Hans F Fuchs, MD, Sebastian Brinkmann, MD, Dolores Mueller, Martin Maus, Marc Bludau, MD, Wolfgang Schroeder, Professor, Christiane J Bruns, Professor, Jessica M Leers, MD. University of Cologne, Department of General Surgery, Cologne Germany
Introduction: 24-hour esophageal pH metry is not designed to detect laryngopharyngeal reflux (LPR). The new Laryngopharyngeal pH-monitoring system (Restech) may detect LPR better. There is no established correlation between these two techniques as only small case series exist. Aim of this study is to examine the correlation between the two techniques with a large patient collective.
Methods: All patients received a complete diagnostic work-up for gastroesophageal reflux including symptoms, endoscopy, 24h pH-metry, high resolution manometry and Restech. One-hundred consecutive patients with suspected gastroesophageal reflux disease-related extra-esophageal symptoms were evaluated using 24-h laryngopharyngeal and concomitant esophageal pH-monitoring. Subsequently, the relationship between the two techniques was evaluated.
Results: A total of 100 patients from 12/2013 – 08/2016 were included. Many patients presented extraesophageal symptoms such as cough (50%), hoarseness (36%), and globus sensation (31%). Classical reflux symptoms such as heart burn (63%), regurgitation (54%), retrosternal pain (47%), and dysphagia (31%) were also present. Extraesophageal symptoms without classical symptoms existed in 8 patients (8%). The 24 hour pH metry was positive in 71 patients(71%) with a mean DeMeester Score of 73.8 [15-292]. In 24% of patients (n=7) with normal pH-metry, Restech evaluation was pathologic with a mean DeMeester-score of 9.4 [1-13] and a mean Ryan score of 45 [8-85]). In 38% of patients with pathologic esophageal pH-metry, Restech evaluation was normal (n=27, mean DeMeester-score=66.9 [15-255], mean Ryan score=2.8 [2-8]).
Fig.1: Distributon of pH-metry results (ResTech/classic esophageal), ResTech pH probe and intraoral placement
Conclusion: Restech evaluation was positive in more than 40% of cases. Correlation with esophageal pH-metry was weak. Especially in patients with borderline elevated results in 24 hour pH metry, the Restech examination may help to support the decision for or against surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80080
Program Number: S025
Presentation Session: Foregut 1
Presentation Type: Podium