Results of 24-hour pH monitorization in laryngopharyngeal reflux cases presenting with various symptoms

Abstract

Objective: Laryngopharyngeal reflux (LPR), an atypical form of gastroesophageal reflux (GER), may present with non-specific symptoms of upper aerodigestive system. In this study, we aimed to show the LPR frequency of various symptom groups by 24-hour double-channel pH monitorization. Methods: A total of 125 patients and 20 healthy controls were enrolled to this study between July 2007 and July 2008. Patients were assigned to 5 different groups with respect to their chief complaints (gastrointestinal, bronchial, laryngeal, pharyngeal and rhinologic). All patients underwent 24-hour double-channel pH monitorization and diagnosis of LPR was confirmed if one or more pH results were below 4.0 in proximal channel. Results: Laryngopharyngeal reflux was detected in 18 of 19 patients (94%) in gastrointestinal group, 24 of 25 patients (96%) in bronchial group, 26 of 31 patients (83%) in laryngeal group, 27 of 29 patients (93%) in pharyngeal group, 19 of 21 patients (90%) in rhinologic group and 2 of 20 patients (10%) in the control group. The highest incidence of LPR was encountered in the bronchial group, whereas the lowest incidence for LPR was detected in laryngeal group. Conclusion: Laryngopharyngeal reflux may present with a wide spectrum of symptoms in daily otorhinolaryngology practice. With respect to our results, 24-hour double-channel pH monitorization turns out to be a reliable method in the diagnosis of LPR in cases suspected for laryngopharyngeal reflux.

Keywords

• Laryngopharyngeal reflux, gastroesophageal reflux, diagnosis, 24-hour pH monitorization

Farklı belirtilerle başvuran larengofarengeal reflü olgularında 24 saatlik pH monitörizasyon sonuçları

Öz

Amaç: Gastroözofageal reflünün atipik klinik şekillerinden biri olan larengofarengeal reflünün (LFR) kulak burun boğaz hastalıkları pratiğinde pek çok belirtiden sorumlu olduğu düşünülmektedir. Çalışmamızda farklı belirtiler gösteren gruplarda LFR sıklığını 24 saatlik çift kanallı pH metre monitörizasyonu ile göstermeyi amaçladık. Yöntem: Bu çalışma, Temmuz 2007–Temmuz 2008 arasında çeşitli kulak burun boğaz ve baş boyun semptomları ile başvuran olgular üzerinde yapıldı. Semptom ve bulgularına göre olgular 5 farklı grup (gastrointestinal, bronşial, larengeal, farengeal, rinolojik) ve herhangi bir yakınması olmayan bireylerden bir kontrol grubu oluşturuldu. Tüm olgulara 24 saatlik çift kanallı pH monitörizasyonu yapıldı. Proksimal kanalda bir ve daha fazla pH değerinin 4.0'ın altına düşmesi LFR pozitif olarak kabul edildi. Bulgular: Ölçüm sonuçlarına göre LFR, gastrointestinal semptom grubunda %94 (18/19), bronşial semptom grubunda %96 (24/25), larengeal semptom grubunda %83 (26/31), farengeal semptom %93 (27/29), rinolojik semptom grubunda %90 (19/21), kontrol grubunda ise %10 (2/20) sıklığında tespit edilmiştir. Semptomlara göre değerlendirildiğinde larengofarengeal reflü en sık bronşial grupta saptanırken, en düşük insidans larengeal grupta gözlenmiştir. Sonuç: Larengofarengeal reflü, klinikte oldukça farklı kulak burun boğaz semptomlarıyla karşımıza çıkabilmektedir. Larengofarengeal reflüden şüphelenilen olgularda kesin tanı için 24 saatlik çift kanallı pH monitörizasyonu etkin bir yöntem teşkil etmektedir.

Anahtar Kelimeler

• Larengofarengeal reflü, gastroözefageal reflü, tanı, 24 saatlik pH monitörizasyonu

Kaynakça

1. Koufman JA. The otolaryngologic manifestations of gastroe- sophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour ph-monitoring and an exper- imental investigation of the role of acid and pepsin in the devel- opment of laryngeal injury. Laryngoscope 1991;101(4 Pt 2 Suppl 53):1-78.
2. Koufman JA. Laryngopharyngeal reflux is different from classic gas- troesophageal reflux disease. Ear Nose Throat J 2002;81(9 Suppl 2):7-9.
3. Postma GN, Belafsky PC, Aviv JE, Koufman JA. Laryngopharyngeal reflux testing. Ear Nose Throat J 2002;81(9 Suppl 2):14-8.
4. Yorulmaz I, Ozlugedik S, Kucuk B. Gastroesophageal reflux dis- ease: symptoms versus pH monitoring results. Otolaryngol Head Neck Surg 2003;129:582-6.
5. Ylitalo R, Lindestad PA, Ramel S. Symptoms laryngeal findings and 24-hour pH monitoring in patients with suspected gastroe- sophago-pharyngeal reflux. Laryngoscope 2001;111:1735-41.
6. Qadeer MA, Swoger J, Milstein C, et al. Correlation between symp- toms and laryngeal signs in laryngopharyngeal reflux. Laryngoscope 2005;115:1947-52.
7. Belafsky PC, Postma GN, Koufman JA. Laryngopharyngeal reflux symptoms improve before changes in physical findings. Laryngoscope 2001;111:979-81.
8. Belafsky PC, Postma GN, Koufman JA. The validity and relia- bility of the reflux finding score (RFS). Laryngoscope 2001;111: 1313-7.

