title: Diagnosis of supra-esophageal gastric reflux: correlation of oropharyngeal pH with esophageal impedance monitoring for gastro-esophageal reflux.
abstract: BACKGROUND
  Oropharyngeal (OP) pH monitoring has been developed as a new way to diagnose supra-esophageal gastric reflux (SEGR), but has not been well validated. Our aim was to determine the correlation between OP pH and gastro-esophageal reflux (GER) events detected by multichannel intraluminal impedance-pH (MII-pH).
  
  
  METHODS
  Fifteen patients (11 males, median age 10.8 years) with suspected GER were prospectively evaluated with ambulatory 24-h OP pH monitoring (positioned at the level of the uvula) and concomitant esophageal MII-pH monitoring. Potential OP events were identified by the conventional pH threshold of <4 and by the following alternative criteria: (i) relative pH drop >10% from 15-min baseline and (ii) absolute pH drop below thresholds of <5.5, 5.0, and 4.5. The 2-min window preceding each OP event was analyzed for correlation with an episode of GER detected by MII-pH.
  
  
  RESULTS
  A total of 926 GER events were detected by MII-pH. Application of alternative pH criteria increased the identification of potential OP pH events; however, a higher proportion of OP events had no temporal correlation with GER (45-81%), compared with the conventional definition of pH < 4 (40%). A total of 306 full-column acid reflux episodes were detected by MII-pH, of which 10 (3.3%) were also identified by OP pH monitoring.
  
  
  CONCLUSIONS
  Use of extended pH criteria increased the detection of potential SEGR events, but the majority of decreases in OP pH were not temporally correlated with GER. Oropharyngeal pH monitoring without concurrent esophageal measurements may overestimate the presence of SEGR in children.
authors: Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02155, USA.
authors: E
authors: E
authors: Chiou
authors: R
authors: R
authors: Rosen
authors: H
authors: H
authors: Jiang
authors: S
authors: S
authors: Nurko
references: Pediatrics. 2010 Apr;125(4):e925-30
references: 20351005
references: Gastroenterology. 1995 Nov;109(5):1575-82
references: 7557141
references: J Voice. 2009 Jul;23(4):498-504
references: 18468849
references: Thorax. 2009 Feb;64(2):167-73
references: 19176842
references: Am J Gastroenterol. 1988 Apr;83(4):358-61
references: 3348191
references: J Pediatr Gastroenterol Nutr. 2008 May;46(5):520-3
references: 18493206
references: Biometrics. 1999 Mar;55(1):137-48
references: 11318148
references: Am J Gastroenterol. 2004 Jun;99(6):1037-43
references: 15180722
references: Dig Dis Sci. 1997 Nov;42(11):2222-6
references: 9398798
references: Laryngoscope. 2007 Mar;117(3):470-4
references: 17279055
references: Neurogastroenterol Motil. 2009 Mar;21(3):253-8
references: 19019016
references: Am J Physiol. 1994 Mar;266(3 Pt 1):G357-62
references: 8166276
references: Aliment Pharmacol Ther. 2007 May 1;25(9):1003-17
references: 17439501
references: Am J Gastroenterol. 1989 Dec;84(12):1503-8
references: 2596451
references: Gastroenterology. 1999 Nov;117(5):1051-61
references: 10535867
references: Am J Gastroenterol. 2006 Aug;101(8):1900-20; quiz 1943
references: 16928254
references: Laryngoscope. 2006 Feb;116(2):254-60
references: 16467715
references: Am J Gastroenterol. 1991 Feb;86(2):160-4
references: 1992627
references: Am J Gastroenterol. 2004 Dec;99(12):2452-8
references: 15571595
references: Laryngoscope. 1991 Apr;101(4 Pt 2 Suppl 53):1-78
references: 1895864
references: Laryngoscope. 2009 Aug;119(8):1639-43
references: 19504553
references: Ann Otol Rhinol Laryngol. 2009 Sep;118(9):677-85
references: 19810610
references: Ann Otol Rhinol Laryngol. 2009 Mar;118(3):166-71
references: 19374146
references: Ann Intern Med. 1961 Aug;55:292-300
references: 13778812
references: Ann Otol Rhinol Laryngol. 2009 Jan;118(1):1-5
references: 19244956
references: Gut. 2006 Oct;55(10):1398-402
references: 16556669
references: J Gastrointest Surg. 2009 Aug;13(8):1422-9
references: 19421822
references: Gastroenterology. 2001 Dec;121(6):1294-9
references: 11729108
references: J Pediatr Gastroenterol Nutr. 2001;32 Suppl 2:S1-31
references: 11525610
references: Surg Endosc. 2006 Dec;20(12):1824-30
references: 17063301
references: Am J Gastroenterol. 2009 May;104(5):1278-95; quiz 1296
references: 19352345
references: Am J Gastroenterol. 2008 May;103(5):1090-6
references: 18445095
references: J Clin Gastroenterol. 2009 May-Jun;43(5):414-9
references: 19197196
references: Aliment Pharmacol Ther. 2009 Feb 1;29(3):258-72
references: 19143046
references: Otolaryngol Head Neck Surg. 2009 Nov;141(5):559-63
references: 19861190
references: Chest. 2000 Oct;118(4):1214-7
references: 11035701