[Optimal diagnostic criteria of ENT manifestations of GERD].
BACKGROUND
GERD has a number of extraesophageal manifestations (EEM) such as ENT, pulmonary etc. 24-hours pH monitoring in distal esophagus is widely used to confirm the diagnosis but its cut-off values for the diagnosing of extraesophageal manifestations of GERD (for example ENT) are unknown.


OBJECTIVE
To evaluate the optimal cut-off values for mean pH, time pH < 4 a day in the proximal esophagus and number of high gastroesophageal refluxes (HGR) in regard to presence of extraesophageal manifestations of GERD.


METHODS
Ninety one GERD patients (50 men, 41 women, 42.33 +/- 16.1 y.o.) were examined using dual-probe 24-hours pH monitoring. The proximal probe was placed in the upper 1/3 part of esophagus over the upper esophageal sphincter. To confirm the presence of ENT manifestations of GERD all the patients were examined by qualified ENT-specialist; special ENT tests (laryngoscopy, pharyngoscopy with cytology and bacteriology) were performed. Toxic, allergic and infectious etiology of ENT were exclusion criteria. ROC curve analysis was used to evaluate optimal cut-off values of pH-studies. The cut-off values were chosen by the optimal diagnostic sensitivity (DSp)/specificity (DSp) ratio.


RESULTS
ENT diseases were found in 59 of all the examined patients (chronic pharyngitis in 79.66% of them). HGR was found in 76.27% of patients in ENT group and in 43.75% of controls (consisted of GERD patients without signs of ENT pathology, n = 32), p = 0.0026. Mean number of HGRs was higher in ENT group compared to controls: (M +/- s) 12.51 +/- 18.56 vs 2.84 +/- 7.11 respectively, p (Mann-Whitney U-test) = 0.0003. Mean pH levels in the proximal esophagus were lower in the ENT group: (M +/- m) 6.32 +/- 0.52 vs 6.58 +/- 0.42, p = 0.011. Mean time pH <4 in the proximal esophagus differed significantly between ENT and GERD patients without ENT: 3.19 +/- 6.76 min in ENT group compared to 2.42 +/- 10.02 min in controls, p = 0.003. The calculated cut-off values for the number of high GER were 2 (DSn 71.19%, DSp 68.75%) or 3 (DSn = 61.02%, DSp = 71.88%); for mean pH in the proximal esophagus--6.3 (DSn = 75%, DSp = 51.47) or 6.4 (DSn = 68.75%, DSp = 58.82%); for time pH < 4--optimal value was 25 sec (DSn = 72.88%, DSp = 68.75%).


CONCLUSIONS
Proximal pH monitoring may be useful in diagnosing extraesophageal manifestation of GERD. Optimal cut-off values of number of high GER are 2 to 3, mean pH 6.3-6.4 and time pH < 4 - 25 sec.
S V
SV
Morozov
L V
LV
Gibadullina
V A
VA
Isakova
V M
VM
Svistushkin
D000328:Adult; D002908:Chronic Disease; D004947:Esophagus / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007827:Laryngitis / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D007828:Laryngoscopy / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010612:Pharyngitis / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology