Diagnosis of supra-esophageal gastric reflux: correlation of oropharyngeal pH with esophageal impedance monitoring for gastro-esophageal reflux

被引:30
作者
Chiou, E. [1 ]
Rosen, R. [1 ]
Jiang, H. [1 ,2 ]
Nurko, S. [1 ]
机构
[1] Childrens Hosp, Ctr Motil & Funct Gastrointestinal Disorders, Boston, MA 02155 USA
[2] Childrens Hosp, Clin Res Program, Boston, MA 02155 USA
基金
美国国家卫生研究院;
关键词
esophageal impedance; gastro-esophageal reflux; oropharyngeal pH monitoring; supra-esophageal gastric reflux; NONACID REFLUX; NORMAL VALUES; DISEASE; ACID; CHILDREN; PEPSIN; SENSITIVITY; DEFINITION; PARAMETER; EPISODES;
D O I
10.1111/j.1365-2982.2011.01726.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Oropharyngeal (OP) pH monitoring has been developed as a new way to diagnose supra-esophageal gastric reflux (SEGR), but has not been well validated. Our aim was to determine the correlation between OP pH and gastro-esophageal reflux (GER) events detected by multichannel intraluminal impedance-pH (MII-pH). Methods Fifteen patients (11 males, median age 10.8 years) with suspected GER were prospectively evaluated with ambulatory 24-h OP pH monitoring (positioned at the level of the uvula) and concomitant esophageal MII-pH monitoring. Potential OP events were identified by the conventional pH threshold of <4 and by the following alternative criteria: (i) relative pH drop >10% from 15-min baseline and (ii) absolute pH drop below thresholds of <5.5, 5.0, and 4.5. The 2-min window preceding each OP event was analyzed for correlation with an episode of GER detected by MII-pH. Key Results A total of 926 GER events were detected by MII-pH. Application of alternative pH criteria increased the identification of potential OP pH events; however, a higher proportion of OP events had no temporal correlation with GER (45-81%), compared with the conventional definition of pH <4 (40%). A total of 306 full-column acid reflux episodes were detected by MII-pH, of which 10 (3.3%) were also identified by OP pH monitoring. Conclusions & Inferences Use of extended pH criteria increased the detection of potential SEGR events, but the majority of decreases in OP pH were not temporally correlated with GER. Oropharyngeal pH monitoring without concurrent esophageal measurements may overestimate the presence of SEGR in children.
引用
收藏
页码:717 / E326
页数:9
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