Résumé |
en
Objectives/Hypothesis: To investigate the profile of patients with laryngopharyngeal reflux (LPR) at hypopharyngeal–esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring and the relationship between hypopharyngeal-proximal reflux episodes (HREs) and saliva pepsin concentration. Study Design: Prospective non-controlled. Methods: Patients were recruited from three European hospitals from January 2018 to October 2019. Patients benefited from HEMII-pH monitoring and saliva collections to measure saliva pepsin concentration in the same time. Saliva pepsin concentration was measured in the morning (fasting), after lunch, and after dinner. The LPR profile of patients was studied through a breakdown of the HEMII-pH findings over the 24 hours of testing. The relationship between the concentrations of saliva pepsin and 24-hour HREs was studied through linear multiple regression. Results: One hundred twenty-six patients completed the study. The HEMII-pH analyses revealed that 73.99% of HREs occurred outside 1-hour postmeal times, whereas 20.49% and 5.52% of HREs occurred during the 1-hour postmeal and nighttime, respectively. Seventy-four patients (58.73%) did not have nighttime HREs. Patients with both daytime and nighttime HREs had more severe HEMII-pH parameters and reflux symptom score compared with patients with only daytime HREs. There were no significant associations between HREs and saliva pepsin concentration. Conclusions: Unlike gastroesophageal reflux disease, HREs occur less frequently after meals and nighttime. The analysis of the HEMII-pH profile of the LPR patients has to be considered to develop future personalized therapeutic strategies. Level of Evidence: 4 Laryngoscope, 131:268–276, 2021.
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Auteur(s)
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Jér̂ome René Lechien
1, 2
, Francois Bobin
3
, Giovanni Dapri
, Pierre Eisendrath
, Charelle Salem
, François Mouawad
4
, Mihaela Horoi
, Marie Paule Thill
, Didier Dequanter
, Alexandra Rodriguez
, Vinciane Muls
, Sven Saussez
1
Hôpital Foch [Suresnes]
( 410109 )
- 40 Rue Worth 92150 Suresnes
- France
2
UVSQ Santé -
Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
( 472222 )
- 2 avenue de la Source de la Bièvre - 78180 Montigny-le-Bretonneux
- France
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Université de Versailles Saint-Quentin-en-Yvelines ( 81173 )
3
ELSAN-Polyclinique de Poitiers
( 575016 )
- France
4
Faculté de Médecine Henri Warembourg - Université de Lille
( 451073 )
- Faculté de Médecine de Lille -- Université de Lille - 2 Avenue Eugène Avinée - 59120 Loos
- France
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Financement |
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BE076201837630 International Business Machines Corporation, IBM Medtronic Minneapolis Heart Institute, MHI
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Patients with LPR symptoms and findings were recruited from three European hospitals (University Hospital Centers Saint-Pierre and Cesar De Pape Hospital, Brussels, Belgium; and Polyclinic of Poitiers?Elsan, Poitiers, France) from January 2018 to October 2019. The diagnosis was confirmed through positive HEMII-pH. Gastrointestinal (GI) endoscopy was proposed to elderly patients and those with GERD symptoms. The exclusion criteria were similar to those described in a previous publication.10 The local ethics committee approved the study protocol (no. BE076201837630). Patients were invited to participate and the informed consent was obtained. The local ethics committee approved the study protocol (no. BE076201837630). Patients were invited to participate and the informed consent was obtained. Patients with LPR symptoms and findings were recruited from three European hospitals (University Hospital Centers Saint-Pierre and Cesar De Pape Hospital, Brussels, Belgium; and Polyclinic of Poitiers?Elsan, Poitiers, France) from January 2018 to October 2019. The diagnosis was confirmed through positive HEMII-pH. Gastrointestinal (GI) endoscopy was proposed to elderly patients and those with GERD symptoms. The exclusion criteria were similar to those described in a previous publication.10 The characteristics of a HEMII-pH monitoring device, placement, and