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KMID : 1812020230290020174
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Journal of Neurogastroenterology and Motility
2023 Volume.29 No. 2 p.174 ~ p.182
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Distal Mean Nocturnal Baseline Impedance Predicts Pathological Reflux of Isolated Laryngopharyngeal Reflux Symptoms
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Hua-Nong Luo
Chen-Chi Wang
Ying-Cheng Lin
Chun-Yi Chuang
Yung-An Tsou
Ja-Chih Fu
Sheng-Shun Yang
Chi-Sen Chang
Han-Chung Lien
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Abstract
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Background/AimsDiagnosis of isolated laryngopharyngeal reflux symptoms (ILPRS), ie, without concomitant typical reflux symptoms (CTRS), remains difficult. Mean nocturnal baseline impedance (MNBI) reflects impaired mucosal integrity. We determined whether esophageal MNBI could predict pathological esophagopharyngeal reflux (pH+) in patients with ILPRS.
MethodsIn this cross-sectional study conducted in Taiwan, non-erosive or low-grade esophagitis patients with predominant laryngopharyngeal reflux symptoms underwent combined hypopharyngeal multichannel intraluminal impedance-pH monitoring when off acid suppressants. Participants were divided into the ILPRS (n = 94) and CTRS (n = 63) groups. Asymptomatic subjects without esophagitis (n = 25) served as healthy controls. The MNBI values at 3 cm and 5 cm above the lower esophageal sphincter (LES) and the proximal esophagus were measured.
ResultsDistal but not proximal esophageal median MNBI values were significantly lower in patients with pH+ than in those with pH? (ILPRS in pH+ vs pH?: 1607 Ω vs 2709 Ω and 1885 Ω vs 2563 Ω at 3 cm and 5 cm above LES, respectively; CTRS in pH+ vs pH?: 1476 vs 2307 Ω and 1500 vs 2301 Ω at 3 cm and 5 cm above LES, respectively, P < 0.05 for all). No significant differences of any MNBI exist between any pH? subgroups and healthy controls. The areas under the receiver operating characteristic curve in the ILPRS group were 0.75 and 0.80, compared to the pH? subgroup and healthy controls (P < 0.001 for both), respectively. Interobserver reproducibility was good (Spearman correlation 0.93, P < 0.0001).
ConclusionDistal esophageal MNBI predicts pathological reflux in patients with ILPRS.
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KEYWORD
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Diagnosis, Esophageal pH monitoring, Gastroesophageal reflux, Laryngopharyngeal reflux
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