Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (5): 101-106.doi: 10.6040/j.issn.1673-3770.0.2019.114

• Original Article • Previous Articles    

Simultaneous Dx-pH monitoring of the oropharynx and esophagus for laryngopharyngeal reflux disease research

Lei WANG1,Gang WANG2,Wei WU1(),Hongdan LIU1,Bingxin XU1,Xin LI1,Haolun HAN1,Baowei LI1,Ruiying DING1,Lianyong LI3   

  1. 1. Department of Otolaryngology Head and Neck Surgery, Characteristic Medical Center of Strategic Support Army, Beijing 100101, China
    2. State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, Beijing 100101, China
    3. Department of Gastroenterology, Characteristic Medical Center of Strategic Support Army, Beijing 100101, China
  • Received:2019-03-11 Revised:2019-05-09 Online:2019-09-20 Published:2019-10-15
  • Contact: Wei WU E-mail:ent306ww@126.com

RichHTML

8

PDF (PC)

264

Abstract: Objective

To investigate the relationship between laryngopharyngeal reflux disease（LPRD）and gastroesophageal reflux disease (GERD) by simultaneous Dx-pH monitoring of the oropharynx and esophagus.

Methods

This was a retrospective study of 56 patients, who had presented with suspected laryngopharyngeal reflux at the Department of Otolaryngology Head and Neck Surgery, Chinese PLA 306th Hospital, from June to December 2017. All patients were evaluated using the reflux symptom index (RSI), reflux finding score (RFS), gastroesophageal reflux disease questionnaire (GerdQ), simultaneous 24 hour Dx-pH monitoring of the oropharynx and esophagus, and gastroscopy.

 Results

Synchronous pH monitoring revealed 17 cases had a positive Ryan score, implying LRPD, of which, 12 cases (70.6%, 12/17) were diagnosed with LPRD alone. Further, 20 cases were diagnosed with GERD, of which, 15 cases (75%, 15/20) were GERD alone. The number of patients with only LPRD was higher than the number diagnosed with both LPRD and GERD (29.4%, 5/17). There were no statistical differences in total percent acid exposure time or the total number of oropharyngeal pH events between the “LPRD only” and the “LPRD+GERD” groups. Additionally, there were no statistical differences in the esophageal reflux indices between the “GERD only” group and the “LPRD+GERD” group. Eleven cases (64.7%, 11/17) of LPRD were negative for GERD, determined by the GerdQ, Dx-pH esophageal probe tests, and gastroscopy.

 Conclusion

LPRD and GERD can exist independently. Most LPRD cases are not accompanied by GERD and LPRD is not secondary to severe GERD.

Key words: Laryngopharyngeal reflux disease, Gastroesophageal reflux disease, Dx-pH monitoring.

CLC Number: 

  • R766

Table 1

Comparison of reflux indices between the LPRD +GERD group and the LPRD only group"

组别

口咽部探头

（pH<5.5）

食管LES上5 cm探头

（pH<4.0）
AET 酸反流总次数 AET

酸反流

总次数

 持续超过5 min酸反流次数

最长酸暴露

时间（min）
单纯LPRD组（x±s） 9.47±11.68 78.33±90.78 0.65±0.68 19.00 (2.75,33.50) 0.17±0.39 1.75±2.01
LPRD合并GERD组[M(P25,P75)] 2.26 (0.62,15.91)

123.00 (30.50,

237.50)

 11.80 (5.34,15.40)

132.00 (78.00,

190.00)

7.00 (2.50,

10.00)

23.00 (10.00,

31.00)
Z -0.422 -0.897 -3.166 -3.059 -3.543 -3.192
P 0.673 0.370 0.002 0.002 ＜0.001 0.001

Table 2

Comparison of reflux indices between the GERD only group and the LPRD only group"

