D. Kiagiadaki, V. Bachy, M. Remacle, S. Van Der Vorst, G. Lawson Efficacy of LPR diagnosis with the oropharyngeal pH monitoring system: retrospective data of a 2 years’ study. D. Kiagiadaki, V. Bachy, M. Remacle, S. Van Der Vorst, G. Lawson Laryngology - Head & Neck Surgery Unit, Department of ENT-Head & Neck Surgery, of Louvain University Hospital of Mont Godinne, Belgium.

Introduction-Background LPR different entity from GERD (Koufman, 2006) Suspicion of LPR: clinical history, findings and symptoms. Diagnostic strategy in clinical practice (Ford, 2005) Multichannel impedance and pH monitoring TNE or EGD While EGD reveals esophageal lesions in 50% of typical GERD patients, it is abnormal in less than 20% of LPR laryngitis (Vaezi, 20004) Manometry Barium Accuracy in oropharyngeal environment?? 24 – hour oropharyngeal pH monitoring system (liquid and aerozolized acid levels measurement) Kiagiadaki et al. ORL-HNS Nice 2013

Patients and methods Retrospective study: 11/2010-11/2012 65 patients (31 females, 34 males) mean age 51.5 years. 24-hour oropharyngeal pH monitoring with the Restech Dx-pH SystemTM Indications: Presence of ENT signs and/or symptoms of LPR pharyngo-laryngeal symptoms (32.3%) pharyngeal (27.7%) globus pharyngeus/throat clearing/chronic cough laryngeal symptoms alone (24.6%) Other (3.1) Diagnosis Efficacy of treatment Analysis after the extraction of meals according to mean pH values and the RYAN score. Kiagiadaki et al. ORL-HNS Nice 2013

Results (1): RYAN score and pH values Cut off pH values: 6.5-6.0: mild 5.9-5.5: moderate <5.5: severe 58.5% of patients: severe reflux -36% upright -15% supine -47% both Mean pH value in patients with pathol. RYAN score: 6.4(+/- 0.4) Kiagiadaki et al. ORL-HNS Nice 2013

Kiagiadaki et al. ORL-HNS Nice 2013 Results (2) Gastroscopy in 33 patients: 27 before/5 after 3/5 patients with normal double probe pHmetry: severe reflux 52 patients under treatment 11 normal 32 severe 9 mild - moderate reflux GASTROSCOPY RESULT Total NORMAL OESOPH.A OESOPH.B BARRET HERN.HIATAL NON COMPL. SEVERE REFLUX (RYAN SCORE) YES 8 3 1 13 NO 5 4 20 16 33 UNDER TREATMENT 14 7 30 Kiagiadaki et al. ORL-HNS Nice 2013

Kiagiadaki et al. ORL-HNS Nice 2013 Conclusions Mean pH values alone could not predict the severity of reflux. The number and duration of acidity episodes indicated the severity of reflux (RYAN score). Oropharyngeal 24-hour pH monitoring was proven a useful method for the accurate diagnosis of LPR, confirming either the need or the effectiveness of medical treatment. Kiagiadaki et al. ORL-HNS Nice 2013

Discussion - Prospectives Advantages of oropharyngeal pH monitoring over 24 – hour double probe pHmetry: accuracy and tolerance. Lacking prospective randomized studies of its efficacy for extraesophageal reflux diagnosis/ efficacy of PPIs treatment. Kiagiadaki et al. ORL-HNS Nice 2013