Diagnostic approach to gastroesophageal reflux disease associated respiratory complications: role of dual channel pH-metry

Aim: to investigate the value of different methods, particularly the usefulness of routine 24-hr dual channel esophageal pH-metry, in the diagnosis of GERD associated respiratory complications. Patients and methods: 100 subjects with GERD associated airway complications were submitted to 24-hr dual channel esophageal pH monitoring, upper gastrointestinal endoscopy, esophageal manometry and video barium esophagography and their symptoms were analysed. Results: 25% of patients (pts) with GERD associated airway complications did not have reflux symptoms. 5cm above LES the DeMeester score was pathological only in 39% of the pts. Additional 10% had a normal DeMeester score, but abnormal postprandial and/or nocturnal reflux activity. Further 50% showed only short reflux episodes at this level. 20cm above the LES, 24-hr pH-monitoring showed pathological reflux activity in only 14% of pts, while proximal reflux episodes were detected in further 68% of the pts. Upper gastrointestinal endoscopy was normal in 18%, revealed NERD in 27% and ERD in 55% of the pts, respectively. Esophageal manometry showed impaired LES function in 63% of the pts. No differences were observed in the results of detailed symptom analysis, endoscopy and LES manometry between patients with or without proximal esophageal acid exposure. However the DeMeester score was abnormal (43% vs. 28%) and barium swallow showed pharyngeal reflux in greater proportion of pts (76% vs. 50%) with proximal esophageal reflux than pts without proximal acid reflux. Conclusions: Dual channel 24-hr pH-monitoring is a valuable method in the diagnosis of GERD induced respiratory complications. It detected pharyngeal reflux in 82% of our pts, while the reflux activity was pathological only in 49% of these pts at the distal sensor. Moreover our results provide evidence that short reflux episodes may have a pathological role in the development of GERD induced respiratory complications.