Zusammenfassung
Der extraösophageale Reflux (EER) wird heute in Zusammenhang mit zahlreichen Erkrankungen des oberen Aerodigestivtrakts diskutiert. Er wird mittels 2-Kanal-pH-Metrie gemessen. Es existieren aber nur spärliche Daten über Normalwerte. Deshalb haben wir bei gesunden Probanden (n=40) die Zahl der Refluxereignisse, die Fraktionszeit (Zeitspanne, in der der pH ≤4 ist) und den Refluxflächenindex (RAI) bestimmt. Da bekannt ist, dass Pepsin bereits ab einem pH ≤5 generiert wird, wurden diese Daten zusätzlich bei einem pH ≤5 erhoben. Das Vorliegen einer Refluxerkrankung bei den Probanden wurde anamnestisch, klinisch und durch Berechnung des DeMeester-Scores ausgeschlossen. Insgesamt wurden so die Daten von 30 Probanden der endgültigen Normalwertbestimmung zugeführt. Im 24-stündigen Beobachtungszeitraum betrug der Normalwert für die mittlere Zahl der Refluxe 2,6±0,9 (95er-Perzentile 4,4), die Fraktion 0,1±0,04 (95er-Perzentile 0,2) und für den RAI 3,8±1,5 (95er-Perzentile 6,8). Die Daten für einen Schwellenwert bei pH ≤5 lagen um das 10-fache höher.
Abstract
Extraesophageal reflux (EER) causes multiple diseases of the upper aerodigestive tract. EER is diagnosed by two-channel pH testing. However, little data exist about normal values. Therefore, we performed ambulatory two-channel pH testing in healthy volunteers and determined normal values for the number of reflux episodes, fraction, and reflux area index. These values were determined for pH ≤4 as commonly used as well as for pH ≤5 because pepsin is still generated at a pH of 5. In 40 healthy volunteers, ambulatory 24-h two-channel pH testing was performed. Asymptomatic gastroesophageal reflux was excluded by the DeMeester index. Ten subjects with a DeMeester score >14.72 were excluded from the evaluation. In the other patients, the mean number of reflux episodes was 2.6±0.9 (95th percentile 4.4), the fraction of pH ≤4 was 0.1±0.04% (95th percentile 0.2), and the reflux area index was 3.8±1.5 (95th percentile 6.8). Data for the threshold of pH ≤5 were 10 times higher.
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Literatur
Aviv JE, Liu H, Parides M et al. (2000) Laryngopharyngeal sensory deficits in patients with laryngopharyngeal reflux and dysphagia. Ann Otol Rhinol Laryngol 109: 1000–1006
Belafsky PC, Postma GN, Koufman JA (2001) The validity and reliability of the reflux finding score (RFS). Laryngoscope 111: 1313–1317
DiBaise JK, Olusola BF, Huerter JV, Quigley EM (2002) Role of GERD in chronic resistant sinusitis: a prospective, open label, pilot trial. Am J Gastroenterol 97: 843–850
Harding SM, Guzzo MR, Richter JE (2000). The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med 162: 34–39
Jecker P, Schuon R, Mann WJ (2003) The need for 24-h double probe pH monitoring in the diagnosis of laryngo-pharyngeal reflux. HNO 51: 704–709
Jecker P, Orloff L, Mann WJ (2005) Extraesophageal reflux and upper aerodigestive tract diseases. ORL J Otorhinolaryngol Relat Spec 7: 185–191
Johnson LF, Demeester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62: 325–332
Koufman JA (1991) 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 101: 1–78
Koufman JA, Belafsky PC, Bach KK et al. (2002) Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. Laryngoscope 112: 1606–1609
Mainie I, Tutuian R, Shay S et al. (2006) Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance pH-monitoring. Gut 55: 1398–1402
Meyer TK, Olsen E, Merati A (2004) Contemporary diagnostic and management techniques for extraesophageal reflux disease. Curr Opin Otolaryngol Head Neck Surg 12: 519–524
Noordzij JP, Khidr A, Desper E et al. (2002) Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope 112: 2192–2195
Postma GN (2000) Ambulatory pH monitoring methodology. Ann Otol Rhinol Laryngol Suppl 184: 10–14
Powitzky E (2002) Extraesophageal reflux: the role in laryngeal disease. Curr Opin Otolaryngol Head Neck Surg 10: 485–491
Schade G, Hess M (2002) Clinical management of reflux laryngitis. HNO 50: 172–176
Smit CF, Tan J, Devriese PP et al. (1998) Ambulatory pH measurements at the upper esophageal sphincter. Laryngoscope 108: 299–302
Tasker A, Dettmar PW, Panetti M et al. (2002) Is gastric reflux a cause of otitis media with effusion in children? Laryngoscope 112: 1930–1934
Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M et al. (1989) Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants. J Pediatr Gastroenterol Nutr 9: 34–39
Vincent DAJ, Garrett JD, Radionoff SL et al. (2000) The proximal probe in esophageal pH monitoring: development of a normative database. J Voice 14: 247–254
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Jecker, P., Schuon, R., Morales, C. et al. Normalwertbestimmung des extraösophagealen Reflux (EER) in der 24-h-2-Kanal-pH-Metrie. HNO 56, 1040–1045 (2008). https://doi.org/10.1007/s00106-008-1672-7
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DOI: https://doi.org/10.1007/s00106-008-1672-7