LPR testing.docx

1、LPR testingLaryngopharyngeal reflux testing.Ads by Googlei cured my acid reflux3 simple grocery items work miracle Naturally stop acid reflux here.www.AcidR STOP GERD NaturallyHeal the Digestive Dysfunction Causing the GERD +. 100% Guaranteed Diet For Acid RefluxLooking for Diet For Acid Reflux? See

2、 our Diet For Acid Reflux guide.Link to this pageAbstract Reflux testing is still evolving as new technology. New criteria for determination of clinical and subclinical subclinical/subclinical/ (sub-klini-kl) without clinical manifestations. subclinicaladj.Not manifesting characteristic clinical sym

3、ptoms. Used of a disease or condition. laryngopharyngeal reflux are surfacing. The technique and interpretation of pH monitoring, the current gold standard, are still somewhat controversial. The authors experience and opinions are presented herein. Introduction Testing for laryngopharyngeal reflux (

4、LPRSee LPR/LPD. lpr - Line printer. The Unix print command. This does not actually print files but rather copies (or links) them to a spool area from where a daemon copies them to the printer. . Click the link for more information.) can involve six different modalities: (1) the laryngeal laryngeal/l

5、aryngeal/ (lah-rinje-al) pertaining to the larynx. laryngealor laryngaladj.Of, relating to, affecting, or near the larynx. examination, (2) ambulatory 24-hour double-probe (simultaneous esophageal and pharyngeal pharyngeal/pharyngeal/ (fah-rinje-al) pertaining to the pharynx. pharyngealor pharyngala

6、dj.Of, relating to, located in, or coming from the pharynx. ) pH monitoring, (3) esophageal manometry Esophageal manometryA test in which a thin tube is passed into the esophagus to measure the degree of pressure exerted by the muscles of the esophageal wall.Mentioned in: Achalasia , (4) esophagosco

7、py or esophagography, (5) laryngeal sensory testing, and (6) intraluminal impedance monitoring. These modalities are not equally important. Impedance monitoring is still new enough that its value is as yet undetermined. Ads by GoogleThroat Discs SootheSingers, Speakers - Sore Throats Hoarseness Phle

8、gm Dryness Tickles Acid Reflux ReliefInstant Relief for Acid Reflux. Select Acid Reflux Treatments Now!HeartburnRelief.info/AcidRefluxWhen a patient has symptoms that suggest LPR, the clinician should perform a complete otolaryngologic examination and fiberoptic laryngoscopy. The clinician should al

9、so consider pH monitoring and a screening examination of the esophagus. LPR is best diagnosed by ambulatory 24-hour double-probe pH monitoring. (1,2) Barium esophagography, radionucleotide scanning, the Bernstein acid perfusion test acid perfusion testn.See Bernstein test. , and esophagoscopy with b

10、iopsy are often negative in LPR patients. This is probably because most LPR patients do not develop esophagitisesophagitis/esophagitis/ (e-sof?ah-jitis) inflammation of the esophagus. chronic peptic esophagitis reflux e. . Click the link for more information., which is typically observed in gastroen

11、terology patients with gastroesophageal reflux disease gastroesophageal reflux disease (GERD)Disorder characterized by frequent passage of gastric contents from the stomach back into the esophagus. Symptoms of GERD may include heartburn, coughing, frequent clearing of the throat, and difficulty in s

12、wallowing. (GERD GERDgastroesophageal reflux disease. GERDabbr.gastroesophageal reflux diseaseGERD). Traditional diagnostic tests for GERD are often falsely negative in LPR. (1,2) pH monitoring Ambulatory 24-hour double-probe pH monitoring (pH-metry) is both highly sensitive and specific for LPR. (2

13、-5) In fact, it is superior to any other diagnostic modality, including barium swallow barium swallown.See upper GI series.Barium swallowBarium is used to coat the throat in order to take x-ray pictures of the tissues lining the throat. , endoscopy endoscopyExamination of the bodys interior through

14、an instrument inserted into a natural opening or an incision, usually as an outpatient procedure. Endoscopes include the upper gastrointestinal endoscope (for the esophagus, stomach, and duodenum), the colonoscope (for the , and single-probe esophageal pH testing, in the diagnosis of LPR. Furthermor

