Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Controlled Clinical Trial
. 2012 Jan;16(1):16-24; discussion 24-5.
doi: 10.1007/s11605-011-1741-1. Epub 2011 Oct 28.

How much pharyngeal exposure is "normal"? Normative data for laryngopharyngeal reflux events using hypopharyngeal multichannel intraluminal impedance (HMII)

Toshitaka Hoppo  1 , Alejandro F Sanz, Katie S Nason, Thomas L Carroll, Clark Rosen, Daniel P Normolle, Nicholas J Shaheen, James D Luketich, Blair A Jobe
Affiliations
Controlled Clinical Trial

How much pharyngeal exposure is "normal"? Normative data for laryngopharyngeal reflux events using hypopharyngeal multichannel intraluminal impedance (HMII)

Toshitaka Hoppo et al. J Gastrointest Surg. 2012 Jan.

Abstract

Background: Laryngopharyngeal reflux (LPR) can cause atypical symptoms, asthma, and pulmonary fibrosis. The aim of this study was to establish the normative data for LPR using hypopharyngeal multichannel intraluminal impedance-pH (HMII).

Methods: Asymptomatic subjects underwent endoscopy followed by 24-h HMII using a specialized impedance catheter configured to detect LPR before and after a 2-week course of proton pump inhibitors (PPI). Subjects were excluded if they had esophageal pathology or a positive DeMeester score. A cohort of 24 LPR patients who had a complete response to treatment was used for comparison with the normative data.

Results: Forty subjects were enrolled. Thirty-four subjects completed one, and 25 completed both HMII testing periods off and on PPI. There was no difference in the total number of reflux events between off and on PPI [22 (8-32) and 24 (10-28), respectively, p = 0.89]. The 95th percentiles of LPR off and on PPI were 0 and 1, respectively. All patients with treatment responsive LPR had pre-treatment HMII values of LPR greater than the 95th percentile.

Conclusion: LPR events are rare in an asymptomatic population. One or more LPR events should be considered abnormal in patients with LPR symptoms regardless of whether there is a positive DeMeester score.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
A specialized, bifurcated impedance catheter configured to detect LPR. The long arm branch of the catheter had two electrode pairs positioned at 3 and 5 cm proximal to the esophagogastric junction with the pH sensor positioned 5 cm proximal to the junction. The short arm branch had two electrode pairs each in the proximal esophagus and the hypopharynx with the second pH sensor located 0.5 cm proximal to the cricopharyngeus muscle
Fig. 2
Fig. 2
Impedance tracing of acid LPR. Acid LPR is defined when retrograde bolus transit occurs across all ring sets and ultimately reaches the hypopharynx in addition to both esophageal and pharyngeal pH sensors dropping <4
Fig. 3
Fig. 3
Flow chart of study subjects. From a total of 75 subjects who responded to the advertisements, 40 subjects were enrolled. Forty subjects underwent HMII off PPI and 33 on PPI. Complete data sets were available for final analysis in 34 subjects off PPI and 25 subjects on PPI
Fig. 4
Fig. 4
Normal subjects (off PPI) vs. treatment responsive LPR patients (off PPI). All patients with treatment responsive LPR had pre-treatment HMII values greater than the 95th percentile values of normal subjects in all criteria except total number of reflux events
See this image and copyright information in PMC

References

    1. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991 Apr;101(4 Pt 2 Suppl 53):1–78. - PubMed
    1. Lang IM, Haworth ST, Medda BK, Roerig DL, Forster HV, Shaker R. Airway responses to esophageal acidification. Am J Physiol Regul Integr Comp Physiol. 2008 Jan;294(1):R211–R219. - PubMed
    1. Barry DW, Vaezi MF. Laryngopharyngeal reflux: More questions than answers. Cleve Clin J Med. 2010 May;77(5):327–334. - PubMed
    1. Vaezi MF, Qadeer MA, Lopez R, Colabianchi N. Laryngeal cancer and gastroesophageal reflux disease: a case–control study. Am J Med. 2006 Sep;119(9):768–776. - PubMed
    1. Carrau RL, Khidr A, Crawley JA, Hillson EM, Davis JK, Pashos CL. The impact of laryngopharyngeal reflux on patient-reported quality of life. Laryngoscope. 2004 Apr;114(4):670–674. - PubMed

Publication types

Substances