Pharyngeal pH Research Articles

Correlation between oropharyngeal pH-monitoring and esophageal pH-impedance monitoring in patients with suspected GERD-related extra-esophageal symptoms.

24-hour esophageal pH-impedance (pH-MII) is not totally reliable for laryngopharyngeal reflux (LPR). Oropharyngeal (OP) pH-monitoring with the Dx-pH probe may detect LPR better. The correlation between these two techniques is not thoroughly established. Aim of this study is to examine the correlation between OP pH-metry and esophageal pH-MII monitoring. Thirty-six consecutive patients with suspected gastroesophageal reflux disease-related extra-esophageal symptoms were evaluated using 24-h OP-pH and concomitant esophageal pH-MII monitoring. OP events were defined as: drop in pH below thresholds of 5.5, 5.0, 4.5, 4.0 or drop in pH of at least 10% from a running baseline. Temporal relationship between OP and esophageal reflux events and outcomes of the two tests were evaluated. 2394 refluxes were detected by pH-MII; of these only 120 were detected also by OP Dx-probe. On the other hand, the proportion of OP-pH events which were temporally related to an episode of distal reflux ranged from 0% to 17%, depending on the proximal pH criteria used. In 8/36 patients both tests were pathological, while in 10/36 they were both normal; 14/36 patients had pathological OP reflux, but a normal pH-MII test; 4/36 patients had pathological pH-MII, but a normal OP reflux. The correlation between OP pH-metry and pH-MII was weak. At present, the absence of a reliable gold standard for the diagnosis of LPR and the uncertain etiology of the pharyngeal pH alterations make it difficult to decide which is the most reliable technique for the diagnosis of true LPR.

Pharyngeal pH alone is not reliable for the detection of pharyngeal reflux events: A study with oesophageal and pharyngeal pH-impedance monitoring.

Pharyngeal pH probes and pH-impedance catheters have been developed for the diagnosis of laryngo-pharyngeal reflux. To determine the reliability of pharyngeal pH alone for the detection of pharyngeal reflux events. 24-h pH-impedance recordings performed in 45 healthy subjects with a bifurcated probe for detection of pharyngeal and oesophageal reflux events were reviewed. Pharyngeal pH drops to below 4 and 5 were analysed for the simultaneous occurrence of pharyngeal reflux, gastro-oesophageal reflux, and swallows, according to impedance patterns. Only 7.0% of pharyngeal pH drops to below 5 identified with impedance corresponded to pharyngeal reflux, while 92.6% were related to swallows and 10.2 and 13.3% were associated with proximal and distal gastro-oesophageal reflux events, respectively. Of pharyngeal pH drops to below 4, 13.2% were related to pharyngeal reflux, 87.5% were related to swallows, and 18.1 and 21.5% were associated with proximal and distal gastro-oesophageal reflux events, respectively. This study demonstrates that pharyngeal pH alone is not reliable for the detection of pharyngeal reflux and that adding distal oesophageal pH analysis is not helpful. The only reliable analysis should take into account impedance patterns demonstrating the presence of pharyngeal reflux event preceded by a distal and proximal reflux event within the oesophagus.

Functional testing: pharyngeal pH monitoring and high‐resolution manometry

The following paper on functional testing of the pharynx includes commentaries on the use of 24-h pH-impedance testing to identify patients with nonacid reflux and the caveats associated with automatic and visual analysis; the potential diagnostic yield of ambulatory high-resolution manomentry (HRM), particularly in identifying non-cardiac chest pain and transient lower esophageal sphincter relaxations; the differential manometric identification of conditions facilitated by using solid swallows, and the advantages of the newly developed ResTech oropharyngeal pH probe in the detection of proximal reflux events.