组别

咽部探头

（pH<5.5）

食管LES上5cm探头

（pH<4.0）
AET 酸反流总次数 AET

酸反流

总次数

 持续超过5min酸反流次数

最长酸暴露

时间（min）

单纯GERD组

（x±s）

 0.44±1.10 2.67±6.32 19.81±14.54 153.00 (115.00;188.00) 8.00 (2.00;18.00) 70.47±93.84
LPRD合并GERD组[M(P25,P75)] 2.26 (0.62,15.91) 123.00 (30.50,237.50) 11.80 (5.34,15.40) 132.00 (78.00,190.00) 7.00 (2.50,10.00) 23.00 (10.00,31.00)
Z -3.005 -3.399 -0.829 -0.873 -0.395 -0.743
P 0.003 0.001 0.407 0.383 0.693 0.457
1 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组，中华医学会耳鼻咽喉头颈外科学分会咽喉学组 .咽喉反流性疾病诊断与治疗专家共识（2015年）[J].中华耳鼻咽喉头颈外科杂志，2016, 51(5): 324-326.
Subspecialty Group of Laryngopharyngology, Eeitorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Laryngopharyngology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association . Experts consensus on diagnosis and treatment of laryngopharyngeal reflux disease (2015) [J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(5): 324-326.
2 Vakil N , van Zanten SV , Kahrilas P , et al . The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus[J]. Am J Gastroenterol, 2006, 101(8): 1900-1920; quiz 1943. doi:10.1111/j.1572-0241.2006.00630.x .
doi: 10.1111/j.1572-0241.2006.00630.x
3 Chong VH . Laryngopharyngeal reflux is not always secondary to gastroesophageal reflux[J]. Eur Arch Otorhinolaryngol, 2010, 267(2): 321-322. doi:10.1007/s00405-009-1137-y .
doi: 10.1007/s00405-009-1137-y
4 Koufman JA . Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease[J]. Ear Nose Throat J, 2002, 81(9 Suppl2): 7-9. doi: 10.1103/PhysRevLett.77.3605 .
doi: 10.1103/PhysRevLett.77.3605
5 Ayazi S , Lipham JC , Hagen JA , et al . A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold[J]. J Gastrointest Surg, 2009, 13(8): 1422-1429. doi:10.1007/s11605-009-0915- 6 .
doi: 10.1007/s11605-009-0915- 6
6 吴玮, 王刚, 王磊, 等 . Ryan指数在诊断咽喉反流性疾病中的探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(12): 885-889. doi:10.3760/cma.j.issn.1673-0860.2017.12.002 .
doi: 10.3760/cma.j.issn.1673-0860.2017.12.002
WU Wei , WANG Gang , WANG Lei , et al . Ryan index for detection of laryngopharyngeal reflux diseases[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(12): 885-889. doi:10.3760/cma.j.issn.1673-0860.2017.12.002 .
doi: 10.3760/cma.j.issn.1673-0860.2017.12.002
7 郑杰元, 张立红, 李晶兢, 等 . 咽喉反流症状指数量表中文版的信度及效度评价[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(11): 894-898. doi:10.3760/cma.j.issn.1673-0860.2012.11.004 .
doi: 10.3760/cma.j.issn.1673-0860.2012.11.004
ZHENG Jieyuan , ZHANG Lihong , LI Jingke , et al . Chinese version of the reflux symtom index was evaluated for reliability and validity[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2012, 47(11): 894-898. doi:10.3760/cma.j.issn.1673-0860.2012.11.004 .
doi: 10.3760/cma.j.issn.1673-0860.2012.11.004
8 Dent J , Jones R , Vakil N , et al . A management strategy for GERD based on the gastroesophageal reflux disease questionnaire(GerdQ) [J]. Gut, 2007, 56: A75.
9 李进让, Belafsky Peter C , 张立红 . 中国喉科医师应用反流体征评分量表的信度研究[J]. 中国耳鼻咽喉头颈外科, 2012, 19(7): 388-390.
LI Jinrang , Belafsky Peter C , ZHANG Lihong . Reliability of the reflux finding score used in Chinese laryngologist[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2012, 19(7): 388-390.
10 顾清, 王虹, 顾而立, 等 . 胃食管反流病问卷评分对胃食管反流病患者食管酸暴露的预测意义[J]. 中华消化杂志, 2011, 31(1): 45-49. doi:10.3760/cma.j.issn.0254-1432.2011.01.011 .
doi: 10.3760/cma.j.issn.0254-1432.2011.01.011
GU Qing , WANG Hong , GU Erli , et al . The value of the gastroesophageal reflux disease questionnaire score for acid exposure prediction in gastroesophageal reflux disease patients[J]. Chinese Journal of Digestion, 2011, 31(1): 45-49. doi:10.3760/cma.j.issn.0254-1432.2011.01.011 .
doi: 10.3760/cma.j.issn.0254-1432.2011.01.011
11 Lee JH , Park SY , Cho SB , et al . Reflux episode reaching the proximal esophagus are associated with chronic cough[J]. Gut Liver, 2012, 6(2): 197-202. doi:10. 5009/gnl.2012.6.2.197 .
doi: 10. 5009/gnl.2012.6.2.197
12 Patel A , Sayuk GS , Gyawali CP . Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease[J]. Clin Gastroenterol Hepatol, 2015, 13(5): 884-891. doi:10.1016/j.cgh.2014.08.029 .
doi: 10.1016/j.cgh.2014.08.029
13 Katz PO , Gerson LB , Vela MF . Guidelines for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2013, 108(3): 308-328; quiz 329. doi:10.1038/ajg.2012.444 .