9. Harrell S, Evans B, Goudy S, et al. Design and implementation of an ambulatory pH monitoring protocol in patients with sus- pected laryngopharyngeal reflux. Laryngoscope 2005;115:89-92.
10. Belafsky P C. Symptoms and findings of laryngopharyngeal reflux. Ear Nose Throat J 2002;81(9 Suppl 2):10-13.
11. Abbeele T, Couloigner V, Faure C, Narcy P. The role of 24 h pH- recording in pediatric otolaryngologic gastro-esophageal reflux disease. Int J Pediatr Otorhinolaryngol. 2003;67 Suppl 1:S95-100.
12. Divi V, Benninger MS Diagnosis and management of laryn- gopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg 2006;14:124-7.
13. Koufman JA, Belafsky PC, Bach KK, Daniel E, Postma GN. Prevalence of esophagitis in patients with ph-documented laryn- gopharyngeal reflux. Laryngoscope 2002;112:1606-9.
14. Belafsky PC. Abnormal endoscopic pharyngeal and laryngeal find- ings attributable to reflux. Am J Med 2003;115 Suppl 3A:90S-96S.
15. Belafsky PC, Postma GN, Koufman JA. The association between laryngeal pseudosulcus and laryngopharyngeal reflux. Otolaryngol Head Neck Surg 2002;126:649-52.
16. Reichel O, Keller J, Rasp G, Hagedorn H, Berghaus A. Efficacy of once-daily esomeprazole treatment in patients with laryn- gopharyngeal reflux evaluated by 24-hour pH monitoring. Otolaryngology–Head and Neck Surgery 2007;136:205-10.
17. Hirano I. Review article: modern technology in the diagnosis of gastro-oesophageal reflux disease – Bilitec, intraluminal imped- ance and Bravo capsule pH monitoring. Aliment Pharmacol Ther 2006;23 Suppl 1:12-24.
18. Lam P, Wei WI, Hui Y, Ho WK. Prevalence of pH-document- ed laryngopharyngeal reflux in Chinese patients with clinically suspected reflux laryngitis. Am J Otolaryngol 2006;27:186-9.
19. Mims JW. The impact of extra-esophageal reflux upon diseases of the upper respiratory tract. Curr Opin Otolaryngol Head Neck Surg 2008;16:242-6.
20. Tauber S, Gross M, Issing WJ. Association of laryngopharyngeal symptoms with gastroesophageal reflux disease. Laryngoscope 2002;112:879-86.
21. Bove MJ, Rosen C. Diagnosis and management of laryngopha- ryngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg 2006;14:116-23.
22. Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology- Head and Neck Surgery. Otolaryngol Head Neck Surg 2002;127: 32-5.
23. Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2000;123:385-8.
24. Celik M, Alkan Z, Ercan I, et al. Cricopharyngeal muscle elec- tromyography in laryngopharyngeal reflux. Laryngoscope 2005; 115:138-42.
25. Maceri DR, Zim S. Laryngospasm: an atypical manifestation of severe gastroesophageal reflux disease (GERD). Laryngoscope 2001;111:1976-9.
26. Ulualp SO, Toohill RJ, Shaker R. Pharyngeal acid reflux in patients with single and multiple otolaryngologic disorders. Otolaryngol Head Neck Surg 1999;121:725-30.
27. Ulualp SO, Toohill RJ, Hoffmann R, Shaker R. Pharyngeal pH monitoring in patients with posterior laryngitis. Otolaryngol Head Neck Surg 1999;120:672-7.
28. Murry T, Tabaee A, Aviv JE. Respiratory retraining of refracto- ry cough and laryngopharyngeal reflux in patients with paradox- ical vocal fold movement disorder. Laryngoscope 2004;114: 1341-5.
29. Oridate N, Mesuda Y, Nishizawa N, et al. The prevalence of laryn- geal pseudosulcus among Japanese patients with laryngopharyngeal reflux related symptoms. Auris Nasus Larynx 2005;32:39-42.
30. Del Gaudio JM. Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis. Laryngoscope 2005;115:946-57.
31. Bu açık erişim makalenin, ticari kullanım amacı ve içerik değişikliği dışında kalan çoğaltma, dağıtma vb. tüm kullanım hakları, bilinen standartlarda kay
32. nak olarak gösterilmesi koşuluyla Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND3.0) Lisansı aracılığıyla
33. (http://creativecommons.org/licenses/by-nc-nd/3.0/) bedelsiz kullanıma sunulmuştur.
34. Makalenin atıf künyesi: Kar M, San İ, Korkmaz B, Özgönül A, İynen İ. Farklı belirtilerle başvuran laringofaringeal reflü olgularında 24 saatlik pH
35. monitörizasyon sonuçları. J Med Updates 2012;2(3):106-113.