Journal article
Loss of Alkalization in Proximal Esophagus: a New Diagnostic Paradigm for Patients with Laryngopharyngeal Reflux
Journal of gastrointestinal surgery, v 14(11), pp 1653-1658
01 Nov 2010
PMID: 20835772
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Cervical esophageal pH monitoring using a pH threshold of < 4 in the diagnosis of laryngopharyngeal reflux (LPR) is disappointing. We hypothesized that failure to maintain adequate alkalization instead of acidification of the cervical esophagus may be a better indicator of cervical esophageal exposure to gastric juice. The aim of this study was to define normal values for the percent time the cervical esophagus is exposed to a pH a parts per thousand yen7 and to use the inability to maintain this as an indicator for diagnosis of LPR.
Fifty-nine asymptomatic volunteers had a complete foregut evaluation including pH monitoring of the cervical esophagus. Cervical esophageal exposure to a pH < 4 was calculated, and the records were reanalyzed using the threshold pH a parts per thousand yen7. The sensitivity of these two pH thresholds was compared in a group of 51 patients with LPR symptoms that were completely relieved after an antireflux operation.
Compared to normal subjects, patients with LPR were less able to maintain an alkaline pH in the cervical esophagus, as expressed by a lower median percent time pH a parts per thousand yenaEuro parts per thousand 7 (10.4 vs. 38.2, p < 0.0001). In normal subjects, the fifth percentile value for percent time pH a parts per thousand yenaEuro parts per thousand 7 in the cervical esophagus was 19.6%. In 84% of the LPR patients (43/51), the percent time pH a parts per thousand yenaEuro parts per thousand 7 were below the threshold of 19.6%. In contrast, 69% (35/51) had an abnormal test when the pH records were analyzed using the percent time pH < 4. Of the 16 patients with a false negative test using pH < 4, 11 (69%) were identified as having an abnormal study when the threshold of pH a parts per thousand yenaEuro parts per thousand 7 was used.
Normal subjects should have a pH a parts per thousand yen7 in cervical esophagus for at least 19.6% of the monitored period. Failure to maintain this alkaline environment is a more sensitive indicator in the diagnosis of the LPR and identifies two thirds of the patients with a false negative test using pH < 4.
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Details
- Title
- Loss of Alkalization in Proximal Esophagus: a New Diagnostic Paradigm for Patients with Laryngopharyngeal Reflux
- Creators
- Shahin Ayazi - University of Southern CaliforniaJeffrey A. Hagen - University of Southern CaliforniaJoerg Zehetner - University of Southern CaliforniaMatt Lilley - University of Southern CaliforniaPriyanka Wali - University of Southern CaliforniaFlorian Augustin - University of Southern CaliforniaArzu Oezcelik - University of Southern CaliforniaHelen J. Sohn - University of Southern CaliforniaJohn C. Lipham - University of Southern CaliforniaSteven R. DeMeester - University of Southern CaliforniaTom R. DeMeester - University of Southern California
- Publication Details
- Journal of gastrointestinal surgery, v 14(11), pp 1653-1658
- Publisher
- Springer Nature
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000283135000005
- Scopus ID
- 2-s2.0-77958495781
- Other Identifier
- 991022048292204721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Gastroenterology & Hepatology
- Surgery