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. 2016 Oct 28;22(40):8991-8998.
doi: 10.3748/wjg.v22.i40.8991.

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

Sandro Passaretti  1 , Giorgia Mazzoleni  1 , Cristian Vailati  1 , Pier Alberto Testoni  1
Affiliations

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

Sandro Passaretti et al. World J Gastroenterol. .

Abstract

Aim: To investigate the relationship between pathological oropharyngeal (OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes.

Methods: In this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease (GERD). We enrolled only patients with a reflux symptom index (RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal high-resolution manometry (HRM). Patients were divided into two groups on the basis of a normal or pathological pH-metric finding (Ryan Score) and all manometric characteristics of the two groups were compared.

Results: We examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure (median 71 mmHg vs 126 mmHg, P = 0.004) and the median proximal contractile integral (median 215.5 cm•mmHg•s vs 313.5 cm•mmHg•s, P = 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mmHg isobaric contour (38.7% vs 15.38%, P < 0.0001).

Conclusion: In patients with suspected GERD-related extra-esophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility.

Keywords: Esophagus; Gastroesophageal reflux disease; High resolution manometry; Motility; Oropharyngeal reflux; pH-metry.

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Conflict of interest statement

Conflict-of-interest statement: All authors have no competing financial, professional or personal interests that might have influenced the performance or presentation of the study.

Figures

Figure 1
Figure 1
The proximal contractile integral. The proximal contractile integral (PCI) is calculated applying the same algorithm used for the distal contractile integral to quantify contractile pressure exceeding 20 mmHg in the region outlined by the white line. The high- resolution manometry tracing on the left refers to a patient with pathological oropharyngeal (OP) acid exposure (weaker PCI = lighter colors), while the tracing on the right refers to a patient with normal OP acid exposure (stronger PCI = darker color).
Figure 2
Figure 2
Clinical manifestations of the study population. Number of patients with normal or pathological oropharyngeal acid exposure. Differences between groups are not statistically significant.
See this image and copyright information in PMC

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