The Hypopharyngeal Reflux in Double-pH/Z Does Not Correlate with the Reflux Finding Score in Patients with Laryngopharyngeal Reflux
Authors:
Tatiana Haličková 1
; L. Nosáková 2; R. Michalová 3
Authors place of work:
Klinika ORL a chirurgie hlavy a krku, Ústredná vojenská nemocnica SNP – FN, Ružomberok
1; Interná klinika – gastroenterologická, Jesseniova lekárska fakulta UK, Univerzitná nemocnica Martin
2; I. Interná klinika, Jesseniova lekárska fakulta UK, Univerzitná nemocnica Martin
3
Published in the journal:
Otorinolaryngol Foniatr, 67, 2018, No. 2, pp. 60-66.
Category:
Original Article
Summary
Introduction:
Laryngopharyngeal reflux (LPR) is defined as retrograde gastric fluid flow above the upper esophageal sphincter in upper and lower respiratory tract, pharynx and oral cavity. Diagnosis of laryngopharyngeal reflux significantly limits nonspecific clinical manifestations and its problematic capture by pH metric measurements. In clinical practice, the Reflux Finding Score (RFS) is traditionally used using flexible laryngoscopy to assess the rate of changes in larynx and vocal cords caused by LPR and Reflux Symptom Index (RSI), a questionnaire focusing on the patient‘s subjective troubles due to reflux. Two-channel pH metry with impedance currently allows for the most accurate detection of LPR episodes in the hypopharyngeal region.
Aims and Methods:
Analysis of 24-hour two-channel pH measurements in symptomatic patients with positive RFS (RFS> 7) in terms of number of LPR episodes. Our hypothesis predicted a positive relationship between LPR and total RFS. We prospectively examined 36 patients with chronic laryngopharyngeal symptoms, the diagnosis of which has not led to a clear identification of the cause of the difficulties. We performed a flexible laryngoscopy with RFS determination and a 24 hour two-channel pH metry with impedance. In patients with positive RFS and at least one LPR episode on a 24 hour two-channel pH metry with impedance, we evaluated the relationship between LPR and total RFS.
Results:
Statistically we evaluated 17 patients. Average RFS was 9.88 ± 0.39. LPR episodes were divided into groups according to the pH drop in the proximal pH sensor (pH <6, 5.5, 5, 4.5, 4). We found that the number of LPR episodes with a marked decrease in pH in the hypopharynx is low and predominates LPR with a lower pH decrease in the hypopharynx. We did not confirm a statistically significant correlation between LPR and RFS, irrespective of the pH decrease in the hypopharynx. We did not confirm a significant relationship even if we evaluated only those who had a positive RSI (RSI> 13) (n = 12) at the same time, even if we evaluated only patients who had pseudosulcus vocalis (n = 12).
Conclusion:
We have not confirmed the direct relationship between LPR episodes and total RFS in patients with laryngopharyngeal reflux. It was not present regardless of the pH decrease in the hypopharynx. Increasing the inclusion criteria also did not produce a positive correlation. The 24-hour impedance pH metry probably does not reflect all aspects of the LPR effect on the vocal / larynx area.
Keywords:
laryngopharyngeal reflux, pH metry, impedance, Reflux Symptom Index, Reflux Finding Score, pseudosulcus vocalis
Zdroje
1. Bánovčin, P., Jr., Halička, J., Haličková, M. et al.: Studies on the regulation of transient lower esophageal sphincter relaxations (TLESRs) by acid in the esophagus and stomach. Dis Esophagus, 29, 2016, 5: s. 484-489.
2. Belafsky, P. C., Postma, G. N., Koufman, J. A.: The validity and reliability of the Reflux Finding Score (RFS). Laryngoscope, 111, 2001, 8, s. 1313-1317.
3. Belafsky, P. C., Postma, G. N., Koufman, J. A.: Validity and reliability of the Reflux Symptom Index (RSI). J. Voice, 16, 2002, 2, s. 274-277.
4. Belafsky, P. C., Postma, G. N., Koufman, J. A.: The association between laryngeal pseudosulcus and laryngopharyngeal reflux. Otolaryngol. Head Neck Surg., 126, 2002, 6: s. 649-652.
5 Ďuriček, M., Bánovčin, P., Hyrdel, R.: Poruchy motility pažeráka – Chicagská klasifikácia, v.3.0: Esophageal motility disorders – The Chicago classification, v.3.0, Gastroenterologie a hepatologie. Praha., Ambit Media, 69, 2015, s. 130-138.
6. Formánek, M., Jančatová, D., Komínek, P. et al.: Comparison of impedance and pepsin detection in the laryngeal mucosa to determine impedance values that indicate pathological laryngopharyngeal reflux. Clin. Transl. Gastroenterol., 2017, 8(10), e123.
