Content area
Full text
Surg Endosc (2013) 27:41134118 DOI 10.1007/s00464-013-3076-3
Pharyngeal pH monitoring better predicts a successful outcome for extraesophageal reux symptoms after antireux surgery
Stephanie G. Worrell Steven R. DeMeester
Christina L. Greene Daniel S. Oh
Jeffrey A. Hagen
Received: 26 April 2013 / Accepted: 14 June 2013 / Published online: 9 July 2013 Springer Science+Business Media New York 2013
AbstractBackground Gastroesophageal reux disease can be associated with extraesophageal symptoms (hoarseness, cough, asthma, and globus). However, these symptoms may have a multifactorial etiology. Proximal pH monitoring has been proposed as a means of identifying patients where reux is the cause of the extraesophageal symptoms. The aim of this study was to determine whether proximal esophageal or pharyngeal pH monitoring better identied patients with extraesophageal symptoms that improved after antireux surgery.
Methods A retrospective chart review was performed to identify all patients who had esophageal and pharyngeal pH monitoring before an antireux operation. A composite score was used to dene an abnormal result with each test. A successful outcome was dened as improvement or resolution of extraesophageal symptoms.
Results There were 20 patients identied. Antireux surgery led to a successful outcome in 14 patients (70 %). Restech better identied patients with extraesophageal symptoms who had a successful outcome with antireux surgery (12 of 14 [86 %] based on abnormal Restech versus 5 of 10 [50 %] based on abnormal proximal probe, p = 0.06). Comparing only the 15 patients who had both
proximal esophageal and pharyngeal pH monitoring, Restech again better identied those who had a successful outcome with antireux surgery (9 of 10 [90 %] based on abnormal Restech versus 5 of 10 [50 %] based on abnormal proximal probe, p = 0.05). The positive and negative predictive values for symptomatic improvement after a fundoplication were better for an abnormal Restech score than for an abnormal proximal esophageal score (80 vs. 71 % and 60 vs. 38 %, respectively). In two patients with a successful outcome, Restech was the only positive test. Conclusions In patients with extraesophageal reux symptoms, proximal esophageal pH monitoring failed to identify half of the patients who had a successful outcome after antireux surgery. In contrast, an abnormal Restech pH test was present in 90 % of patients with a successful outcome. Further,...