Advertisement

Dysphagia

, Volume 19, Issue 4, pp 248–255 | Cite as

Laryngopharyngeal Reflux: Trends in Diagnostic Interpretation Criteria

  • Brynn E. Richardson
  • Barbara M. HeywoodEmail author
  • H. Steven Sims
  • Julie Stoner
  • Donald A. Leopold
Article

Abstract

Laryngopharyngeal reflux (LPR) is becoming recognized as a clinical entity with a variety of presentations distinct from those of gastroesophageal reflux disease (GERD). However, much uncertainty remains as to what is considered pathologic versus physiologic reflux. The aim of the study was to determine the normal range of pharyngeal reflux (PR) occurring in healthy adults based on pH-monitoring parameters utilized in the DeMeester scoring system for GERD. We have reviewed the current pool of prospective literature examining ambulatory dual-channel pH-monitoring study data derived from hypopharyngeal proximal probes in normal adults. From our review we have identified trends in several monitoring parameters based on the DeMeester scoring system for GERD. Our discussion recognizes and accepts the limitations imposed by small sample sizes and the number of healthy individuals that would be required to determine the general adult physiologic range of PR. We also explore the possible need for separate normal PR reference intervals based on age or gender disparities. Additional discussion and the summary address future directions for LPR research notably, (1) identification of the most appropriate research paradigm for LPR (i.e., pH 4 vs. 5), (2) establishing reproducibility for the appropriate LPR research paradigm, and (3) complementary modalities to ambulatory dual-channel pH monitoring for the study of acid and nonacid bolus movement within the esophagus

Keywords

Laryngopharyngeal reflux Pharyngeal reflux Extraesophageal reflux Gastroesophageal reflux Acid reflux Deglutition Deglutition disorders 

