Diagnosis of Laryngopharyngeal Reflux Disease in Patients with Voice Disorders Using Combined Multi-channel Intraluminal Impedance and pH Monitoring (MII-pH)
Authors:
J. Vydrová 1; P. Brandtl 2; J. Dubová 1; O. Bendová 1; F. Šram 1; R. Domagalská 1
Authors‘ workplace:
Hlasové a sluchové centrum , Praha, Medical Healthcom, s. r. o., Praha
1; Centrum pro diagnostiku gastroenterologických chorob, Praha
2
Published in:
Otorinolaryngol Foniatr, 62, 2013, No. 4, pp. 191-197.
Category:
Original Article
Overview
The penetration of duodenogastric contents, i.e. refluxed fluid, above the upper esophageal sphincter (UES) is often responsible for voice disorders and other symptoms in ENT. In the last decade, the method of combined multichannel intraluminal impedance and pH monitoring (MII-pH) was developed for reflux diagnosis but has not yet been sufficiently tested on patients with voice disorders. The aim of this work was to find out on the sensitivity and usefulness of this method for diagnosing laryngopharyngeal reflux disease (LPRD) in voice disorders.
Methods:
111 patients with voice disorders were selected based on pathological findings on laryngeal mucosa diagnosed through laryngeal stroboscopy (Reflux Finding Score over 7) and Reflux Symptom Index value over 13. These patients underwent 24 hours MII-pH monitoring in order to determine the extent and pH of the reflux episodes.
Results:
Episodes of acidic or weakly acidic reflux through the upper esophageal sphincter (UES) were detected in 94% of the patients. In 98% subjects these episodes reached the Z2 sensor located 2 cm distal from the upper edge of the esophageal sphincter. In 100% of the subjects the refluxate reached the Z3 sensor located 4 cm distally from the upper edge of the esophageal sphincter. The pH of the reflux episodes reaching the UES was weekly acidic in 20% patients, both acidic and weakly acidic in 71% acidic in only 3% patients. The De Meester score was abnormal in only 38% of patients.
Discussion and conclusion:
The sensitivity of the combined MII-pH was found to be highly superior to the traditional methods. Single channel pH metry (de Meester score) would have neglected reflux findings in 62% and the double-channel pH metry in 20% of patients, thereby reducing the chance of LPRD being correctly diagnosed and treated. The MII-pH is considered to be a highly useful method for detecting LPRD in patients with voice disorders.
Keywords:
voice disorders, laryngopharyngeal reflux, Multichannel intraluminal impedance, gastroenterology
Sources
1. Altman, K. W., Irwin, R. S.: Cough: An interdisciplinary problem, Otolaryngol. Clin. N. Amer., 43, 2010, s. 1-13.
2. Belafsky, P. C., Postma, G. N., Koufman, J. A.: Validity and reliability of the reflux symptom index (RSI). J. Voice, 16, 2002, 2, s. 274-277.
3. Belafsky, C. P., Postma, G. N., Amin, R. M., Koufman J. M.: Symptoms and findings of laryngopharyngeal reflux. Ear. Nose & Throat Journal, 81, 2002, 9, s. 10-13, 18.
4. Belafsky, C. P., Postma, G. N., Koufman J. M.: The validity and reliability of the reflux finding score. Laryngoscope, 111, 2001, s. 1313-1317.
5. Gill, G. A., Artur, C., Hampson, F., Dettmar, P. W., Moorghan, M., Pignatelli, M.: Characterisation of acid and pepsin damaged laryngeal and oesophageal mucosa. Gastroenterology, 122, 2002, (Suppl. 4) s. 415.
6. How Much Pharyngeal Exposure Is “Normal”? Normative Data for Laryngopharyngeal Reflux Events Using Hypopharyngeal Multichannel Intraluminal Impedance (HMII) Toshitaka Hoppo & Alejandro F. Sanz & Katie S. Nason &Thomas L. Carroll & Clark Rosen & Daniel P. Normolle &.
7. Johnston, N., Wells, C. W., Samuels, T. L. et al.: Pepsin in nonacidic refluxate can damage hypopharyngeal epithelial cells. The Annals of Otology, Rhinology & Laryngology, 118, 2009, s. 677-680.
