Diagnostic value of different investigational techniques of gastroesophageal reflux disease (GERD) related supra-esophageal complications

Aim: to investigate the diagnostic value of different investigational techniques in GERD patients (pts) with respiratory complications.

Patients, methods: 50 pts (F/M 37/13) with lower (41/50) or upper (9/50) airway diseases were enrolled. The diagnosis of GERD was based on the result of upper gastrointestinal endoscopy, 2 channel 24h esophageal pH monitoring and esophageal manometry. The presence of respiratory and reflux symptoms was evaluated by means of a questionnaire.

Results: Typical reflux symptoms were observed in 42/50 pts. Endoscopy revealed non-erosive forms of GERD in 30 pts while erosive esophagitis was detected in 20 pts respectively. Manometry was normal in 22 pts and showed impaired LES function in 28 pts. In case of lower respiratory complications (41/50), distal esophageal pH metry demonstrated abnormal DeMeester score in 17 pts, 24 had abnormal postprandial and 16 had diurnal reflux events. Normal pH values were detected at the distal site in 1 pt. Proximal esophageal pH metry (15cm above the distal electrode) revealed postprandial, diurnal and nocturnal reflux events in 21, 8 and 3 pts respectively, while 9 had normal results. In pts with upper airway diseases (9/50), the distal pH values demonstrated an abnormal DeMeester score in 2 pts, 8 had pathological postprandial reflux events, and 1 had normal values. Proximal pH metry revealed postprandial reflux events in 7 pts and appeared normal in 2 cases.

Conclusions: 2ch pH monitoring has been shown to be more sensitive diagnostic method than endoscopy and manometry in GERD patients with supra-esophageal manifestation. These investigations have demonstrated that short reflux events are characteristic in more than half of this population.