The need for 24-h double probe pH monitoring in the diagnosis of laryngo-pharyngeal reflux

Background. Laryngopharyngeal reflux disease (LPRD) can have various causes. Because LPRD differs from gastroesophageal reflux disease (GERD), the pH monitoring has to be performed directly next to the entrance of the larynx. This is now possible using a new system called pH-RESPONSE Methods. The ambulatory pH was monitored using the double probe pH-RESPONSET(TM) in 20 patients with suspected LPRD. The number of refluxes, the number of long refluxes and the period in which the pH was below 4 were compared at the level of the larynx with the data from the esophageal electrode. The DeMeester score was also determined. Results. The system was well tolerated by 19/20 patients. In 12 patients a GERD could be proved and ten also had LPRD. Surprisingly, these patients had no typical signs such as heart burn. The number of refluxes measured in the esophagus was a third that of the larynx. The average time of pH below 4 was 30 min. Conclusion. The pH-RESPONSE(TM) easily allows ambulatory 24-h double probe pH monitoring to diagnose LPRD. Because large differences were found between data form the esophagus from the level of the larynx, 24-h double probe pH monitoring should be a standard procedure before starting any therapy for LPRD.