7. Halička, J., Bánovčin, P., Jr., Haličková, M. et al.: Acid infusion into the esophagus increases the number of meal-induced transient lower esophageal sphincter relaxations (TLESRs) in healthy volunteers. Neurogastroenterol. Motil, 26, 2014, 10, s. 1469-1476.
8. Chang, B. A., MacNeil, S. D., Morrison, M. D. et al.: The reliability of reflux finding score among general otolaryngologists. J. Voice, 29, 2015, 5, s. 572-577.
9. Koufman, J. A.: The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope, 101, 1991, 4 (Pt 2 Suppl. 53), s. 1-78.
10. Lee, J. S., Jung, A. R., Park, J. M. et al.: Comparison of characteristics according to reflux type in patients with laryngopharyngeal reflux. Clin. Exp. Otorhinolaryngol., 2017.
11. Mittal, R. K., Holloway, R., Dent, J.: Effect of atropine on the frequency of reflux and transient lower esophageal sphincter relaxation in normal subjects. Gastroenterology, 109, 1995, 5, s. 1547-1554.
12. Musser, J., Kelchner, L., Neils- Strunjas, J. et al.: A comparison of rating scales used in the diagnosis of extraesophageal reflux. J. Voice, 25, 2011, 3, s. 293-300.
13. Noordzij, J. P., Khidr, A., Desper, E. et al.: Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope, 112, 2002, 12, s. 2192-2195.
14. Oelschlager, B. K., Eubanks, T. R., Maronian, N. et al.: Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gastroesophageal-laryngeal reflux. J. Gastrointest. Surg., 6, 2002, 2, s. 189-194.
15. Postma, G. N.: Ambulatory pH monitoring methodology. An. Otol. Rhinol. Laryngeal., 184, Suppl., 2000, s. 10-14.
16. Samuels, T. L., Johnston, N.: Pepsin as a causal agent of inflammation during nonacidic reflux. Otolaryngol Head Neck Surg, 2009. 141(5): s. 559-563.
17. Sifrim, D., Holloway, R., Silny, J. et al.: Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology, 120, 2001, 7, s. 1588-1598.
18. Varechová, S., Mikler, J., Murgaš, D. et al.: Cough reflex sensitivity in children with suspected and confirmed gastroesophageal reflux disease. J. Physiol. Pharmacol., 58, 2007, Suppl 5(Pt 2), s. 717-727.
19. Wong, R. K., Hanson, D. G., Waring, P. J. et al.: ENT manifestations of gastroesophageal reflux. Am. J. Gastroenterol., 95, 2000, (8 Suppl), s. S15-22.
20. Ylitalo, R., Lindestad, P. A., Hertegard, S.: Is pseudosulcus alone a reliable sign of gastroesophago-pharyngeal reflux? Clin. Otolaryng. Alálie. Sci., 29, 2004, 1, s. 47-50.
21. Zeleník, K., Matoušek, P., Tedla, M. et al.: Extraesophageal reflux: What is the best parameter for pH-monitoring data analysis from the perspective of patient response to proton pump inhibitors? Gastroenterol. Res. Pract., 2013. 2013: s. 736486.
22. Zeleník, K., Čáp, P., Chlumský, J. et al.: Mimojícnové projevy refluxní choroby. In Zeleník, K.: Definice základních pojmů, historie a epidemiologie. 1. vyd., Havlíčkův Brod, vyd. Tobiáš, 2013, s. 18.
23. Zeleník, K., Čáp, P., Chlumský, J. et al: Mimojícnové projevy refluxní choroby. In Zeleník, K., Kučová H., Komínek, P.: Základní diagnostické metody. 1. vyd., Havlíčkův Brod, vyd. Tobiáš, 2013, s. 71.
24. Zeleník, K., Čáp, P., Chlumský, J. et al: Mimojícnové projevy refluxní choroby. In Vítek, P., Zeleník, K.: Patofyziologie refluxní choroby jícnu a extraezofageálního refluxu. 1. vyd., Havlíčkův Brod, vyd. Tobiáš, 2013, s. 47-59.
Štítky
Audiology Paediatric ENT ENT (Otorhinolaryngology)Článok vyšiel v časopise
Otorhinolaryngology and Phoniatrics
2018 Číslo 2
Najčítanejšie v tomto čísle
- Cysts Originating from Cervical Lymphatic Ducts
- The Closure of Nasal Septal Perforation by Custom Made Septal Obturators - First Experiences
- The Hypopharyngeal Reflux in Double-pH/Z Does Not Correlate with the Reflux Finding Score in Patients with Laryngopharyngeal Reflux
- Posterior Glottic Stenosis