The value of laryngopharyngeal pH-Metry (Restech©) in patients with GERD and extraesophageal symptoms

Hans F Fuchs, MD¹, Henner M Schmidt, MD², Sebastian Brinkmann, MD¹, Wolfgang Schroder, MD¹, Christian A Gutschow, MD², Arnulf H Holscher, MD¹, Jessica M Leers, MD¹. ¹Department of Surgery, University of Cologne, Germany, ²Department of Surgery, University Hospital Zurich, Switzerland

Introduction: The evaluation of extraesophageal reflux symptoms is difficult and mostly based on patient’s history. With the introduction of Restech© objective measurements of laryngopharyngeal reflux became possible. The aim of this study is to evaluate the value of Restech© in patients with GERD and extraesophageal refluxsymptoms.

Methods and Procedures: Retrospective analysis of all patients who received a complete diagnostic work-up for reflux including symptoms, endoscopy, 24h pH-metry, high resolution manometry and Restech. For comparison a well evaluated scoring system was used.

Figure: Restech© device in place, transoral view

Results: A total of 26 patients consecutive patients from 12/2013 – 03/2015 were included. They all had extraesophageal symptoms such as cough (54%), hoarseness (42%), globus sensation (31%) and asthma (8%). Classical symptoms such as heart burn (58%), regurgitation (46%), odynophagia (19%) and retrosternal pain (19%) were also present. Extraesophageal symptoms without classical symptoms existed in 2 patients (18%). The 24 hours pH metry was positive in 73% (n=19, DeMeester Score 96 [16-285])  and normal  in 27% of patients (n=7, DeMeester-Score=9 [0-14]). Restech evaluation in patients with pathologic pH metry was positive in 8/19 cases (median DeMeester-Score=69 [16-285], median Ryan score=210 [35-650]). In 71% pf patients with normal pH-metry, Restech evaluation was pathologic (n=5, median DeMeester-score=12 [10-14], median Ryan score=67 [55-82]).

Conclusions: Restech Evaluation was positive in more than 50% of cases. Especially in patients with borderline elevated results in 24 hour pH metry, the restech examination helps support the decision for or against surgery. To validate this technique further studies which include post-operative data are necessary and currently ongoing.