Gastrointestinal function testing model using a new laryngopharyngeal pH probe(Restech)in patients after Ivor-Lewis esophagectomy

摘要

BACKGROUND There is no established correlation between 24-h esophageal pH-metry(Eso-pH)and the new laryngopharyngeal pH-monitoring system(Restech)as only small case series exist.Eso-pH was not designed to detect laryngopharyngeal reflux(LPR)and Restech may detect LPR better.We have previously published a dataset using the two techniques in a large patient collective with gastroesophageal reflux disease.Anatomically,patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists.AIM To use a human reflux model to examine our previously published correlation in these patients.METHODS Patients after Ivor Lewis esophagectomy underwent our routine follow-up program with surveillance endoscopies,computed tomography scans and further exams following surgery.Only patients with a complete check-up program and reflux symptoms were offered inclusion into this prospective study and evaluated using Restech and simultaneous Eso-pH.Subsequently,the relationship between the two techniques was evaluated RESULTS A total of 43 patients from May 2016-November 2018 were included.All patients presented with mainly typical reflux symptoms such as heartburn(74%),regurgitation(84%),chest pain(58%),and dysphagia(47%).Extraesophageal symptoms such as cough,hoarseness,asthma symptoms,and globus sensation were also present.Esophageal 24-hour pH-metry was abnormal in 88%of patients with a mean DeMeester Score of 229.45[range 26.4-319.5].Restech evaluation was abnormal in 61%of cases in this highly selective patient cohort.All patients with abnormal supine LPR were also abnormal for supine esophageal reflux measured by conventional Eso-pH.CONCLUSION Patients following esophagectomy and reconstruction with gastric interposition can ideally serve as a human reflux model.Interestingly,laryngopharyngeal reflux phases occur mainly in the upright position.In this human volume-reflux model,results of simultaneous esophageal and laryngopharyngeal(Restech)pHmetry showed 100%correlation as being explicable by one of our reflux scenarios.