Introduction It is suggested that hoarseness along with typical signs on laryngoscopy can be caused by oesophago-pharyngeal reflux, often referred to as LPR. New methods are proposed to assess pharyngeal exposure to gastric contents. They are suggested to measure (1) liquid or mixed gas-liquid acid and non-acid reflux (HMII-pH), (2) aerosolized acid reflux (Dx-pH measuring system, Restech), and (3) presence of pepsin in saliva. We aimed to quantify pharyngeal exposure to gastric contents in patients with hoarseness and healthy controls using the above techniques.
Methods 21 patients with hoarseness and a positive laryngoscopy (mean age: 51 range: 23–75) and 10 asymptomatic controls (mean age: 26, range: 21–34) underwent simultaneous HMII-pH monitoring, oropharyngeal pH monitoring and saliva pepsin sampling. The HMII-pH catheter was located with impedance sensors in the oesophageal body, 3–5 cm distal and 0–2 cm proximal to the UOS. The Dx-pH catheter was located posterior to the uvula and pepsin in saliva was measured using an in vitro device utilising two pepsin monoclonal antibodies (PepTest) at five different times during the 24-h period. Patients were studied “off” PPI.
Results Healthy controls had (1) no liquid or mixed gas/liquid reflux in the pharynx, (2) two controls had +ve Dx-pH and (3) two controls had more than one saliva sample +ve for pepsin with the other tests negative. Patients were classified into four groups: (a) all tests +ve (n=2); (b) two tests +ve (MII-pH + pepsin (n=5) or MII-pH + Dx-pH (n=3); (c) all tests negative (n=5) and (d) patients with +ve Dx-pH or pepsin without evidence of HMII detected reflux. These patients were considered negative (n=6). Dx-pH drops were poorly associated with HMII-pH reflux. 11% of Dx-pH drops to pH<4, 15% of pH drops to pH<5 and 10% of pH drops to pH<5.5 coincided with HMII detected liquid or gas reflux in the oesophageal body. The detection of pepsin in saliva occurred in 7/10 patients with acid or non-acid HMII detected reflux. Positive pepsin saliva samples were preceded by more reflux events in the previous 60 min 3 (1–4) than negative samples 0 (0–2) p<0.0001.
Conclusion We identified a subgroup of patients with hoarseness with objective detection of oesophago-pharyngeal reflux (10/21). (b) the majority of oropharyngeal pH drops detected by Dx-pH do not correlate with retrograde flow (liquid or gas) in the oesophageal body. (c) Detection of pepsin in saliva suggests the likelihood of reflux episodes in the previous 60 min.
Competing interests None declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.