RESUMEN
Objective@#To evaluate the feasibility of pepsin strip test in the diagnosis of laryngopharyngeal reflux.@*Methods@#From August 2017 to September 2018,80 patients in Department of Otorhniolaryngology Head and Neck Surgery,Chinese People′s Liberation Army General Hospital-Six Medical Centre, underwent pepsin strip test and 24-hour multichannel intraluminal impedance(MII)-pH monitoring. The results of the two methods were analyzed for consistency,and 24-hour MII-pH monitoring was used as a statistical reference for the sensitivity and specificity of pepsin strip test in the diagnosis of laryngopharyngeal reflux. Data were analyzed by SPSS 19.0 software.@*Results@#There were 57 patients with positive pepsin test strip and 23 patients with negative pepsin test strip. The score of reflux symptoms and signs, and the positive rate of laryngopharyngeal reflux events in patients with positive pepsin strip test were significantly higher than those in patients with negative pepsin test strip. If there was one or more throat reflux events (including acid reflux,weak acid reflux and alkali reflux) as the positive results of 24-hour MII-pH monitoring,the consistency between the results of pepsin strip and 24-hour MII-pH was moderate (Kappa=0.614). The sensitivity and specificity of pepsin strip were 86.9% (53/61) and 78.9% (15/19) respectively.@*Conclusions@#Pepsin strip detection has the advantages of non-invasive,cheap and easy to operate.As an objective method for early diagnosis of laryngopharyngeal reflux, pepsin strip detectionis feasible,but can not be the final diagnosis for laryngopharyngeal reflux disease.
RESUMEN
Objective@#To observe the incidence and to determine the significance of laryngopharyngeal reflux (LPR) in laryngeal cancer and vocal leukoplakia.@*Methods@#The patients who had been diagnosed as laryngeal cancer or vocal leukoplakia between January 2014 and June 2017 were included in this study. All of them received 24-hour multichannel intraluminal impedance-pH monitoring. The prevalence of LPR and numerous parameters from the 24-hour pH monitoring in laryngeal cancer patient and vocal leukoplakia patient groups were analyzed. The chi-square test was used for counting data, t test and Mann-Whitney U were used for measuring data.@*Results@#In the 91 laryngeal cancer patients, the prevalence of pathologic LPR was 28.6%(26/91), the median number[P25, P75, P95]of acid reflux events was 0[0, 3, 5], time of acid exposure was 0[0, 14, 234]s, number of weakly acidic reflux events was 3[0, 6, 11]. In the 54 vocal leukoplakia patients, the prevalence of pathologic LPR was 29.6%(16/54), the number of acid reflux events was 0[0, 3, 4], time of acid exposure was 0[0, 13, 118]s, number of weakly acidic reflux events was 1.5[0, 5, 9]. The incidence of LPR did not vary in the laryngeal cancer patient and vocal leukoplakia patient groups, but were both higher than healthy Chinese volunteers according to a report in the other literature. Furthermore, all the three patients with no history of tobacco or alcohol existed acid or weakly acidic reflux episodes.@*Conclusions@#Laryngopharyngeal reflux might play a role as an etiologic factor in laryngeal cancer and vocal leukoplakia.
RESUMEN
Objective@#The consistency and characteristics of 24-hour multichannel intraluminal impedance(MII)-pH monitoring and Dx-pH monitoring in the diagnosis of laryngopharyngeal reflux were investigated.@*Methods@#Fifty-two patients with laryngopharyngeal reflux related symptoms or disease between March and October 2017 were included in this study.All patients were evaluated with 24-hour MII-pH monitoring and Dx-pH monitoring at the same time, recording each patient′s number of positive laryngopharyngeal reflux events, time of acid clearance and Ryan index.The data was analysed with Mann-Whitney U test and consistency check.@*Results@#Among all 52 patients, 16 patients(30.7%) had a positive MII-pH monitoring result and 14 patients(26.9%) had a positive Dx-pH monitoring results.The consistency of both technique for measurement of laryngopharyngeal reflux was general(κ=0.626). With MII-pH monitoring for reference, the sensitivity and specificity of 24-hour pH monitoring were 68.8% and 91.7%.A total of 62 positive reflux events(pH<4) were measured with MII-pH monitoring, and 50 positive reflux events(upright pH<5.5 or supine pH<5.0)were detected by Dx-pH monitoring.There were 44 positive reflux events detected by both techniques, the mean time of acid clearance was 22.8[13.5; 42.6] s. Correspondingly, 18 reflux events were measured by MII-pH monitoring without positive results of Dx-pH monitoring, the mean time of acid clearance was 5.2[3.5; 6.5] s. There was significant difference in the time of acid clearance between two groups(U=858.5, P<0.05).@*Conclusions@#Dx-pH monitoring can accurately measure the change of pH value in airway, but exists the possibility of misdiagnosis especially when the time of acid clearance in laryngopharynx is short. MII-pH and Dx-pH monitoring can be complementary technique in the diagnosis of laryngopharyngeal reflux.
RESUMEN
Laryngopharyngeal reflux has become increasingly prevalent and received more and more attention. The "gold standard" for identifying and measuring laryngopharyngeal reflux disease is 24-hour multichannel intraluminal impedance pH monitoring. In this paper, we review the clinical application of this monitoring technology.
Asunto(s)
Humanos , Impedancia Eléctrica , Monitorización del pH Esofágico , Reflujo Gastroesofágico , Reflujo Laringofaríngeo , DiagnósticoRESUMEN
<p><b>OBJECTIVE</b>To explore the diagnostic characteristics of 24 hours multichannel intraluminal impedance-pH (MII-pH) monitoring in patients with laryngopharyngeal reflux (LPR).</p><p><b>METHODS</b>Patients who were suspected to have laryngopharyngeal reflux (LRP) between February and December 2014 were included. The frequency of pH < 4 waveform, artifacts, numbers of acid reflux events, weakly acidic reflux events, weakly alkaline reflux events, time of acid exposure, time of acid clearance, acid reflux events in upright position and supine position, reflux symptom index(RSI) and reflux findings score (RFS) were analyzed.</p><p><b>RESULTS</b>Forty-five times pH < 4 reflux waveform were identified according to software analysis.140 pH drops of 4 were observed according to manual analysis, in which 78 times were caused by reflux and 62 artifacts. The consistency of manual analysis and software automatically analysis was general (κ = 0.234). The positive rate of 60 patients was 28.3% (17/60). In the 17 LPR patients, the median number [P25, P75] of acid reflux events was 5.0 [4.0, 8.8], weakly acidic reflux events was 6.5 [5.3, 10.3], weakly alkaline reflux events was 1.0 [0.0, 2.0], time of acid exposure was 3.8 [2.3, 7.2] min, time of acid clearance was 36.0 [21.5, 57.6] s, acid reflux events in upright position was 4.0[3.0, 4.8] and in supine position was 1.5 [0.0, 2.3]. All the data were approximately identical with the domestic and foreign literature. 24 hours MII-pH monitoring and RSI + RFS had medium consistency (κ = 0.590).</p><p><b>CONCLUSIONS</b>24 hours MII-pH monitoring has ideal repeatability, but false positive and false negative can not be avoided completely. The diagnosis of laryngopharyngeal reflux should be combined with medical history and laryngoscopy.</p>