Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-04T18:04:11.826Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of different pH thresholds for 24-hour dual probe pH monitoring in patients with suspected laryngopharyngeal reflux

Published online by Cambridge University Press:  23 May 2007

O Reichel  and
W J Issing
O Reichel*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany
W J Issing
Affiliation:
Department of Otorhinolaryngology, The Freeman Hospital, Newcastle Upon Tyne, UK
*
Address for correspondence: Dr Oliver Reichel, Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Klinikum Grosshadern, Marchionini-Strasse 15, 81377 Munich, Germany. Fax: +49 89 70 95 68 69 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

The gold standard test for laryngopharyngeal reflux is 24-hour pH monitoring, which determines the reflux area index with a pH threshold of less than four (i.e. the reflux area index four). However, refluxed pepsin is able to cause laryngeal injury at pH levels above five.

Study design:

Prospective study.

Materials and methods:

In order to establish normative values for a reflux area index with a pH threshold of less than five (i.e. the reflux area index five), 29 healthy volunteers underwent pH monitoring. In 45 patients with suspected laryngopharyngeal reflux, reflux area index four and reflux area index five were determined by pH study.

Results:

In healthy volunteers, the reflux area index five was 72.6 (95th percentile). In 29 of 44 patients, laryngopharyngeal reflux was diagnosed due to a reflux area index four of greater than 6.3. However, the reflux area index five revealed laryngopharyngeal reflux in six more patients.

Conclusions:

For exact analysis of pH monitoring results, two pH thresholds (less than four and less than five) must be considered. Further studies with a larger number of healthy volunteers are necessary in order to reveal normative values for the reflux area index five parameter.

Keywords

PepsinGastric Acidity DeterminationGastro-Oesophageal RefluxLarynx
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 5 , May 2008 , pp. 485 - 489
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Altman, KW, Stephens, RM, Lyttle, CS, Weiss, KB. Changing impact of gastroesophageal reflux in medical and otolaryngology practice. Laryngoscope 2005;115:1145–53Google Scholar
2 Koufman, JA, Weiner, GJ, Wallace, CW, Castell, DO. Reflux laryngitis and its sequelae. J Voice 1988;2:78–9Google Scholar
3 Reichel, O, Hagedorn, H, Berghaus, A. Diagnosis and treatment of laryngopharyngeal reflux. Laryngorhinootologie 2006;85:919–24Google Scholar
4 Karkos, PD, Wilson, JA. Empiric treatment of laryngopharyngeal reflux with proton pump inhibitors: a systematic review. Laryngoscope 2006;116:145–8Google Scholar
5 Vincent, DA, Garrett, JD, Radionoff, SL, Reussner, LA, Stasney, CR. The proximal probe in esophageal pH monitoring: development of a normative database. J Voice 2000;14:247–54Google Scholar
6 Piper, DW, Fenton, BH. pH stability and activity curves of pepsin with special reference to their clinical properties. Gut 1965;6:506–8Google Scholar
7 Dobhan, R, Castell, DO. Normal and abnormal proximal esophageal acid exposure: results of ambulatory dual-probe pH monitoring. Am J Gastroenterol 1993;88:25–9Google Scholar
8 Johnston, N, Knight, J, Dettmar, PW, Lively, MO, Koufman, J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope 2004;114:2129–34Google Scholar
9 Knight, J, Lively, MO, Johnston, N, Dettmar, PW, Koufman, JA. Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux. Laryngoscope 2005;115:1473–8Google Scholar
10 Belafsky, PC, Postma, GN, Koufman, JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274–7Google Scholar
11 Belafsky, PC, Postma, GN, Koufman, JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001;111:1313–17Google Scholar
12 Smit, CF, Tan, J, Devriese, PP, Mathus-Vliegen, LM, Brandsen, M, Schouwenberg, PF. Ambulatory pH measurements at the upper esophageal sphincter. Laryngoscope 1998;108:299–302Google Scholar
13 Johnson, LF, DeMeester, TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am L Gastroenterol 1974;62:325–32Google Scholar
14 Book, DT, Rhee, JS, Toohill, RJ, Smith, TL. Perspectives in laryngopharyngeal reflux: an international survey. Laryngoscope 2002;112:1399–406Google Scholar
15 Milstein, CF, Charbel, S, Hicks, DM, Abelson, TI, Richter, JE, Vaezi, MF. Prevalence of laryngeal irritation signs associated with reflux in asymptomatic volunteers: impact of endoscopic technique (rigid vs. flexible laryngoscope). Laryngoscope 2005;115:2256–61Google Scholar
16 Tuttle, SG, Ruffin, F. The physiology of heartburn. Ann Intern Med 1961;55:292–300Google Scholar
17 DelGaudio, JM. Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinisitis. Laryngoscope 2005;115:946–57Google Scholar
18 Issing, WJ, Karkos, PD, Perreas, K, Folwaczny, C, Reichel, O. Dual-probe 24-hour ambulatory pH monitoring for diagnosis of laryngopharyngeal reflux. J Laryngol Otol 2004;118:845–8Google Scholar
19 Tasker, A, Dettmar, PW, Panetti, M, Koufman, JA, Birchall, JP, Pearson, JP. Is gastric reflux a cause of otitis media with effusion in children? Laryngoscope 2002;112:1930–4Google Scholar
20 Adhami, T, Goldblum, JR, Richter, JE, Vaezi, MF. The role of gastric and duodenal agents in laryngeal injury: an experimental canine model. Am J Gastroenterol 2004;99:2098–106Google Scholar
21 Gill, GA, Johnston, N, Buda, A, Pignatelli, M, Pearson, J, Dettmar, PW et al. Laryngeal epithelial defences against laryngopharyngeal reflux: investigations of e-cadherin, carbonic anhydrase isoenzyme III, and pepsin. Ann Otol Rhinol Laryngol 2005;114:913–21Google Scholar
22 Johnston, N, Bulmer, D, Gill, GA, Panetti, M, Ross, PE, Pearson, JP et al. Cell biology of laryngeal epithelial defences in health and disease: further studies. Ann Otol Rhinol Laryngol 2003;112:481–91CrossRefGoogle Scholar
23 Johnston, N, Dettmar, PW, Lively, MO, Postma, GN, Belafsky, PC, Birchall, M et al. Effect of pepsin on laryngeal stress protein (Sep 70, Sep 53, and Hsp 70) response: role in laryngopharyngeal reflux disease. Ann Otol Rhinol Laryngol 2006;115:47–58Google Scholar
24 Belafsky, PC, Vaezi, MF, DeVault, K. Treatment of chronic throat symptoms with PPIs should be preceded by pH monitoring. Debate. Am J Gastroenterol 2006;101:6–11Google Scholar
25 Vaezi, MF, Richter, JE, Stasney, CR, Spiegel, JR, Iannuzzi, RA, Crawley, JA et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope 2006;116:254–60Google Scholar
26 Amin, MR, Postma, GN, Johnson, P, Digges, N, Koufman, JA. Proton pump inhibitor resistance in the treatment of laryngopharyngeal reflux. Otolaryngol Head Neck Surg 2001;125:374–8Google Scholar