Pharyngeal pH monitoring better predicts a successful outcome for extraesophageal reflux symptoms after antireflux surgery

Gastroesophageal reflux disease can be associated with extraesophageal symptoms (hoarseness, cough, asthma, and globus). However, these symptoms may have a multifactorial etiology. Proximal pH monitoring has been proposed as a means of identifying patients where reflux is the cause of the extraesophageal symptoms. The aim of this study was to determine whether proximal esophageal or pharyngeal pH monitoring better identified patients with extraesophageal symptoms that improved after antireflux surgery. A retrospective chart review was performed to identify all patients who had esophageal and pharyngeal pH monitoring before an antireflux operation. A composite score was used to define an abnormal result with each test. A successful outcome was defined as improvement or resolution of extraesophageal symptoms. There were 20 patients identified. Antireflux surgery led to a successful outcome in 14 patients (70 %). Restech better identified patients with extraesophageal symptoms who had a successful outcome with antireflux surgery (12 of 14 [86 %] based on abnormal Restech versus 5 of 10 [50 %] based on abnormal proximal probe, p = 0.06). Comparing only the 15 patients who had both proximal esophageal and pharyngeal pH monitoring, Restech again better identified those who had a successful outcome with antireflux surgery (9 of 10 [90 %] based on abnormal Restech versus 5 of 10 [50 %] based on abnormal proximal probe, p = 0.05). The positive and negative predictive values for symptomatic improvement after a fundoplication were better for an abnormal Restech score than for an abnormal proximal esophageal score (80 vs. 71 % and 60 vs. 38 %, respectively). In two patients with a successful outcome, Restech was the only positive test. In patients with extraesophageal reflux symptoms, proximal esophageal pH monitoring failed to identify half of the patients who had a successful outcome after antireflux surgery. In contrast, an abnormal Restech pH test was present in 90 % of patients with a successful outcome. Further, a negative Restech study more reliably indicated the absence of reflux-induced extraesophageal symptoms. Our results indicate that Restech pharyngeal pH monitoring should be utilized in the evaluation of patients with extraesophageal symptoms that may be associated with reflux disease.

Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children

ObjectiveA prospective study was carried out to determine the sensitivity and specificity of reflux symptoms and laryngeal findings to diagnose laryngopharyngeal reflux (LPR) and gastro-esophageal reflux (GER) in children with asthma by comparing the results of double probe pH monitorization and to determine the difference between controlled and uncontrolled asthma in terms of GER and LPR coexistence. MethodsA total of 50 patients (23 girls, mean age 10.8±0.4 years) with mild to moderate persistent asthma were included in this study. The patients were divided in two groups according to the asthma control status as controlled (n=27) vs. uncontrolled asthma (n=23). All patients completed the reflux symptom questionnaire and then they underwent flexible fiberoptic laryngoscopy and 24h double probe (pharyngeal and esophageal) pH monitorization. Laryngopharyngeal and gastroesophageal reflux were defined according to the double probe pH meter results. ResultsThe prevalences of LPR and GER were 70% and 46% in asthmatic patients, respectively. The reflux symptom score and LPR disease index were not useful to predict LPR or GER. There was no association between asthma control status and LPR and GER. Vocal nodule seems to be a valuable sign to evaluate LPR in asthmatic children. ConclusionsThe reflux symptom score and LPR disease index do not seem reliable to diagnose LPR and GER in children with asthma. The frequency of LPR and GER are independent of asthma control, atopy and long acting beta agonist usage.

Oropharyngeal pH Monitoring for Laryngopharyngeal Reflux: Is It a Reliable Test Before Therapy?

