Extraesophageal Reflux: What Is the Best Parameter for pH-Monitoring Data Analysis from the Perspective of Patient Response to Proton Pump Inhibitors?

Karol Zelenik,Jakub Syrovatka,Pavel Kominek,Petr Matousek,Miroslav Tedla

doi:10.1155/2013/736486

Abstract

Objectives. To analyze the pH-monitoring records of patients with suspected extraesophageal reflux (EER) using three different parameters (number of refluxes (NOR), acid exposure time (AET), and reflux area index (RAI)), with a view to determining which type of analysis is best at selecting the patients who will respond to a proton pump inhibitor (PPI). Methods. Demographic data were obtained and the level of the complaint was assessed using the Visual Analogue Scale. A dual probe pH-monitoring study was conducted. NOR greater than six, AET more than 0.1%, and RAI higher than 6.3 mpH were taken to be the thresholds for EER. Subsequently the response to a 12-week PPI trial was analyzed. Results. A total of 81 patients were analyzed. The percentages of patients with substantial EER based on NOR, AET, and RAI were 36%, 28% and 26%, respectively. Statistically significant, often positive PPI trials were confirmed in the group identified as having substantial EER using all three types of analysis. When using AET and RAI, the significance was more pronounced (P = 0.012 and P = 0.013, resp.) in comparison with NOR (P = 0.033). Conclusions. Patients with EER diagnosed using AET or RAI will respond to PPI significantly often.

Highlights

Ambulatory 24-hour dual probe pH-monitoring remains a widely used diagnostic method for detecting extraesophageal re ux (EER)
To analyze the pH-monitoring records of patients with suspected extraesophageal re ux (EER) using three different parameters (number of re uxes (NOR), acid exposure time (AET), and re ux area index (RAI)), with a view to determining which type of analysis is best at selecting the patients who will respond to a proton pump inhibitor (PPI)
Signi cant, o en positive PPI trials in the group with substantial EER in comparison to the group without EER as determined using all types of analysis (NOR, AET, and RAI) was con rmed as well (PP PPPPPP, PP PPPPPP, and PP PPPPPP, resp.) (Table 4)

Summary

Introduction

Ambulatory 24-hour dual probe pH-monitoring remains a widely used diagnostic method for detecting extraesophageal re ux (EER). There are three basic parameters being used for data analysis: number of re uxes (NOR), acid exposure time (AET), and re ux area index (RAI) (Figure 1) [2, 3]. NOR is the sum of all re ux episodes per 24 hours, regardless of their duration and the pH level reached. Re ux area (RA) is the sum of the area under the curve for all episodes of pH < 4.0 recorded during the study in units of Ph∗minutes. E RAI (in units of mpH) is the RA corrected for the duration of the study. RAI takes into consideration the AET and the level of pH decline and is currently considered the most accurate parameter for measuring the severity of EER (Figure 1) [2, 3]

Objectives

Results

Conclusion