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A novel technique for measurement of supraesophageal acid gastroesophageal reflux in patients with otolaryngological disease



A novel technique for measurement of supraesophageal acid gastroesophageal reflux in patients with otolaryngological disease



Digestive Disease Week Abstracts & Itinerary Planner : Abstract No T1622



Gastroesophageal reflux (GER) may play a role in the aetiology of otolaryngological diseases including laryngitis, globus, cough and sinusitis. However, the correlation of supraesophageal (SE) complications with GER has been difficult to determine due to technical failures caused by loss of contact of the pH sensor with the pharyngeal mucosa. We evaluated a novel circumferential antimony pH sensor for measurement of SE reflux in patients with otolaryngological disease. METHODS: 58 patients (23M:35F, mean 57 yrs) with otolaryngological disease (34 sinusitis; 7 chronic cough; 9 laryngeal symptoms; 4 globus; 2 nasal obstruction; 2 other) underwent 24 hr pH monitoring using a 4-ch pH probe incorporating 2 circumferential sensors positioned in the naso/hypopharynx and 2 standard unidirectional sensors positioned in the proximal/distal esophagus. The probe was bifurcated with 3 proximal sensors (9cm apart; 2 circumferential and 1 standard) on one arm and a standard sensor located on a second arm, allowing independent positioning of the distal sensor 5cm above the LES. Acid GER episodes were identified by a drop in distal esophageal pH to below pH 4 for >4 sec. The proximal extent of GER was indicated by a sequential pH drop of >1 pH unit in the proximal channels. RESULTS: The pH recordings achieved using the circumferential pH sensors exhibited a stable baseline and were free of artefact. The median(IQR) reflux index (%time pH<4) was 3.2%(1.0-6.4), 0.2%(0-0.8), 0%(0-0) and 0%(0-0) in the distal/proximal esophagus, hypo/nasopharynx respectively. 22(39%) patients had a RI >4% in the distal esophagus with 4(7%) also having a RI >4% in the proximal esophagus. Of a total of 1151 acid reflux episodes recorded, 824(71.6%) were localized to the distal esophagus, 298(25.8%) reached the proximal esophagus, 27(2.4%) the hypopharynx and 2(0.2%) the nasopharynx. Episodes of SE reflux were recorded in 16(29%) patients, but the incidence was low at only 1(1-2) episode(s)/patient. CONCLUSION: Circumferential pH sensors enable accurate continuous recording of pH within the hypo/nasopharynx of patients with otolaryngological disease. Although a high proportion of these patients had significant esophageal acid exposure, the incidence of SE reflux, in particular into the nasopharynx, was extremely low. These data suggest that SE complications of GER, such as sinusitis, are unlikely to result from direct exposure of the nasal cavity to gastric refluxate but may result from other mechanisms.

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Accession: 034312449

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DOI: 10.1016/S0016-5085(03)82706-3


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