Current methods of measuring pharyngeal pH are problematic. The aim of the study was to assess the ability of the oropharyngeal pH monitoring (Restech) in predicting the response to proton pump inhibitor (PPI) therapy in patients with gastroesophageal reflux disease-related laryngopharyngeal symptoms. The study design is prospective and uncontrolled. Twenty-two consecutive naive patients with chronic laryngeal symptoms were enrolled. Reflux symptom index, fibrolaryngoscopy, and 24-hour oropharyngeal pH monitoring were performed. Both patients and laryngoscopist were blinded by the results of Restech. All the patients were given a 3-month therapy with pantoprazole of 40mg twice a day and then repeated both the reflux symptom index and fibrolaryngoscopic evaluation. Patients were considered as responders if a five-point decrease in symptom score was recorded. Thirteen of the 22 patients (59.1%) responded to therapy. Laryngoscopic findings did not correlate with the clinical improvement after the 3 months of PPI. Nine patients (40.9%) had a pathologic Restech study, and all resulted responsive to PPI; nine patients (40.9%) with a negative Restech were nonresponsive to PPI, and four patients (18.2%) despite a negative Restech resulted responsive to therapy. Responsive patients showed both a higher oropharyngeal acid exposure in orthostatic position and a higher Ryan score, compared with nonresponders (49.74±58.11 vs 2.12±0.0, P=0.002). Considering responsiveness to medical therapy as the gold standard of laryngopharyngeal reflux (LPR) for the diagnosis of LPR, Restech showed a sensitivity of 69% and a specificity of 100%. The high specificity and reasonable sensitivity of this technique make the Restech an interesting tool before therapy of patients with pharyngoesophageal reflux.

Correlation between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease

To discuss the occurrence correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and gastroesophageal reflux disease (GERD). Forty-three patients suspected of laryngopharyngeal reflux disease underwent combined multichannel intraluminal impedance and esophageal manometry (MII-EM), twenty-four-hour esophageal and pharyngeal pH and impedance monitoring and PSG. Subjects were grouped according to the detections. The difference of the measurement between groups were Compared. The possible relationship between the two diseases was analyzed. Fourteen of all the subjects can be diagnosed to have GERD (32.6%). Twenty-six can be diagnosed to have OSAHS (60.5%). There were 10 patients had OSAHS and GERD simultaneously, which took over 38.5% of the OSAHS group, and 71.4% of the GERD group. BMI (P = 0.000) and lower esophageal sphincter (LES) residual pressure (P = 0.021) were significantly different among the four groups OSAHS, GERD, OSAHS and GERD, and control (non-OSAHS and non-GERD), but no linear relationship between LES residual pressure and prevalence or severity of the two diseases was found. In OSAHS group, AHI were positively correlated with the following indictors: the DeMeester score (r = 0.45), acid exposure of the distal esophagus (r = 0.491). There seems to be no Linear correlation among reflux indicators, sleep indicators, and esophageal functional indicators in GERD group. Linear correlation was not found among reflux indicators, sleep indicators, and esophageal functional indicators in OSAHS and GERD group (P > 0.05). The incidence and the severity of GERD and OSAHS were related to each other. Reflux events may aggravate OSAHS. The two diseases may have some relationship on the esophageal function, especially on the regulation of the LES pressure.

Chronic cough and obstructive sleep apnoea: reflux-associated cough hypersensitivity?: Table 1–

Obstructive sleep apnoea (OSA) is being increasingly recognised as a cause of chronic cough. The impact of continuous positive airway pressure (CPAP) therapy and the mechanism of this association are not well understood. We describe a patient with OSA and chronic cough who responded well to CPAP. Objective and subjective assessments of cough on treatment with CPAP, off CPAP and on follow-up as well as pharyngeal pH monitoring suggest a possible mechanism for this association. A 61-yr-old male who was a nonsmoker presented to the Hull Cough Clinic (Hull, UK) with a dry cough of 2 yrs’ duration. He did not complain of associated breathlessness or wheezing or a history of post-nasal drip. He did complain of heart burn and treatment with acid-suppressive therapy in the past lead to some improvement in his cough, though it continued to be a significant problem. Previous trials of inhaled and nasal corticosteroids did not improve his cough. He did not have any comorbidities and was not on regular medications. His body mass index was 31 kg·m−2. General physical examination and examination of the respiratory system were unremarkable. A chest radiograph and spirometry were normal. On further questioning, he had a history of snoring for many years. He also complained that his sleep quality was not good and he felt somewhat sleepy in the day time. His Epworth Sleepiness Scale score was 12. This raised the clinical suspicion of OSA. Treatment with lansoprazole was initiated and a sleep study was organised. At review, on treatment with lansoprazole, his cough was slightly better, although, …

The role of extraesophageal reflux in medically and surgically refractory rhinosinusitis

