Müller Dolores Thea, Schulte Elena, Babic Benjamin, Knepper Laura, Fuchs Claudia, Schröder Wolfgang, Bruns Christiane J, Leers Jessica M, Fuchs Hans Friedrich
Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Köln 50937, Germany.
World J Gastrointest Surg. 2020 May 27;12(5):236-246. doi: 10.4240/wjgs.v12.i5.236.
When gastroesophageal reflux contents reach above the upper esophageal sphincter, patients may, in addition to typical reflux symptoms, present with atypical, extraesophageal symptoms related to laryngopharyngeal reflux (LPR). Surgical treatment of LPR has shown to lead to 70% symptom improvement, however no gold standard for the diagnosis of LPR exists. In 2007, the Restech Dx-pH was released as a valid method to measure acid exposure above the upper esophageal sphincter. Recently, a new software update was introduced for analysis of measured pH data and calculation of composite scores. The effect of the changes applied to the new software version have not yet been analyzed.
To compare results generated by DataView 3 to the most recently released DataView 4.
All patients with gastroesophageal reflux disease symptoms were seen in a specialized surgical outpatient clinic for gastrointestinal function testing. Retrospective chart review was performed of all patients presenting with suspected gastroesophageal reflux disease and extraesophageal reflux symptoms, who underwent laryngopharyngeal pH monitoring using the Restech Dx-pH system (Respiratory Technology Corp., Houston, TX, United States) and simultaneous esophageal pH monitoring. DataView 3 and DataView 4 were used to evaluate Restech studies obtained. Diary entries such as mealtimes, supine and upright periods, and symptoms were entered manually to ensure accuracy and precise conversion of data between both software versions. Paired test was performed for statistical analysis of results.
A total of 174 patients (63.8% female) met inclusion criteria, all suffering from extraesophageal reflux symptoms as well as typical gastroesophageal reflux disease symptoms. Mean RYAN score upright was 48.77 in DataView 3 compared to 22.17 in DataView 4, showing a significant difference ( = 0.0001). Similar results were shown for supine period (mean RYAN Score DataView 3 5.29 1.42 in DataView 4, = 0.0001). For upright periods 80 patients showed a decrease of value of the RYAN score with a mean of -58.9 (mean 51.1% decrease). For supine position 25 patients showed a decrease of value of the RYAN score with a mean of -15.13 [range (-153.44)-(-0.01)], which equals a mean decrease of value of 44.5%. Ten patients showed no oropharyngeal acid exposure in DataView 3, but mild/moderate ( = 7) or severe ( = 3) acid exposure in DataView 4. Correlation with positive esophageal pH measurement was improved in all 10 patients.
Results of both software versions cannot be compared to each other. However, our data suggests that DataView 4 may be an improvement of the Restech pH measurement in the evaluation of LPR.
当胃食管反流物到达食管上括约肌上方时，患者除了出现典型的反流症状外，还可能出现与喉咽反流（LPR）相关的非典型食管外症状。LPR的手术治疗已显示可使70%的症状得到改善，然而目前尚无LPR诊断的金标准。2007年，Restech Dx-pH作为一种测量食管上括约肌上方酸暴露的有效方法被推出。最近，引入了一个新的软件更新，用于分析测量的pH数据和计算综合评分。尚未分析应用于新软件版本的更改所产生的影响。
比较DataView 3与最新发布的DataView 4所产生的结果。
所有有胃食管反流病症状的患者均在专门的外科门诊进行胃肠功能测试。对所有疑似胃食管反流病和食管外反流症状、使用Restech Dx-pH系统（美国德克萨斯州休斯顿呼吸技术公司）进行喉咽pH监测并同时进行食管pH监测的患者进行回顾性病历审查。使用DataView 3和DataView 4评估获得的Restech研究。手动输入进餐时间、仰卧和直立时段以及症状等日记条目，以确保两个软件版本之间数据的准确性和精确转换。对结果进行配对检验以进行统计分析。
共有174例患者（63.8%为女性）符合纳入标准，均患有食管外反流症状以及典型的胃食管反流病症状。DataView 3中直立位的平均RYAN评分为48.77，而DataView 4中为22.17，显示出显著差异（ = 0.0001）。仰卧位也显示出类似结果（DataView 3的平均RYAN评分为5.29，DataView 4为1.42， = 0.0001）。在直立时段，80例患者的RYAN评分值下降，平均下降-58.9（平均下降51.1%）。在仰卧位，25例患者的RYAN评分值下降，平均下降-15.13[范围（-153.44）-（-0.01）]，相当于平均下降值44.5%。10例患者在DataView 3中未显示口咽酸暴露，但在DataView 4中显示轻度/中度（ = 7）或重度（ = 3）酸暴露。所有10例患者与食管pH测量阳性的相关性均得到改善。
两个软件版本的结果无法相互比较。然而，我们的数据表明，在评估LPR时，DataView 4可能是Restech pH测量的一种改进。