doi: 10.1038/ajg.2012.444
14 Groome M , Cotton JP , Borland M , et al . Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux[J]. Laryngoscope, 2007, 117(8): 1424-1428. doi:10.1097/MLG.0b013e31806865cf .
doi: 10.1097/MLG.0b013e31806865cf
15 Sataloff RT , Hawkshaw MJ , Gupta R . Laryngopharyngeal reflux and voice disorders: an overview on disease mechanisms, treatments, and research advances[J]. Discov Med, 2010, 10(52): 213-224. doi: 10.1185/03007995. 2010.510925 .
doi: 10.1185/03007995. 2010.510925
16 Vardouniotis AS , Karatzanis AD , Tzortzaki E , et al . Molecular pathways and genetic factors in the pathogenesis of laryngopharyngeal reflux[J]. Eur Arch Otorhinolaryngol, 2009, 266(6): 795-801. doi:10.1007/s00405-009-0966-z .
doi: 10.1007/s00405-009-0966-z
17 Masaany M , Marina MB , Sharifa Ezat WP , et al . Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux[J]. J Laryngol Otol, 2011, 125(5): 502-508. doi:10.1017/S0022215111000120 .
doi: 10.1017/S0022215111000120
18 冯桂建, 赵丽莉, 邹宁, 等 . 基于症状学探讨胃食管反流病和喉咽反流病的关系[J]. 中华医学杂志, 2011, 91(35): 2472-2475. doi:10.3760/cma.j.issn.0376-2491.2011. 35.008 .
doi: 10.3760/cma.j.issn.0376-2491.2011.35.008
FENG Guijian , ZHAO Lili , ZOU Ning , et al . Symptom-based relationship between gastroesophageal reflux disease and laryngopharyngeal reflux disease[J]. National Medical Journal of China, 2011, 91(35): 2472-2475. doi:10.3760/cma.j.issn.0376-2491.2011.35.008 .
doi: 10.3760/cma.j.issn.0376-2491.2011.35.008
19 张立红, 熊灵峰, 郑宏伟, 等 . 双探头24小时pH监测对咽喉反流的诊断价值及特点[J]. 中国耳鼻咽喉头颈外科, 2012, 19(6): 323-326.
ZHANG Lihong , XIONG Lingfeng , ZHENG Hongwei , et al . Diagnostic value and characteristics of 24 hours dual probe pH monitoring in patients with laryngopharyngeal reflux[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2012, 19(6): 323-326.
20 Koufman JA , Aviv JE , Casiano RR , et al . Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery[J]. Otolaryngol Head Neck Surg, 2002, 127(1): 32-35. doi:10.1067/mhn.2002.125760 .
doi: 10.1067/mhn.2002.125760
21 Johnston N , Knight J , Dettmar PW , et al . Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease[J]. Laryngoscope, 2004, 114(12): 2129-2134. doi:10.1097/01.mlg. 0000149445.07146.03 .
doi: 10.1097/01.mlg. 0000149445.07146.03
22 Campagnolo AM , Priston J , Thoen RH , et al . Laryngopharyngeal reflux: diagnosis, treatment, and latest research[J]. Int Arch Otorhinolaryngol, 2014, 18(2): 184-191. doi:10.1055/s-0033-1352504 .
doi: 10.1055/s-0033-1352504
23 王磊, 吴玮, 王刚, 等 . 咽部生化指标诊断咽喉反流性疾病意义探讨[J]. 中华医学杂志, 2018, 98(8): 596-600. doi:10.3760/cma.j.issn.0376-2491.2018.08.009 .
doi: 10.3760/cma.j.issn.0376-2491.2018.08.009
WANG Lei , WU Wei , WANG Gang , et al . Significance of pharyngeal biochemical indexes in the diagnosis of laryngopharyngeal reflux disease[J]. National Medical Journal of China, 2018, 98(8): 596-600. doi:10.3760/cma.j.issn.0376-2491.2018.08.009 .
doi: 10.3760/cma.j.issn.0376-2491.2018.08.009
24 Basseri B , Conklin JL , Mertens RB , et al . Heterotopic gastric mucosa (inlet patch) in a patient with laryngopharyngeal reflux (LPR) and laryngeal carcinoma: a case report and review of literature[J]. Dis Esophagus, 2009, 22(4): E1-E5. doi:10.1111/j.1442-2050. 2008. 00915.x .
doi: 10.1111/j.1442-2050. 2008. 00915.x
[1] Yongyao LANG,Yun YANG,Qing LIU,Lindi XU,Ziping LIN. Analysis of influencing factors and observation of therapeutic effects in patients with laryngopharyngeal reflux disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 119-123.
[2] WANG Gang, WU Wei, WANG Lei, LIU Hongdan, XU Xiaohang, XU Bingxin, DING Ruiying, ZHOU Ying, HAN Haolun, GONG Jing,LI Baowei, SUN Zhezhe. Correlation analysis between Ryan index and reflux symptom index and reflux finding score, in the diagnosis of [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 48-52.
[3] LI Zewen, GUO Junyu, ZHOU Jie, YAN Fubo, YANG Zhimin, DING Zhuhua. Relationship between gastroesophageal reflux disease and laryngeal carcinoma: a meta-analysis. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(3): 40-46.
[4] CHEN Xun, YANG Yun, CHEN Zhibin. Research on diagnosis and treatment of laryngopharyngeal reflux disease. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(1): 67-69.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd