Diagnostic value of the dual channel esophageal pH-metry in supraesophageal manifestations of gastroesophageal reflux disease

Abstract

Aim: To compare the value of 24-h dual channel pH-metry in the diagnosis of GERD associated respiratory complications with symptom analysis, endoscopy, esophageal manometry and distal pH-monitoring. Patients, methods: 117 patients (pts) with GERD (43 pts with asthma, 44 pts with chronic hoarseness and 30 pts without supraesophageal manifestation) were submitted to detailed symptom analysis, upper gastrointestinal endoscopy, esophageal manometry and 24-h dual channel esophageal pH-monitoring. Results: Silent GERD was observed more frequently among asthma pts (21%) and pts with hoarseness (18%) than in pts without respiratory symptoms (3%). The endoscopic score based on Los Angeles classification (NERD=0, LA-A=1, LA-B=2, LA-C=3, LA-D=4) was not significantly different between the 3 pts groups (0.6±0.14 in asthma, 0.7±0.17 in hoarseness and 0.6±0.17 in pts without supraesophageal manifestations). No differences were observed in the results of LES manometry between pts with or without respiratory complaints (LES pressure: 15.3±1.49, 12.0±0.98 and 14.5±2.18 Hgmm). 5cm above LES the pH parameters were less pathological in pts with supraesophageal manifestations as compared with respiratory symptom free pts (DeMeester score: 14.5±1.98, 12.4±1.37 vs. 22.2±5.16, p<0.05; fraction time below pH 4: 3.5±0.61% and 2.7±0.40% vs. 9.9±2.25%, p<0.05). In contrast to the distal esophageal parameters, pH-monitoring 20cm above LES showed significantly pronounced reflux activity in pts with airway symptoms as compared with pts without supraesophageal manifestations (fraction time below pH 4: 0.7±0.18%, 0.5±0.14% vs. 0.3±0.08%, p<0.05). Conclusions: Symptom analysis, endoscopy, manometry and conventional distal pH-metry were not able to separate the GERD pts with airway complications from respiratory symptom free GERD subjects, only proximal pH-monitoring was able to select GERD pts with supraesophageal manifestations. Our results evidence the diagnostic value of routine dual channel pH-monitoring in the diagnosis of GERD induced respiratory complications.