Esophageal function tests are not helpful in symptoms suspicious of extraesophageal reflux – a prospective study in 74 patients

Abstract

Background/Aims: Symptoms suspicious of extraesophageal reflux (SSEER) include globus, chronic cough, mucous obstruction and hoarseness. Reports of conventional esophageal function tests and measurement of extraesophageal reflux (EER) in these patients are spare providing conflicting results.

Methods: In a prospective study we evaluated 60 patients with SSEER by esophageal function tests (esophageal manometry, combined 24 h pH – metry – impedance and oropharyngeal pH measurement, Dx – pH measurement) and esophagogastroduodenoscopy (EGD). The patients were stratified into 2 groups according to their accompanying reflux symptoms. Group 1, n = 23, comprised patients with SSEER solely and group 2, n = 37 patients with SSEER and reflux symptoms. The patients were compared to patients with reflux symptoms solely (group 3, n = 14).

Results: There were no significant differences between the groups according to age, sex and BMI. Patients with SSEER and reflux symptoms (group 2) showed significantly increased proportion of pathological acid reflux, de Meester Score, pH < 4 overall and in upright positon and hypotensive lower esophageal sphincter pressure compared to patients with SSEER solely (group 1) but no significant difference to patients with reflux symptoms solely (group 3). All the other parameters of esophageal testing including non–acid reflux and EER were not significantly different between the three groups.

Conclusion: The results of the present study do not support a causal link between SSEER and esophageal motility disorders, acid or non–acid reflux and EER as measured by conventional esophageal function tests and oropharyngeal pH measurement.

Zusammenfassung

Hintergrund/Ziele: Symptome verdächtig auf einen extraösophagealen Reflux (SSEER) beinhalten Globus, chronischen Husten, Schleimobstruktion und Heiserkeit. Ösophagusfunktionsuntersuchungen und Berichte über Messungen des extraösophagealen Refluxes (EER) sind selten und ergeben widersprüchliche Ergebnisse.

Methoden: In einer prospektiven Studie wurden 60 Patienten mit Verdacht auf SSEER durch Ösophagusfunktionsuntersuchungen (Ösophagusmanometrie, kombinierte 24 Stunden pH-Metrie-Impedanzmessung und oropharyngeale Refluxmessung, Dx – pH-Messung) und Ösophagogastroduodenoskopie evaluiert. Die Patienten wurden anhand ihrer Refluxbeschwerden in 2 Gruppen stratifiziert. Gruppe 1, n = 23, beinhalteten Patienten mit SSEER ohne weitere Beschwerden und Gruppe 2, n = 37, Patienten mit SSEER und Refluxbeschwerden. Die Patienten wurden mit Patienten mit ausschließlichen Refluxbeschwerden verglichen (Gruppe 3, n = 14).

Ergebnisse: Die Gruppen waren bez. Alter, Geschlecht und BMI vergleichbar. Patienten mit SSEER und Refluxbeschwerden (Gruppe 2) zeigten einen signifikant erhöhten Anteil eines pathologischen Refluxes, des de Meester Scores, des pH < 4 gesamt und in aufrechter Position und eines hypotensiven unteren Ösophagussphinkters im Vergleich mit Patienten ausschließlichen SSEEP (Gruppe 1), waren aber im Vergleich zu Patienten mit ausschließlichen Refluxbeschwerden (Gruppe 3) nicht signifikant unterschiedlich. Alle weiteren Ösophagusfunktionsparameter einschließlich des nicht–saurer Refluxes und EER waren zwischen den 3 Gruppen nicht signifikant unterschiedlich.

Schlussfolgerung: Die Ergebnisse der Studie können eine ursächliche Bedeutung zwischen SSEER und Ösophagusfunktionsstörungen, einem sauren bzw. nicht–sauren Reflux bzw. EER anhand der Ösophagusfunktionsuntersuchungen und der oropharyngealen Säuremessung nicht bestätigen.

Schlüsselwörter

Globus - Husten - Heiserkeit - extraösophagealer Reflux - oropharyngeale pH-Metrie - Dx – pH Messung - 24 Stunden pH-Metrie-Impedanzmessung - Ösophagusmanometrie

Key words

globus - cough - hoarseness reflux - extraesophageal reflux - oropharyngeal pH–metry - Dx-pH measurement system - 24 h pH – metry – impedance measurement - esophageal manometry

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