Standard Reflux Test Research Articles

Diagnosis and management of supraesophageal complications of reflux disease

Supraesophageal reflux disease may manifest in numerous ways, including reflux laryngitis, long-term cough, long-term sinusitis, and dental enamel loss. The mechanisms of pharyngeal and laryngeal reflux are not clearly defined, and standard reflux testing does not consistently demonstrate supraesophageal reflux. The diagnosis is usually based on clinical suspicion when other causes of symptoms are not found and on the patient’s response to empiric acid suppression. With the development of dual-and triple-probe pH monitoring, through which proximal esophageal pH can be assessed along with distal esophageal pH, the physician may be able to correlate reflux with patient symptoms. Therapy consists primarily of behavioral modifications and aggressive acid suppression, though some alternative therapies do exist.

Extraesophageal reflux in pediatric patients with upper respiratory symptoms.

To systematically review published literature describing the association between reflux and upper airway symptoms in children. Structured MEDLINE search of English-language articles published since 1966. We selected articles examining reflux in conjunction with stridor, apnea, sudden infant death syndrome, life-threatening events, and laryngomalacia. Studies that focused on lower airway symptoms or adults were excluded. Articles were abstracted for patient factors, elements of study design, methods of reflux diagnosis, and definition of pathologic reflux. Ninety-nine articles were identified, 56 of which specifically examined reflux and upper respiratory symptoms in children. Of these, 10 compared reflux incidence in symptomatic patients and a set of predetermined control patients, while the remainder reported prevalence data only. Overall, symptomatic patients were diagnosed with reflux frequently, with a range from 27% to 100%. In studies that attempted to compare patients with controls, only 2 provided statistical comparisons of the patient groups, and none adjusted for confounding owing to study design. There was marked heterogeneity in methods used to diagnose reflux in the studies reviewed, with only 34% using dual-channel pH testing; definitions of pathologic reflux were also variable. Evidence seems to support the hypothesis that reflux is associated with upper airway symptoms in children. However, the strength of this correlation and the risk of upper airway symptoms attributable to reflux are difficult to determine given the limitations of available literature. Future research studies should seek standard reflux testing methods, clear comparison groups, and more rigorous statistical methods.

Diagnosis and management of supra-esophageal complications of reflux disease.

Supra-esophageal reflux disease may be manifested in numerous ways, including reflux laryngitis, chronic cough, chronic sinusitis, and dental enamel loss. The mechanisms of pharyngeal and laryngeal reflux are not clearly defined, and standard reflux testing does not consistently demonstrate supra-esophageal reflux. The diagnosis is usually based on clinical suspicion when other causes of symptoms are not found and on the patient's response to empiric acid suppression. With the development of triple-probe pH monitoring, through which pharyngeal pH can be assessed along with esophageal pH, the physician may now be able to demonstrate pharyngeal reflux in relation to patient symptoms. Therapy consists primarily of behavioral modification and aggressive acid suppression, although some alternative therapies exist.

An alternative fundoplicative maneuver for gastroesophageal reflux

Twenty-two patients with gastroesophageal reflux undergoing an original antireflux operative procedure are presented. The mean time between operation and follow-up was 19 months. The technique consists of a semifundoplicative maneuver with firm intraabdominal fixation of the esophagus by suturing the fundoplication to the diaphragm. There was no mortality. The patients were free of reflux symptoms and complications, and the standard reflux test was negative in all cases. All patients had postoperative lower esophageal sphincter pressure within the normal range. The phenomenon of gas-bloat was not observed, nor was inability to vomit or belch. These results confirm the observations made earlier in a series of 110 patients operated on with the same method. A long-term prospective randomized study is in progress, with the aim of comparing the technique described herein and the Nissen fundoplication.