Luo Hua-Nong, Wang Chen-Chi, Lin Ying-Cheng, Chuang Chun-Yi, Tsou Yung-An, Fu Ja-Chih, Yang Sheng-Shun, Chang Chi-Sen, Lien Han-Chung
Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
J Neurogastroenterol Motil. 2023 Apr 30;29(2):174-182. doi: 10.5056/jnm22049.
BACKGROUND/AIMS: Diagnosis of isolated laryngopharyngeal reflux symptoms (ILPRS), ie, without concomitant typical reflux symptoms (CTRS), remains difficult. Mean nocturnal baseline impedance (MNBI) reflects impaired mucosal integrity. We determined whether esophageal MNBI could predict pathological esophagopharyngeal reflux (pH+) in patients with ILPRS.
In this cross-sectional study conducted in Taiwan, non-erosive or low-grade esophagitis patients with predominant laryngopharyngeal reflux symptoms underwent combined hypopharyngeal multichannel intraluminal impedance-pH monitoring when off acid suppressants. Participants were divided into the ILPRS (n = 94) and CTRS (n = 63) groups. Asymptomatic subjects without esophagitis (n = 25) served as healthy controls. The MNBI values at 3 cm and 5 cm above the lower esophageal sphincter (LES) and the proximal esophagus were measured.
Distal but not proximal esophageal median MNBI values were significantly lower in patients with pH+ than in those with pH- (ILPRS in pH+ vs pH-: 1607 Ω vs 2709 Ω and 1885 Ω vs 2563 Ω at 3 cm and 5 cm above LES, respectively; CTRS in pH+ vs pH-: 1476 vs 2307 Ω and 1500 vs 2301 Ω at 3 cm and 5 cm above LES, respectively, < 0.05 for all). No significant differences of any MNBI exist between any pH- subgroups and healthy controls. The areas under the receiver operating characteristic curve in the ILPRS group were 0.75 and 0.80, compared to the pH- subgroup and healthy controls ( < 0.001 for both), respectively. Interobserver reproducibility was good (Spearman correlation 0.93, < 0.0001).
Distal esophageal MNBI predicts pathological reflux in patients with ILPRS.
背景/目的：孤立性喉咽反流症状（ILPRS），即无伴随典型反流症状（CTRS）的诊断仍然困难。平均夜间基线阻抗（MNBI）反映黏膜完整性受损。我们确定食管MNBI是否能预测ILPRS患者的病理性食管咽反流（pH+）。
在台湾进行的这项横断面研究中，以喉咽反流症状为主的非糜烂性或轻度食管炎患者在停用抑酸剂时接受下咽多通道腔内阻抗-pH联合监测。参与者分为ILPRS组（n = 94）和CTRS组（n = 63）。无食管炎的无症状受试者（n = 25）作为健康对照。测量食管下括约肌（LES）上方3 cm和5 cm以及食管近端的MNBI值。
pH+患者食管远端而非近端的MNBI中位数显著低于pH-患者（ILPRS组中，LES上方3 cm处pH+与pH-分别为1607 Ω 对2709 Ω，5 cm处为1885 Ω 对2563 Ω；CTRS组中，LES上方3 cm处pH+与pH-分别为1476对2307 Ω，5 cm处为1500对2301 Ω，所有比较均P < 0.05）。任何pH-亚组与健康对照之间的MNBI均无显著差异。与pH-亚组和健康对照相比，ILPRS组的受试者工作特征曲线下面积分别为0.75和0.80（两者均P < 0.001）。观察者间的可重复性良好（Spearman相关性为0.93，P < 0.0001）。
食管远端MNBI可预测ILPRS患者的病理性反流。
