Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease

Abstract

Background: pH monitoring can reflect the changes in H⁺ in the airway.

Objectives: To explore the utility of pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease (LPRD).

Material and methods: Clinical data from 956 suspected LPRD patients from February 2016 to March 2018 were analyzed retrospectively.

Results: One hundred forty-one patients had positive Ryan score. The positive rates of reflux symptom index (RSI), reflux finding score (RFS), RSI and RFS and RSI or RFS were 14.7%, 32.5%, 21.9%, 7.8% and 46.5%, respectively. The RFS in the positive Ryan score group was higher than that in the negative Ryan score group [(6 ± 3.5) vs. (4.8 ± 2.9)], while the RSI was not significantly different from that in the negative Ryan score group [(10.9 ± 8) vs. (11.3 ± 7.1)]. Regarding Ryan score as the gold standard in the diagnosis of LPRD, the sensitivity, specificity, positive and negative predictive value of identifying LPRD by RSI/RFS were 15.9%, 86.3%, 50.4% and 54%, respectively.

Conclusions: Ryan score, RSI and RFS have poor correlation in detecting LPRD. Some patients may be missed with the Ryan score as a diagnostic criterion.

Significance: Pharyngeal pH monitoring is useful and more appropriate index is expected.

Chinese abstract

背景：酸碱度监测可以反映气道H⁺的变化。

目的：探讨咽部酸碱度监测在喉咽部反流病（LPRD）诊断中的应用。

材料与方法：回顾性分析2016年2月至2018年3月956例疑患LPRD病人的临床资料。

结果：141例患者的Ryan评分均为阳性。反流症状指数（RSI）、反流发现评分（RFS）、RSI和RFS以及RSI或RFS的阳性率分别为14.7%、32.5%、21.9%、7.8%和46.5%。Ryan评分阳性组的RFS高于Ryan评分阴性组[（6 ±3.5）对（4.8± 2.9）], 而RSI与Ryan评分阴性组的无显著差异[（10.9 ±8）对（11.3± 7.1）]。以Ryan评分作为LPRD诊断的金标准, 通过RSI/RFS比率来鉴别LPRD, 其敏感性、特异性、阳性和阴性预测值分别为15.9%、86.3%、50.4%和54%。

结论：Ryan评分、RSI和RFS与检测LPRD的相关性较差。有些患者可能错过了作为诊断标准的Ryan评分。

意义：咽部酸碱度监测是有运用价值的。期待有更为合适的指标。

Keywords:

• Laryngopharyngeal reflux disease
• pH monitoring
• Ryan score

Disclosure Statement

Gang Wang, Changmin Qu, Lei Wang, Hongdan Liu, Haolun Han, Bingxin Xu, Ying Zhou, Baowei Li, Yiyan Zhang, Zhezhe Sun, Jing Gong, Lianyong Li and Wei Wu have no conflicts of interest or financial ties to disclose. Wei Wu designed the study and revised the manuscript. Changmin Qu designed the study. Gang Wang and Lianyong Li performed data extraction and drafted the manuscript. Lei Wang, Hongdan Liu, Haolun Han, Bingxin Xu, Ying Zhou, Baowei Li, Yiyan Zhang, Zhezhe Sun and Jing Gong critically reviewed and revised the manuscript. All authors approved the final manuscript.