8. Johnston, N., Dettmar, P. W., Bishwokarma, B. et al.: Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoskope, 117, 2007, s. 1036-1039.
9. Johnston, N., Dettmar, P. W., Lively, M. O. et al. Effect of pepsin on laryngeal stress protein (Sep70, Sep53, and Hsp70) response: role in laryngopharyngeal reflux disease. The Annals of Otology, Rhinology & Laryngology, 115, 2006, s. 47-58.
10. Koufman, J. A.: Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear. Nose & Throat Journal, 81, 2002, s. 7-9.
11. Koufman, J. A.: The otolaryngologic manifestations of gastroesophageal reflux disease (GERD):a clinical investigation of 225 patients using ambulatory 24 hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope, 101, 1991, (Suppl. 53), s. 1-78.
12. Poelmans, J., Tack, J.: Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 54, 2005, 10, s. 1492-1499, doi: 10.1136/gut.2004.053025.
13. Refluxní choroba jícnu. Standardy České gastroenterologické společnosti - aktualizace 2009, http://www.cgs-cls.cz.
14. Rožmanic, V., Velepic, M., Ahel, V., Bonifacic, D., Velepic, M.: Gastroesophageal reflux in children with chronic tubotympanal disorders. Journal of Pediatric Gastroenterology & Nutrition, 34, 2002, 3, s. 278-280.
15. Samuels, T. L., Johnston, N.: Pepsin as a causal agent of inflamation during nonacidic reflux. Otolaryngol. Head Neck Surg., 141, 2009, s. 559-563.
16. Sataloff, R. T., Castell, D. O., Katz, P. O., Sataloff, D. M.: Reflux laryngitis and related disorders. Third edition. San Diego, California. Plural Publishing Inc., 2006, s. 52-53.
17. Shay, S., Tutuian, R., Šifrám, D. et al.: Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am. J. Gastroenterol., 99, 2004, 6, s. 1037-1043.
18. Švec, J. G., Šram, F., Schulte, H. K.: Videokymography. In:The Larynx, (edited by Marvin P.. Fried and Alfio Ferlito). San Diego, Oxford, Brisbane, Plural Publishing, 2009, s. 253-274.
19. Vydrová, J., Zeleník K., Brandtl P., Lukáš K., Chlumský J., Sedlák V., Turzíková J., Vojtíšková J., Seifert B.: Extraezofa-geální refluxní choroba - mezioborový konsenzus.
20. Xiao, Y. L., Lin, J. K., Cheung Snaž, S., Tutuian, R., Šifrám, D. et al.: Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am. J. Gastroenterol, 99, 2004, 6, s. 1037-1043.
21. Xiao, Y. L., Lin, J. K., Cheung, T. K. et al.: Normal values of 24-hour combined esophageal multichannel intraluminal impedance and pH monitoring in the Chinese population. Digestion, 79, 2009, 2, s. 109-114.
22. Zeleník, K., Komínek, P., Stárek, I. et al.: Extraezofageální reflux (1. část). Epidemiologie, patofyziologie a diagnostika. Otorinolaryng. a Foniat. /Prague/, 57, 2008, s. 143-150.
23. Zeleník, K., Komínek P., Stárek I., Machytka E.: Extraezofageální reflux (1. část). Epidemiologie, patofyziologie a diagnos-tika. Otorinolaryng. a Foniat. /Prague/, 57, 2008, č. 3, s. 151-158..
24. Zeleník, K., Kopřivová, H., Stárek, I., Schwarz, P., Komínek, P.: Reflux finding score. Otorinolaryng a Foniat. /Prague/, 59, 2010, č. 1, s. 28-31.
25. Zentilin, P., Iiritano, E., Dulbecco, P. et al.: Normal values of 24-h ambulatory intraluminal impedance combined with pHmetry in subjects eating a Mediterranean diet. Dig Liver Dis., 38, 2006, 4, s. 226-232.
26. Zerbib, F., des Varannes, S. B., Roman, S. et al.: Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian–French cohort of healthy subjects. Aliment Pharmacol. Ther., 22, 2005, 10, s. 1011-1021.
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Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
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