Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus.
OBJECTIVE
To investigate the relationship between pathological oropharyngeal (OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes.


METHODS
In this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease (GERD). We enrolled only patients with a reflux symptom index (RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal high-resolution manometry (HRM). Patients were divided into two groups on the basis of a normal or pathological pH-metric finding (Ryan Score) and all manometric characteristics of the two groups were compared.


RESULTS
We examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure (median 71 mmHgvs126 mmHg,P= 0.004) and the median proximal contractile integral (median 215.5 cm•mmHg•svs313.5 cm•mmHg•s,P= 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mmHg isobaric contour (38.7%vs15.38%,P< 0.0001).


CONCLUSIONS
In patients with suspected GERD-related extra-esophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility.
Sandro Passaretti, Giorgia Mazzoleni, Cristian Vailati, Pier Alberto Testoni, Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Sandro
S
Passaretti
Sandro Passaretti, Giorgia Mazzoleni, Cristian Vailati, Pier Alberto Testoni, Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Giorgia
G
Mazzoleni
Sandro Passaretti, Giorgia Mazzoleni, Cristian Vailati, Pier Alberto Testoni, Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Cristian
C
Vailati
Sandro Passaretti, Giorgia Mazzoleni, Cristian Vailati, Pier Alberto Testoni, Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Pier Alberto
PA
Testoni
D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies
Esophagus; Gastroesophageal reflux disease; High resolution manometry; Motility; Oropharyngeal reflux; pH-metry