Journal of Neurogastroenterology and Motility : eISSN 2093-0887 / pISSN 2093-0879

Table. 2.

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 CTRSa ILPRSb Healthy controls
(n = 23)
MNBI(+)
(n = 14)
MNBI(–)
(n = 14)
MNBI(+)
(n = 18)
MNBI(–)
(n = 28)
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 refluxc 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)g 0 (0, 0)h 0 (0, 0)
Excessive pharyngeal acid refluxd 3 (21.4)f 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)g 10 (6, 25) 10 (7, 14)
Distal esophagus
Acid reflux episodes 20 (15, 30)f 14 (4, 28) 25 (11, 34)g 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)g 0.4 (0.3, 0.5) 0.4 (0.3, 0.4)
MNBI value
Proximal esophagus 2448 (2114, 2775)e 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)e 997 (760, 1232) 903 (599, 1271)
6 ± 1 cm 829 (745, 1376) 949 (725, 1190) 786 (631, 1150)e 1047 (885, 1315) 937 (675, 1313)
4 ± 1 cm 890 (727, 1352) 943 (788, 1128) 856 (637, 991)e 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)e 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)e 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 (%).

J Neurogastroenterol Motil 2025;31:63~74 https://doi.org/10.5056/jnm24051
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