To clarify the relationship between chronic rhinosinusitis (CRS) and extraesophageal reflux (EER) using state-of-the-art technology. We hypothesized that patients with medically and surgically refractory CRS would have a greater prevalence of EER. We also hypothesized that there would be evidence of gastric refluxate reaching the nasopharynx and paranasal sinuses. Case-control analysis. Twenty-two patients with medically and surgically refractory rhinosinusitis were enrolled in the study. Subjects all underwent comprehensive testing for EER including 24-hour pharyngeal pH probe, aerosolized nasopharyngeal pH testing, and nasopharyngeal tissue biopsy for pepsin analysis. In addition, the last five subjects underwent nasal lavage pepsin analysis. A control group of healthy subjects underwent the same nasal secretion pepsin analysis. Twenty subjects completed the study. The pharyngeal pH probe results were positive in 19/20 (95%), where the DeMeester score was positive in 9/19 (47%). The nasopharyngeal pH probe data were available in 17/20 patients and correlated poorly with the pharyngeal pH probe testing. In all 20 subjects, nasopharyngeal tissue biopsies were negative for pepsin. However, in the five subjects who underwent nasal lavage pepsin analysis, all were pepsin positive while five healthy control nasal lavage pepsin analysis were negative. This study supports an association of EER with medically and surgically refractory CRS. The finding of pepsin in nasal lavages suggests that direct contact of the refluxate with the paranasal sinus mucosa may play a role in the pathophysiology of CRS in this patient population. Finally, evaluation for pepsin in nasal fluid may be a viable method for determining the presence of refluxate in the nose and paranasal sinuses.

First Agreement Analysis and Day-to-Day Comparison of Pharyngeal pH Monitoring with pH/Impedance Monitoring in Patients with Suspected Laryngopharyngeal Reflux

ObjectiveDiagnosis of laryngopharyngeal reflux (LPR) is still challenging. Recently a diagnostic device for pH values in the aerosolized environment of the pharynx has been introduced (Dx-pH). We evaluated results of Dx-pH with objective criteria of pH/impedance monitoring (MII) and subjective reflux scoring systems and assessed day-to-day variability. DesignThis study makes use of a prospective single-center trial. Thirty patients with suspected LPR were analyzed. Upper endoscopic examination, manometry, phoniatric examination, and reflux scores were assessed. Dx-pH was performed on two consecutive days, first in combination with MII and second as single measurement. Thereafter, proton pump inhibitor (PPI) trial was performed. Patients were interviewed about symptom relief after 3 months. ResultsThere were considerable differences between MII and results on Dx-pH: day 1 (agreement 11 out of 30, kappa 0.137) and day 2 (agreement 14 out of 30, kappa 0.036). Statistically significant differences were detected correlating all single reflux episodes (n = 453) of Dx-pH with MII and vice versa. Furthermore acidic reflux episodes did not result in pH drops of the pharynx. There was a fair agreement between Dx-pH measurements on subsequent days. After follow-up, 3 out of 18 patients with pathological Dx-pH results reported positive response to PPIs, in contrast to 5 out of 6 patients with pathological MII. ConclusionAccording to our data, acid pharyngeal pH levels detected with Dx-pH are not related to GERD and acid esophageal reflux episodes do not result in pharyngeal pH alterations. Hence, present etiology of LPR needs to be reconsidered since neither mixed nor gas reflux events result in pharyngeal pH alteration. Other acid-producing or retaining factors should be taken into account.

The Value of Routine pH Monitoring in the Diagnosis and Treatment of Laryngopharyngeal Reflux

To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR). Case series with planned data collection. Tertiary care center. On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed. No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients (P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively. Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.