References

  1. 1.
    Barbero, GJ 1996Gastroesophageal reflux and upper airway disease: A commentaryOtolaryngol Clin North Am292738PubMedGoogle Scholar
  2. 2.
    Wong, RK, Hanson, DG, Waring, PJ, Shaw, G 2000ENT manifestations of gastroesophageal refluxAm J Gastroenterol95s1522CrossRefPubMedGoogle Scholar
  3. 3.
    Koufman, JA, Aviv, JE, Casiano, RR, Shaw, GY 2002Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology–Head and Neck SurgeryOtolaryngol Head Neck Surg1273235CrossRefPubMedGoogle Scholar
  4. 4.
    Tuttle, SG, Grossman, MI 1958Detection of gastroesophageal reflux by simultaneous measurement of intraluminal pressure and pHProc Soc Exp Biol Med98225227PubMedGoogle Scholar
  5. 5.
    Postma, GN 2000Ambulatory pH monitoring methodologyAnn Otol Rhinol Laryngol1091014Google Scholar
  6. 6.
    Richter, JE 1997Ambulatory esophageal pH monitoringAm J Med103131s134 sCrossRefGoogle Scholar
  7. 7.
    Dhiman, RK, Saraswat, VA, Naik, SR 2002Ambulatory esophageal pH monitoring: technique, interpretations, and clinical indicationsDig Dis Sci47241250CrossRefPubMedGoogle Scholar
  8. 8.
    Smit, CF, Tan, J, Devriese, PP, Mathus-Vliegen, LMH, Brandsen, M, Schouwenburg, PF 1998Ambulatory pH measurements at the upper esophageal sphincterLaryngoscope108299302CrossRefPubMedGoogle Scholar
  9. 9.
    Richter, JE, Bradley, LA, DeMeester, TR, Wu, WC 1992Normal 24-hour ambulatory esophageal pH values: influence of study center, pH electrode, age and genderDig Dis Sci37849856PubMedGoogle Scholar
  10. 10.
    Dobhan, R, Castell, DO 1993Normal and abnormal proximal esophageal acid exposure: results of ambulatory dual-probe pH monitoringAm J Gastroenterol882529PubMedGoogle Scholar
  11. 11.
    Kahrilas, PJ, Quigley, EMM 1996Clinical esophageal pH recording: a technical review for practice guideline developmentGastroenterology11019821996PubMedGoogle Scholar
  12. 12.
    Jacob, P, Kahrilas, PJ, Herzon, G 1991Proximal esophageal pH-metry in patients with “reflux laryngitis.”Gastroenterology100305310PubMedGoogle Scholar
  13. 13.
    Wiener, GJ, Koufman, JA, Wu, WC, Cooper, JB, Richter, JE, Castell, DO 1989Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-hour ambulatory pH monitoringAm J Gastroenterol8415031508PubMedGoogle Scholar
  14. 14.
    Johnson, LF, DeMeester, TR 1974Twenty-four hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal refluxAm J Gastroenterol62325332PubMedGoogle Scholar
  15. 15.
    Koufman, JA 1991The otolaryngologic manifestations of gastroesophageal reflux disease: a clinical investigation of 225 patients using ambulatory 24-h pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injuryLaryngoscope101178Google Scholar
  16. 16.
    Oelschlager, BK, Eubanks, TR, Maronian, N, Hillel, A, Oleynikov, D, Pellegrini, CA 2002Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gastroesophageal–laryngeal refluxJ Gastrointest Surg6189194CrossRefPubMedGoogle Scholar
  17. 17.
    Shaker, R, Milbrath, M, Ren, J, Toohill, R, Hogan, WJ, Li, Q, Hofmann, CL 1995Esophagopharyngeal distribution of refluxed gastric acid in patients with reflux laryngitisGastroenterology10915751582PubMedGoogle Scholar
  18. 18.
    Toohill, RJ, Ulualp, SO, Shaker, R 1998Evaluation of gastroesophageal reflux in patients with laryngotracheal stenosisAnn Otol Rhinol Laryngol10710101014PubMedGoogle Scholar
  19. 19.
    Ulualp, SO, Toohill, RJ, Hoffman, R, Shaker, R 1999Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitisAm J Rhinol13197202PubMedGoogle Scholar
  20. 20.
    Ulualp, SO, Toohill, RJ, Shaker, R, Ulualp, SO, Toohill, RJ, Shaker, R .Pharyngeal acid reflux in patients with single and multiple otolaryngologic disordersOtolaryngol Head Neck Surg121725730CrossRefGoogle Scholar
  21. 21.
    Ulualp, SO, Toohill, RJ, Hoffman, R, Shaker, R 1999Pharyngeal pH monitoring in patients with posterior laryngitisOtolaryngol Head Neck Surg120672677CrossRefPubMedGoogle Scholar
  22. 22.
    Vincent, DA,Jr, Garrett, JD, Radionoff, SL, Reussner, LA, Stasney, CR 2000The proximal probe in esophageal pH monitoring: development of a normative databaseJ Voice14247254PubMedGoogle Scholar
  23. 23.
    Ylitalo, R, Ramel, S 2002Extraesophageal reflux in patients with contact granuloma: a prospective controlled studyAnn Otol Rhinol Laryngol111441446PubMedGoogle Scholar
  24. 24.
    Ylitalo, R, Lindestad, PA, Ramel, S 2001Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal refluxLaryngoscope11117351741CrossRefPubMedGoogle Scholar
  25. 25.
