impedance pH monitoring(24 h MII-pH)with empiric proton pump inhibitor(PPI)therapy in the diagnosis of laryngopharyngeal reflux disease(LPRD), and to analyze the benefits of empiric PPI therapy in patients with negative 24 h MII-pH monitoring. Methods A total of 70 patients suspected of having LPRD, who attended the otolaryngology department of our hospital from January 2017 to December 2019, were selected. Reflux symptom index(RSI)and reflux finding score(RFS)were evaluated. 24-hour MII-pH monitoring and empiric PPI treatment for 8 weeks were performed. The diagnostic results of pH<4 and pH<5 as the pathological threshold defining acid reflux events in 24h MII-pH monitoring was statistically analyzed, and the consistency with empiric PPI therapy was calculated separately. The PPI treatment effect of negative patients with pH <4 but positive with pH <5 was observed. Results Of the 70 patients, 41 responded to empirical PPI treatment. When pH <4 was used as the pathological threshold, 35 patients were positive, the diagnostic results were moderate(κ=0.429)with empiric PPI therapy, and the diagnostic sensitivity was 68.3%. When pH <5 was used as the pathological threshold, 47 patients were positive, the diagnostic results were moderate(κ=0.514)with empiric PPI therapy, the diagnostic sensitivity was 87.8%. A total of 12 patients were negative at pH<4 but positive at pH<5. Among these 12 patients, a total of 8(36-28)patients were effectively treated with empiric PPI treatment, and the treatment response rate was 66.7%. Conclusion The diagnosis of empiric PPI therapy was well consistent with the diagnosis of empiric PPI therapy when pH <5 was used as the pathological threshold. In patients with a negative pH <4 threshold but a positive pH <5 threshold, there are still patients responded to empiric PPI therapy. Suggests that an appropriate increase in the pH threshold could increase the likelihood of benefiting from empiric PPI therapy in patients with negative 24-hour MII-pH monitoring.

Key words: Laryngopharyngeal reflux, 24-hour multichannel intraluminal impedance pH monitoring, Empiric proton pump inhibitor therapy, Reflux symptom index, Reflux sign score, Pathologic threshold

CLC Number: 

  • R766.5
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