title: Pharyngeal pH monitoring in gastrectomy patients - what do we really measure?
abstract: OBJECTIVE
  Diagnosis of laryngopharyngeal reflux (LPR) has dramatically increased over the last years. For diagnosis of gastroesophageal reflux, a newly designed pharyngeal probe (Dx-pH) was recently introduced. It is also recommended to guide therapy decision in antireflux surgery. However, diagnostic results are questionable. Therefore, we establish a reliable reference group with asymptomatic patients after total gastrectomy and, thus, complete extinction of gastric acid production.
  
  
  METHODS
  Pharyngeal pH monitoring was performed in 10 consecutive patients with history of total gastrectomy. All patients were off proton pump inhibitor (PPI) therapy and followed a non-acid diet during the complete measurement period.
  
  
  RESULTS
  All procedures were performed without any complication. Six of the 10 asymptomatic gastrectomy patients (60%) had pathological results derived from the validated reference values (Ryan score) in pharyngeal pH monitoring.
  
  
  CONCLUSIONS
  Pathological pH values assessed by the Dx-pH device, usually interpreted as pathological aerosolized acidic gastroesophageal and/or laryngopharyngeal reflux, are obviously dissociated from gastric acid production. Further studies are required to determine diagnostic value of the new system. Therefore, the pharyngeal pH monitoring system seems currently not to be useful to guide any diagnostic or therapeutic decisions, in particular if surgical therapy is considered.
authors.affiliation: Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Wilhelm
authors.affiliation: Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Alissa
authors.initials: A
authors.lastname: Jell
authors.affiliation: Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
authors.affiliation: Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Monther
authors.initials: M
authors.lastname: Bajbouj
authors.affiliation: Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Valentin
authors.initials: V
authors.lastname: Becker
keywords: Dx-pH; Laryngopharyngeal reflux; gastroesophageal reflux disease; pharyngeal pH monitoring