Clinical utility of 24 hour pharyngeal pH monitoring for hoarseness

Objective: To evaluate the contribution of 24 hour pharyngeal pH monitoring of patient presenting with symptoms of hoarseness, globus, throat clearing, and sore throat. Study Design: Retrospective case study. Setting: Tertiary laryngology practice. Materials and Methods: Results of 167 pharyngeal pH studies performed for complaints of hoarseness, globus, and throat clearing in an outpatient private practice setting from 5/09-12/09 were analyzed for pharyngeal reflux pattern and severity. Patient records were reviewed for chief complaint, symptom duration, ten item Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) scores. Nonparametric testing was used to compare symptom duration, VHI-10 scores, and RSI scores between those patients with and without abnormal pharyngeal pH studies. Results: 71 studies (43%) were normal with zero events below pH 5.5. 32 studies (19%), or 33% of all positive studies showed supine pharyngeal reflux only. 46 studies or 48% of all positive studies showed combination upright daytime reflux events and supine reflux. 18 studies or 19% of all positive studies had only upright events. There was no significant difference in presenting symptoms, symptom duration, or severity scores in the patients that had negative vs. positive pharyngeal pH studies. Conclusion: 24 hour pharyngeal pH study eliminates the diagnosis of reflux in a significant percentage of patients with hoarseness. Severity or duration of symptoms of hoarseness, globus, or throat clearing does not reliably predict presence of reflux.

Fundoplication in chronic intractable cough

BackgroundAirway reflux is a common cause of chronic cough and this is often refractory to medical therapy. Surgery in the form of Nissen fundoplication has been highly successful in the treatment of the classic reflux symptoms of heartburn and dyspepsia. There is a paucity of data regarding response to fundoplication in patients presenting with chronic cough.MethodsWe retrospectively reviewed the case notes of patients from the Hull Cough Clinic who had undergone Nissen fundoplication over the past 6 years. Demographic details, duration of symptoms, presence of other symptoms, results of oesophageal studies, outcome and complications were recorded. Patients were contacted by post and asked to complete a questionnaire detailing current symptoms. In a subgroup with continued troublesome cough 24 hour pharyngeal pH measurements were undertaken.ResultsForty seven patients underwent fundoplication. The average duration of pre-operative cough was 8 years. Gastro intestinal symptoms were present in the majority. In 30 (64%) patients a positive response to treatment was recorded. Mild dysphagia or bloating was seen in 18 patients following surgery. Four patients needed repeat surgical intervention for modification of fundoplication. One patient developed aspiration pneumonia eight weeks following surgery and died of a myocardial infarction. Two thirds of patients with persisting cough had evidence of airway reflux on pharyngeal pH monitoring.ConclusionIn these patients with intractable cough a long term response rate of 63% represents a useful therapeutic option. Treatment failure is more frequent than for classic peptic symptoms and may be related to persistent gaseous reflux.

Refluks krtaniowo-gardłowy (LPR) u pacjentów z przewlekłą chrypką

In 2006 The Global Consensus Group in Montreal pointed out that chronic laryngitis is highly associated with gastroesophageal reflux disease (GERD).To evaluate the frequency of LPR in a selected group of patients with chronic hoarseness. We were also interested in assessment of the relationship between Reflux Symptoms Index (RSI) scores, Ryan scores from the pharyngeal pH monitoring and the morphological changes in the larynx according to Reflux Findings Score (RFS). In addition, we wanted to assess the frequency of various clinical symptoms included in the RSI questionnaire among patients with LPR.42 patients from an outpatient ENT clinic with chronic hoarseness and RSI ≥ 13. All subjects underwent pharyngeal pH monitoring with the Dx-pH System Restech ™ and laryngoscopy.Among 42 patients with chronic hoarseness, LPR was confirmed in 35 patients (83.33%). In 7 subjects pharyngeal pH monitoring was normal. Among all patients with confirmed LPR, only 5 out of 8 elements of RFS laryngoscopic changes were observed. The most frequent inflammatory changes noticed included erythema of the arytenoids and interarytenoid regions (posterior laryngitis). These findings were found in 30 out of 35 patients with LPR. Median value of RFS in patients with LPR was 4.45, which is lower than the cut off value of 7 necessary for recognition of LPR. There is statistically significant positive correlation between Ryan scores and the RFS scale results (correlation coefficient 0.91, p<0.001).Pharyngeal pH monitoring confirmed LPR in 83.33% selected group of patients with chronic hoarseness and RSI ≥ 13. Isolated erythema of arytenoid and interarytenoid region was the most frequent inflammatory abnormality found in the larynx. RFS values below 7 do not exclude the diagnosis of LPR. We can use RFS scales as a prognostic test of severity of LPR - due to statistically significant positive correlation between Ryan score and RFS values. The use of RSI scale revealed that the most frequent symptom among patient with LPR was throat clearing followed by hoarseness.

The Effect of Singing on Laryngopharyngeal Reflux

Objective: While there has been widespread conjecture regarding the role of laryngopharyngeal reflux in singing, there remains no objective data demonstrating that voice use causes increased reflux. We attempted to objectively analyze pharyngeal pH changes during singing to better understand how it is affected by singing. Method: Eight singers underwent 24-hour pharyngeal pH probe testing with the Restech Dx-pH measurement systemTM, one hour of which was spent singing. The mean pH and number of pH drops were recorded. A one-tailed t test was used to compare the mean pH of the time singing with the 2 control values. Results: The mean pH for the control time was 6.8347, for the control time without the time supine was 6.9164, and for the time singing was 7.0286. We were thus able to reject the null hypothesis that singing decreases laryngeal pH ( P = .035). There was an increase in mean pH during the time singing as compared with the 2 control groups. Conclusion: While singers may have increased reflux complaints, our data suggest that the singing itself does not cause an increase in acid exposure to the laryngopharynx.

Mechanisms of Esophago-Pharyngeal Acid Regurgitation in Human Subjects

Esophago-pharyngeal regurgitation is implicated in various otolaryngologic and respiratory disorders. The pathophysiological mechanisms causing regurgitation are still largely unknown.AimTo determine the principal mechanisms behind esophago-pharyngeal regurgitation.MethodsWe studied 11 patients with extra-esophageal GORD symptoms in whom esophago-pharyngeal acid regurgitation had previously been demonstrated using ambulatory, dual (pharyngo-esophageal) pH metry (>2 episodes/day using previously validated pH-metric criteria). Patients underwent continuous, 24 hr, stationary monitoring of pharyngo-esophageal manometry and dual (pharyngeal and esophageal) pH recordings. They were intubated with a 14-channel manometric assembly incorporating 2 sleeve sensors monitoring the upper and lower esophageal sphincters simultaneously. A dual pH catheter recorded pH signals 2 cm above the UES midpoint and 7 cm above the LES midpoint.ResultsA total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded. All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium. All regurgitation events were associated with a relaxation of the UES, which were classified as transient non-swallow related relaxations in 29 (91%) and swallow-related in the remaining 3 (9%). Straining was an additional associated factor in 41% of regurgitation events, but strain alone was not sufficient to cause esophago-pharyngeal regurgitation.ConclusionSome form of active UES relaxation is necessary for regurgitation to occur. The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.Level of EvidenceN/A

First Direct Comparison of Pharyngeal pH Monitoring With Combined pH/Impedance Monitoring in Patients With Suspected Laryngopharyngeal Reflux