    Bove, M, Ruth, M, Cange, L, Månsson, I 200024-H pH monitoring in healthy volunteers: a normative studyScand J Gastroenteroul35234241CrossRefGoogle Scholar
  26. 26.
    Eubanks, TR, Omelanczuk, PE, Maronian, N, Hillel, A, Pope, CE,II, Pellegrini, CA 2001Pharyngeal pH monitoring in 222 patients with suspected laryngeal refluxJ Gastrointest Surg5183190CrossRefPubMedGoogle Scholar
  27. 27.
    Axford, S, Sharp, N, Ross, PE, Pearson, JP, Dettmar, PW, Panetti, M, Koufman, JA 2001Cell biology of laryngeal defenses in health and disease: preliminary studiesAnn Otol Rhinol Laryngol11010991108PubMedGoogle Scholar
  28. 28.
    Hampton, FJ, MacFadyen, UM, Simpson, H 1990Reproducibility of 24 hour oesophageal pH studies in infantsArch Dis Child6512491254PubMedGoogle Scholar
  29. 29.
    Jamieson, JR, Stein, HJ, DeMeester, TR, Bonavina, L, Schwizer, W, Hinder, RA, Albertucci, M 1992Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibilityAm J Gastroenterol8711021111PubMedGoogle Scholar
  30. 30.
    Wiener, GJ, Morgan, TM, Copper, JB, Wu, WC, Castell, DO, Sinclair, JW, Richter, JE 1988Ambulatory 24-hour esophageal pH monitoring: Reproducibility and variability of pH parametersDig Dis Sci3311271133PubMedGoogle Scholar
  31. 31.
    Vaezi, MF, Schroeder, PL, Richter, JE 1997Reproducibility of proximal probe pH parameters in 24-h ambulatory esophageal pH monitoringAm J Gastroenterol92825829PubMedGoogle Scholar
  32. 32.
    Bardan, E, Xie, P, Brasseur, J, Dua, K, Ulualp, SO, Kern, M, Shaker, R 2000Effect of aging on the upper and lower oesophageal sphinctersEur J Gastroenterol1212211225Google Scholar
  33. 33.
    Kahrilas, PJ, Dodds, WJ, Dent, J, Haeberle, B, Hogam, WJ, Andofer, RC 1987Effect of sleep, spontaneous gastroesophageal reflux and a meal on upper esophageal sphincter pressure in normal human volunteersGastroenterology92466471PubMedGoogle Scholar
  34. 34.
    Knight, RE, Wells, JR, Parrish, RS 2000Esophageal dysmotility as an important cofactor in extraesophageal manifestations of gastroesophageal refluxLaryngoscope11014621466CrossRefPubMedGoogle Scholar
  35. 35.
    Shaker, R, Dodds, WJ, Ren, J, Hogam, WJ, Arndorfer, RC 1992Esophagoglottal closure reflex: a mechanism of airway protectionGastroenterology102857861PubMedGoogle Scholar
  36. 36.
    Shaker, R 2000Protective mechanisms against supraesophageal GERDJ Clin Gastroenterol30s38CrossRefPubMedGoogle Scholar
  37. 37.
    Torrico, S, Ren, J, Sui, Z, Hofmann, C, Shaker, R 1998Upper esophageal sphincter function during gastroesophageal reflux events [abstract]Gastroenterology114G3481Google Scholar
  38. 38.
    Gerhardt, DC, Shuck, TJ, Bordeaux, EA 1978Human upper esophageal sphincter. Response to volume, osmotic and acid stimuliGastroenterology75268274PubMedGoogle Scholar
  39. 39.
    Vakil, N, Kahrilas, PG, Dodds, W, Vanagunas, A 1989Absence of an upper esophageal sphincter response to acid refluxAm J Gastroenterol84606610PubMedGoogle Scholar
  40. 40.
    Linet, K 1987Two-stage transformation systems for normalization of reference distributions evaluatedClin Chem33381386PubMedGoogle Scholar
  41. 41.
    Delahunty, JE, Cherry, J 1968Experimentally produced vocal cord granulomasLaryngoscope7819411947PubMedGoogle Scholar
  42. 42.
    Panetti M, ReVille J, Clyne S, et al.: Clinical implications of the functional stability of pepsin. Presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery, September 1998, San Antonio, TXGoogle Scholar
  43. 43.
    Shay, SS, Bomeli, S, Richter, J 2002Multichannel intraluminal impedance accurately detects fasting, recumbent reflux events and their clearingAm J Physiol Gastrointest Liver Physiol283G376G383PubMedGoogle Scholar
  44. 44.
    Castell, DO, Vela, M 2001Combined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal refluxAm J Med111157S159SCrossRefPubMedGoogle Scholar
  45. 45.
    Srinivasan, R, Vela, MF, Katz, PO, Tutuian, R, Castell, JA, Castell, DO 2001Esophageal function testing using multichannel intraluminal impedanceAm J Physiol Gastrointest Liver Physiol280G457G462PubMedGoogle Scholar

Copyright information

© Springer 2004

Authors and Affiliations

  • Brynn E. Richardson
    • 1
  • Barbara M. Heywood
    • 1
    Email author
  • H. Steven Sims
    • 1
  • Julie Stoner
    • 2
  • Donald A. Leopold
    • 1
  1. 1.Department of Otolaryngology–Head and Neck SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of Preventive and Societal MedicineUniversity of Nebraska Medical CenterOmahaUSA

Personalised recommendations