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Updated: Mar 13, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Clinical utility of symptom-based assessment as an indicator of objective gastroesophageal reflux disease
Rafał Astapczyk1, Martyna Niemczuk1, Krzysztof Kurek1
1Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Białystok, Poland.
Introduction:
Patients with troublesome reflux‑like symptoms, in whom routine empirical proton pump inhibitor (PPI) therapy is often unsatisfactory, present a therapeutic challenge and are frequently referred for gastroenterological evaluation to confirm a diagnosis of gastroesophageal reflux disease (GERD).
Objectives:
We aimed to determine the prevalence of objectively confirmed GERD (diagnosed according to the Lyon Consensus 2.0 criteria) in patients with typical and / or atypical troublesome reflux‑like symptoms who did not respond or partially responded to PPI therapy, and were referred for esophageal pH‑impedance monitoring.
Patients And Methods:
This was a retrospective study analyzing pH‑impedance monitoring results of 500 patients who previously underwent endoscopy. A conclusive GERD diagnosis was defined as an acid exposure time (AET) greater than 6%, or 4%-6% with supporting evidence (number of reflux episodes >80/d, and / or mean nocturnal basal impedance <1500 Ω, and / or a positive reflux-symptom association).
Results:
Of the 500 patients analyzed, 477 reported symptoms, which were categorized as follows: isolated typical (n = 49; 10.3%), both typical and atypical (n = 206; 43.2%), and isolated atypical (n = 222; 46.5%). AET greater than 6% was found in 12 (24.5%), 41 (19.9%), and 27 patients (12.2%) in each group, respectively. The inclusion of supportive evidence for patients with AET of 4%-6% increased the number of GERD diagnoses in each group to 23 (46.9%), 68 (33%), and 40 (18%), respectively. When endoscopy findings were factored in, the prevalence of GERD in the whole study population increased from 27% (n = 135) to 29.6% (n = 148). Among the 161 individuals reporting heartburn, 41.6% met the criteria of functional heartburn.
Conclusions:
Only 29.6% of the patients referred for GERD evaluation fulfilled the objective diagnostic criteria for the disease. GERD was present in about half of the patients with isolated typical symptoms, one‑third of those with both typical and atypical symptoms, and fewer than one‑fifth of those with isolated atypical symptoms.
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