Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms - PubMed (original) (raw)

Multicenter Study

. 2024 Apr 1;119(4):627-634.

doi: 10.14309/ajg.0000000000002557. Epub 2023 Oct 13.

Madeline Greytak 1, Alexander M Kaizer 2, Dustin A Carlson 3, Walter W Chan 4 5, Chien-Lin Chen 6, C Prakash Gyawali 7, Andrew Jenkins 4 5, John E Pandolfino 3, Vinathi Polamraju 7, Ming-Wun Wong 6, Rena Yadlapati 1

Affiliations

Multicenter Study

Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms

Amanda J Krause et al. Am J Gastroenterol. 2024.

Abstract

Introduction: Among patients with chronic laryngeal symptoms, ambulatory reflux monitoring off acid suppression is recommended to evaluate for laryngopharyngeal reflux (LPR). However, reflux monitoring systems are diverse in configuration and monitoring capabilities, which present a challenge in creating a diagnostic reference standard in these patients. This study aimed to compare diagnostic yield and performance between reflux monitoring systems in patients with chronic laryngeal symptoms.

Methods: This multicenter, international study of adult patients referred for evaluation of LPR over a 5-year period (March 2018-May 2023) assessed and compared diagnostic yield of pathologic gastroesophageal reflux (GER+) on ambulatory reflux monitoring off acid suppression.

Results: Of 813 patients, 296 (36%) underwent prolonged wireless pH, 532 (65%) underwent 24-hour pH-impedance monitoring, and 15 (2%) underwent both tests. Overall diagnostic yield for GER+ was 36% and greater for prolonged wireless pH compared with that for 24-hour pH-impedance monitoring (50% vs 27%; P < 0.01). Among 15 patients who underwent both prolonged wireless pH and 24-h pH-impedance monitoring, concordance between systems for GER+ was 40%. The most common source of discordance was strong evidence of GER+ across multiple days on prolonged wireless pH compared with no evidence of GER+ on pH-impedance.

Discussion: In this multicenter international study of patients with chronic laryngeal symptoms referred for LPR evaluation, diagnostic yield of ambulatory reflux monitoring off acid suppression was 36% and rose to 50% when using wireless pH monitoring. In patients referred for chronic laryngeal symptoms, 24-hour pH-impedance monitoring may risk a low negative predictive value in patients with unproven GER+ disease.

Copyright © 2023 by The American College of Gastroenterology.

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Conflict of interest statement

Potential Competing Interests:

AJK, AMK, CC, AJ, VP, MW, MG: No disclosures

DAC: Medtronic (Speaking, Consulting, License); Phathom Pharmaceuticals (Consulting); Braintree (Consulting); Medpace (Consulting)

WWC: Advisory Board: Phathom Pharmaceuticals, Sanofi Pharmaceuticals, Regeneron Pharmaceuticals

CPG: Diversatek (Consultant, Grant/Research Support); Medtronic (Consultant); Carnot (speaker)

JEP: AlfaSigma (Consultant); Endogastric solutions (Consultant, Speakers Bureau); Ethicon/ J&J (Advisory Committee/Board Member, Consultant, Speakers Bureau); Medtronic (Advisor or Review Panel Member, Consultant, Intellectual Property/Patents, Royalties, Speakers Bureau); Phathom (Consultant); Takeda (Consultant, Speakers Bureau)

RY: Consultant for Medtronic, Phathom Pharmaceuticals, StatLinkMD, Reckitt Benckiser Healthcare Ltd, Medscape; Research Support: Ironwood Pharmaceuticals; Advisory Board with Stock Options: RJS Mediagnostix

Figures

Figure 1.

Figure 1.

Diagnostic yield (percentage) of GER+ on ambulatory reflux monitoring systems off proton pump inhibitor (PPI) including wireless pH monitoring, multichannel intraluminal impedance with a single distal pH catheter (MII-pH) and hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH). All 24h pH-impedance monitoring refers to all pH-impedance devices, combined into one category.

Figure 2:

Figure 2:

Comparing physiologic and endoscopic findings in patients that underwent both wireless pH monitoring and 24h pH-impedance monitoring off proton pump inhibitor (PPI). Black shading indicates findings that are conclusive for gastro-esophageal reflux disease (GERD); dark grey shading indicates findings that are inconclusive for GERD; light grey shading indicates findings that are normal/no GERD per Lyon consensus.

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