analyses have been described in previous publications.10 Briefly, the HEMII-pH probe was placed in the morning before breakfast (8:00 am). HEMII-pH probe was composed of eight impedance segments and two pH electrodes (Versaflex Z, Digitrapper pH-Z testing system; Medtronic, Minneapolis, MN). Six impedance segments were placed along the esophagus zones (Z1 to Z6), and they were centered at 19, 17, 11, 9, 7, and 5 cm above the LES. Two additional impedance segments were placed 1 and 2 cm above the cricopharyngeal sphincter in the hypopharynx. The pH electrodes were placed 2 cm above the LES and 1 to 2 cm below the cricopharyngeal sphincter, respectively. The proximal (hypopharyngeal) reflux event was defined as an episode that reached two impedance sensors in the hypopharynx. The LPR diagnosis was based on the occurrence of ?1 acid or nonacid HRE.11 The acid reflux episode consisted of an episode with pH ? 4.0. The nonacid reflux episode consisted of an episode with pH > 4.0. Respecting the type of reflux episodes (acid and nonacid), three physicians (f.b., v.m., and c.s.) analyzed the HEMII-pH form to isolate the reflux episodes regarding the following periods of the 24-hour testing: 60 minutes after breakfast; the time between the 60 minutes after breakfast and lunch; the 60 minutes after lunch; the time between the 60 minutes after lunch and dinner; the 60 minutes after dinner; the time between the 60 minutes after dinner and bedtime and nighttime. Patients were off of PPIs during the HEMII-pH testing. Simultaneously to HEMII-pH monitoring, patients were invited to collect saliva samples (1 to 5 mL; throat sputum) 1 to 2 hours after the meals (lunch and dinner) and in the morning (fasting) to study the relationship between HEMII-pH episodes and the saliva pepsin concentrations. The saliva samples were collected into a 30-mL universal sample collection tube containing a pre-established concentration of citric acid to preserve the action of any pepsin present (Peptest kit; RDBiomed, Cottingham, United Kingdom). The pepsin sample collections were stored in the refrigerator. The measurement of pepsin concentration in the saliva samples was performed through the Peptest device (RDBiomed). A trained lab technician received the samples the day following the collection. The steps for pepsin measurement were performed in a standardized procedure, which has been previously described.12 The saliva pepsin concentration was measured using the Cube Reader (opTricon, Berlin, Germany), which detects pepsin down to 16 ng/mL. If the results did not reach that level, the test was considered negative. Symptoms and findings were assessed with Reflux Symptom Score (RSS)13 and Reflux Sign Assessment (RSA),14 respectively. RSS is a self-administered, validated 22-item reported-outcome questionnaire assessing frequency and severity of ear, nose, throat, digestive, and respiratory complaints (Fig. 1). RSA is a validated 61-point LPR physical finding score documenting laryngeal and extralaryngeal findings (Fig. 2). Statistical analyses were performed using the Statistical Package for the Social Sciences for Windows (SPSS version 22,0; IBM, Armonk, NY). The relationships between the HEMII-pH data, the pepsin saliva concentration, and the clinical features were investigated through multiple linear regression. The potential comparison between patient groups with different HEMII-pH profiles was made through Mann-Whitney U test. A level of significance of P <.05 was used. Patients were recruited from three European hospitals from January 2018 to October 2019. Patients benefited from HEMII-pH monitoring and saliva collections to measure saliva pepsin concentration in the same time. Saliva pepsin concentration was measured in the morning (fasting), after lunch, and after dinner. The LPR profile of patients was studied through a breakdown of the HEMII-pH findings over the 24 hours of testing. The relationship between the concentrations of saliva pepsin and 24-hour HREs was studied through linear multiple regression.
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Mots-clés |
en
impedance, laryngitis, Laryngopharyngeal, pepsin, pH monitoring, pharyngeal, profile, reflux, reflux episode, treatment
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