Background
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.
Methods
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.
Key Results
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.
Conclusions & Inferences
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.
The proportion of oropharyngeal‐pH events (detected by Dx‐probe) temporally related to an episode of distal reflux (detected by pH‐MII) ranged from 0% to 17%, depending on the proximal pH criteria used. On the other hand, 2394 refluxes were detected by pH‐MII; of these only 120 were detected also by the Dx‐probe. The correlation between oropharyngeal pH‐metry and pH‐MII was weak.
Abstract Aims A multicentric observational study was performed to update the available information on reflux oesophagitis in Italy. Methods In phase I, the number and severity of reflux oesophagitis ...diagnosed in 1 year (2003) were reported together with the associated endoscopic findings. In phase II, oesophagitis patients consecutively referred in a 3-month period were analysed. A multivariate analysis was used to identify the risk factors for severe oesophagitis. Results 253,992 upper endoscopies were collected. The overall prevalence of oesophagitis was 14.8% and the endoscopic findings associated with oesophagitis were hiatus hernia (46.3%), duodenal ulcer (10.7%), gastric ulcer (3.6%) and Barrett's oesophagus (2.9%). In phase II, 1542 reflux oesophagitis patients were analysed (60.3% males; mean age 50.7 ± 16.6 years). Only 53.4% of patients reported heartburn and/or regurgitation as main complaint. Severe symptoms, age >50 years, hiatus hernia and male gender were identified as independent predictors of severe oesophagitis. Conclusions Oesophagitis is the most frequent among the peptic diseases of the upper gastro-intestinal tract. Only half of the oesophagitis patients reported typical reflux symptoms as dominant. Advanced age, male gender, severe symptoms and hiatus hernia were independent risk factors for severe disease.
