
Importance Clinical Metrics Between Patients With and Without Pathological Esophagopharyngeal Reflux in the Concomitant Typical Reflux Syndrome, Isolated Laryngopharyngeal Reflux Symptoms Groups, and Healthy Controls
Reflux parameters | CTRS |
ILPRS |
Healthy controls (n = 23) |
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---|---|---|---|---|---|---|
MNBI(+) (n = 14) |
MNBI(–) (n = 14) |
MNBI(+) (n = 18) |
MNBI(–) (n = 28) |
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24-hr pH test finding | ||||||
AET | 3.4 (2.1, 7.4)e,f | 0.3 (0, 1.1) | 3.7 (1.3, 6.2)e,g | 0.6 (0.1, 1.3) | 0.3 (0.2, 1.1) | |
Excessive distal esophageal acid reflux |
9 (64.2)e,f | 1 (7.1) | 10 (55.5)e,g | 4 (14.2) | 2 (8.7) | |
Pharyngeal acid reflux episodes | 0 (0, 1)e,f | 0 (0, 0) | 0 (0, 0) |
0 (0, 0)h | 0 (0, 0) | |
Excessive pharyngeal acid reflux |
3 (21.4) |
0 (0.0) | 3 (16.6) | 2 (7.1) | 0 (0.0) | |
Number of reflux events | ||||||
Proximal esophagus | ||||||
Acid reflux episodes | 8 (5, 15)e,f | 3.5 (0, 6) | 10 (5, 22)e,g | 2 (1, 9) | 3 (1, 3) | |
Total episodes | 16 (8, 26) | 9 (6, 18) | 18 (11, 31) |
10 (6, 25) | 10 (7, 14) | |
Distal esophagus | ||||||
Acid reflux episodes | 20 (15, 30) |
14 (4, 28) | 25 (11, 34) |
10 (3, 25) | 7 (5, 10) | |
Total episodes | 42 (25, 45) | 33 (24, 44) | 45 (28, 52) | 33 (20, 50) | 31 (22, 45) | |
Proximal to distal reflux episode ratio (proximal total events/distal total events) | 0.4 (0.3, 0.6) | 0.3 (0.2, 0.4) | 0.4 (0.4, 0.6) |
0.4 (0.3, 0.5) | 0.4 (0.3, 0.4) | |
MNBI value | ||||||
Proximal esophagus | 2448 (2114, 2775) |
3215 (2611, 3432) | 2108 (1879, 3042)e,g | 2978 (2298, 3570) | 2898 (2481, 3185) | |
Distal esophagus | ||||||
5 cm | 926 (385, 1713)e,f | 2955 (2335, 3198) | 1441 (516, 1885)e,g | 2824 (2540, 3892) | 2690 (2183, 3049) | |
3 cm | 1439 (855, 1619)e,f | 2724 (2267, 3338) | 1531 (1118, 1681)e,g | 2839 (2500, 3586) | 2636 (2433, 2969) | |
Proximal to distal MNBI ratio (Proximal/distal 3 cm) | 2.0 (1.2, 3.2)e,f | 1.0 (0.9, 1.4) | 1.5 (1.3, 2.5)e,g | 1.0 (0.7, 1.3) | 1.0 (0.9, 1.1) | |
HRIM-BI value | ||||||
cm below the UES | ||||||
2 ± 1 cm | 985 (768, 1284) | 918 (812, 1142) | 1087 (742, 1322) | 1001 (849, 1410) | 1006 (834, 1315) | |
4 ± 1 cm | 753 (635, 1078) | 740 (663, 951) | 841 (659, 1047) | 925 (702, 1179) | 821 (672, 1091) | |
6 ± 1 cm | 697 (576, 940) | 663 (556, 765) | 761 (558, 1197) | 796 (624, 1133) | 769 (600, 901) | |
Proximal average | 802 (688, 1102) | 778 (727, 966) | 943 (661, 1159) | 953 (695, 1220) | 848 (732, 1033) | |
cm above the LES | ||||||
8 ± 1 cm | 780 (609, 1230) | 806 (667, 1043) | 664 (613, 904) |
997 (760, 1232) | 903 (599, 1271) | |
6 ± 1 cm | 829 (745, 1376) | 949 (725, 1190) | 786 (631, 1150) |
1047 (885, 1315) | 937 (675, 1313) | |
4 ± 1 cm | 890 (727, 1352) | 943 (788, 1128) | 856 (637, 991) |
1231 (882, 1462) | 1182 (744, 1428) | |
2 ± 1 cm | 881 (673, 1140) | 1008 (712, 1219) | 716 (614, 991)e,g | 1343 (863, 1501) | 1221 (811, 1388) | |
Distal average | 837 (692, 1316) | 896(811, 1143) | 798 (619, 932) |
1087 (914, 1387) | 1112 (721, 1349) | |
Proximal to distal HRIM-BI ratio (Proximal average/distal average) | 0.9 (0.8, 1.1) | 0.9 (0.7, 1.3) | 1.2 (0.8, 1.4) |
0.8 (0.7, 1.1) | 1.0 (0.6, 1.3) |
aConcomitant typical reflux syndrome (CTRS) is defined as regurgitation or heartburn at least twice a week with mild symptoms, or once a week with moderate/severe symptoms.
bIsolated laryngopharyngeal reflux symptoms (ILPRS) is defined as patients with laryngopharyngeal reflux without CTRS.
cExcessive distal esophageal acid reflux is defined as subjects with abnormal distal esophageal pH defined as percent time pH < 4 of ≥ 4.2% of 24-hr, or ≥ 6.3% of upright position, or ≥ 1.2% of supine position.
dExcessive pharyngeal acid reflux is defined as pharyngeal acid reflux ≥ 2 episodes.
eP < 0.05 for mean nocturnal baseline impedance (MNBI)(+) vs MNBI(–).
fP < 0.05 for CTRS MNBI(+) vs healthy controls.
P < 0.05 for CTRS MNBI(–) vs healthy controls.
gP < 0.05 for ILPRS MNBI(+) vs healthy controls.
hP < 0.05 for ILPRS MNBI(–) vs healthy controls.
Pearson c2 tests were used for dichotomous variables, whereas Mann–Whitney U tests were used for continuous variables.
AET, % of acid exposure time in the distal esophagus; HRIM-BI, baseline impedance measured during high-resolution impedance manometry; UES, upper esophageal sphincter; LES, lower esophageal sphincter.
MNBI(+) denotes MNBI < 2065.
Data are presented as median (interquartile range) or n (%).