|
Back to 2016 Annual Meeting
Importance of Esophageal Manometry and pH Monitoring for the Evaluation of Extra-Esophageal Manifestations of GERD. A Multicenter Study.
Fernando A. Herbella2, Ciro Andolfi*1, Yalini Vigneswaran1, Marco G. Patti1
1Department of Surgery, University of Chicago, Chicago, IL; 2Surgical Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil
Background: The clinical spectrum of gastroesophageal reflux disease (GERD) ranges from asymptomatic patients to extra-esophageal manifestations such hoarseness, globus and throat clearing. These patients are usually evaluated in ENT clinics, and treated with PPI based on the findings of nasal endoscopy and laryngoscopy. We hypothesized that esophageal manometry and dual probe pH monitoring are essential to assess the presence of abnormal reflux and its proximal extent.
Objective: To determine sensitivity and specificity of symptoms, nasal endoscopy and laryngoscopy for the diagnosis of GERD as compared to pH monitoring.
Design: Retrospective review of prospectively maintained databases.
Setting: Otorhinolaryngology and esophageal teams at two quaternary care centers.
Patients and Methods: Between July 2008 and July 2015, we evaluated by manometry and pH monitoring 79 patients in whom hoarseness, globus and throat clearing were assumed to be secondary to GERD on the basis of nasal endoscopy and laryngoscopy.
Main outcome measures: Presence of abnormal reflux on pH monitoring.
Results: Pathologic reflux by pH monitoring was documented in 36 of the 79 patients (45.6%), with a mean DeMeester score of 44. In 25 of the 36 patients (69.4%) distal and proximal reflux was documented. Among patients with negative pH monitoring, one patient was diagnosed with achalasia. Overall ENT symptoms sensitivity for globus, hoarseness and throat clearing was respectively 11%, 58% and 33%; specificity was respectively 77%, 42% and 58%. Positive predictive value (PPV) for nasal endoscopy and laryngoscopy was 45.6%. Among patients with positive pH monitoring, high-resolution manometry revealed that only 9 patients (25%) had normal peristalsis, and that 13 (36%) had a hypotensive lower esophageal sphincter.
Conclusions: The results of this study showed that: (a) symptoms were unreliable for the diagnosis of GERD; and (b) nasal endoscopy and laryngoscopy have low positive predictive value for the diagnosis of GERD. These data confirm the importance of esophageal manometry and pH monitoring in any patient with suspected extra-esophageal manifestations of GERD before starting empiric therapy with acid reducing medications.
Back to 2016 Annual Meeting
|