Background The origin of laryngopharyngeal reflux (LPR) is unclear. It might be caused by pharyngeal acid exposure and it is thought to be associated with Gastroesophageal Reflux Disease (GERD). To objectify atypical symptoms of GERD currently the combination of pHmetry and impedance monitoring (pH/MII) seems to be the most sensitive method. However, a recently developed method using a pH measurement system probe which is placed in the oropharynx without passing the upper sphincter of the esophagus (Dx-pH Catheter, Restech, San Diego, USA) allows to measure pH values in the aerosolized environment of the nasopharynx. The aim of this study was primarily to measure the reproducibility of the new DxpH device and secondly to compare it with pH/MII in patients with suspected LPR for the first time. Methods In a total of 20 patients with oropharyngeal symptoms suspicious for an atypical GERD Proton Pump Inhibitors were stopped for at least 7 days. All patients were examined by using a reflux finding score (RFS). Thereafter pH/MII and a pharyngeal ph monitoring were applied simultaneously. After removal of the 2 probes the next day a single DxpH-measurement was performed. All functional tests lasted for at least 22 hours. pH/MII was regarded as pathological if pH dropped below 4 inmore than >4% of the recorded time and/or >73 mixed reflux episodes occurred. DxpH-measurement was pathological if the Ryan Score was <9.4 in an upright position or <6.8 in a supine position. Patients and results All patients had pathological findings in RFS. The results of the 1st DxpH-measurement were verified in the following pharyngeal pH-metry in 14/20 (70%) patients. Hence, at 2 consecutive days, pharyngeal measurement had a good concordance in the same patient. However, 11/20 (55%) patients had pathological values derived from DxpH, whereas pH/ MII showed pathological findings in only 5/20 (20%) patients. Overall only 6/20 (30%) results matched with findings in pH/MII. Conclusion DxpH-measurement showed satisfying reproducibility on two consecutive days. However, the pathological results of pharyngeal ph monitoring acquired in this case series were not connected to pathological reflux episodes of GERD in most cases. Potentially, other acid producing or acid retaining factors despite from GERD are accountable for atypical reflux symptoms. This should be subject of further studies.

Abnormal Pharyngeal pH Testing Predicts Response to Proton Pump Inhibitors in Patients with Chronic Cough and Laryngeal Complaints

RATIONALE: Controversy exists as to the role of extra-esophageal reflux in the pathogenesis of chronic cough and laryngopharyngitis. One reason for this lack of consensus is the absence of a reliable diagnostic modality capable of determining which patients are likely to respond to anti-reflux measures. We sought to determine whether abnormal pharyngeal pH testing with the DxpH Measurement System is helpful for predicting which patients presenting with chronic cough and/or laryngeal complaints are likely to respond to acid suppression therapy. METHODS: Nineteen consecutive subjects presenting to an allergy department with cough and/or additional symptoms suspected to be of laryngeal origin and with abnormal pharyngeal pH testing were surveyed regarding symptom response and adherence to treatment with twice daily proton pump inhibitors. Self-reported symptom improvement scores from subjects reporting adherence to acid suppression therapy were compared to those of subjects reporting incomplete adherence to acid suppression therapy. RESULTS: The presenting symptoms included chronic cough, sensation of excessive throat mucus / post-nasal drip, throat clearing, globus, and hoarseness. Of those subjects with abnormal pharyngeal pH studies who took twice daily proton pump inhibitors as directed, 11 of 14 (78.6%) had >50% improvement in symptoms as compared to 1 of 5 subjects (20%) with abnormal pH studies who did not (P = 0.04). CONCLUSIONS: Pharyngeal pH testing with the DxpH Measurement System in patients presenting with symptoms of chronic cough and/or laryngopharyngitis is helpful in predicting response to acid suppression therapy.

Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis: A Review

The histological counterpart of idiopathic pulmonary fibrosis is usual interstitial pneumonia, in which areas of fibrosis of various ages are interspersed with normal lung. This pattern could be explained by repeated episodes of lung injury followed by abnormal wound healing responses. The cause of the initiating alveolar epithelial injury is unknown, but postulated mechanisms include immunological, microbial, or chemical injury, including aspirated gastric refluxate. Reflux is promoted by low basal pressure in the lower oesophageal sphincter and frequent relaxations, potentiated by hiatus hernia or oesophageal dysmotility. In susceptible individuals, repeated microaspiration of gastric refluxate may contribute to the pathogenesis of IPF. Microaspiration of nonacid or gaseous refluxate is poorly detected by current tests for gastroesophageal reflux which were developed for investigating oesophageal symptoms. Further studies using pharyngeal pH probes, high-resolution impedance manometry, and measurement of pepsin in the lung should clarify the impact of reflux and microaspiration in the pathogenesis of IPF.

S119 Variation in pharyngeal pH in the diagnosis of airway reflux

Introduction and objectivesReflux of gastric contents to the laryngopharynx has been implicated in the pathogenesis of chronic cough and may exacerbate other respiratory conditions. Direct measurement of pharyngeal pH is...