15、e, pH-metry reveals the pattern of reflux (figure 1) 50 that subsequent treatment can be custom-tailored to each patient. (2) For example, if a patient does not have supine nocturnal reflux, elevation of the head of the bed need not be recommended. Yet, despite the fact that pH-metry is considered t

16、he gold standard for LPR testing in otolaryngologic practice, there is no consensus with respect to the number of pH sensors, their location, or the interpretation of results. (2) Importance of the pharyngeal probe. The importance of the pharyngeal sensor cannot be overemphasized. When the pharyngea

17、l probe is positive, it is diagnostic for LPR. (1,2) Katz showed in a small number of LPR patients that reliance on only an esophageal probe can result in false-negative results. (6) A review of a consecutive series of 334 pharyngeal-positive pH studies at our center demonstrated that 126 (38%) had

18、normal esophageal acid exposure times in the esophageal probe. (5) In other words Adv. 1. in other words - otherwise stated; in other words, we are brokeput differently , the esophageal exposure times were in the normal range, but some esophageal reflux esophageal refluxn.See gastroesophageal reflux

19、. reached the pharynx pharynx(frngks), area of the gastrointestinal and respiratory tracts which lies between the mouth and the esophagus. In humans, the pharynx is a cone-shaped tube about 4 1-2 in. (11.43 cm) long. . Therefore, if only a single-probe esophageal study had been performed in that gro

20、up, 38% would have been falsely assumed not to have LPR. Similarly in the pediatric pediatric/pediatric/ (pe?de-atrik) pertaining to the health of children. pediatricadj.Of or relating to pediatrics. population, Little et al showed that 78 of 168 children (46%) with pH-documented LPR had normal esop

21、hageal acid exposure times. (7) It is clear that measuring esophageal acid exposure does not allow us to make any assumptions concerning the presence or absence of pharyngeal reflux. One point of clarification for the reader is needed here. In the studies cited above, pharyngeal reflux occurred in t

22、he face of normal esophageal parameters. However, by definition, each pharyngeal reflux event was preceded by an esophageal reflux event. After all, the refluxate must traverse the esophagus to reach the pharynx. But in the situation described above, the percentage of time of esophageal acid exposur

23、e and/or the total number of esophageal reflux events fell within the normal range. If, for example, a 24-hour study showed a total of just 25 esophageal reflux events, that would be considered normal (in our laboratory, up to 51 reflux events per 24 hours is normal). But if some of those esophageal

24、 reflux events reached the pharyngeal probe, the patient would be diagnosed as having LPR-that is, reflux into the pharynx. Abnormal esophageal reflux by pH monitoring does not imply LPR; conversely, normal esophageal reflux by pH monitoring does not rule it out. We believe that the proximal probe s

25、hould be placed in the pharynx and not in the upper esophagus (figure 2), as has been suggested by some. Proximal esophageal reflux does not necessarily correlate with LPR. (8-10) To measure the gastric pH and extrapolate extrapolate - extrapolation those data to imply GERD is clearly invalid. Simil

26、arly, using esophageal pH data (even at a proximal esophageal location) to prove the presence or absence of LPR is invalid, because the upper esophageal sphincter The upper esophageal sphincter (UES) refers to the superior portion of the esophagus.Unlike the lower esophageal sphincter, it is compris

27、ed of striated muscle and is under conscious control. (UES UES UNE (University of New England)Economics SocietyUES Upper East Side (Manhattan, NY)UES Upper Esophageal SphincterUES Unified Energy Systems of RussiaUES Waukesha, Wisconsin ) functions as the final barrier against LPR. In normals and GER

28、D patients, experimental acid instillation into the esophagus increases the UES resting pressure, thereby enhancing its effectiveness as a barrier to LPR. (11) Esophageal manometry. Esophageal manometry is the preferred method of guiding pH probe placement. It is our contention that the use of manom

29、etry manometry/manometry/ (-e-tre) the measurement of pressure by means of a manometer. anal manometry rather than direct visual placement is vital to ensuring accurate placement of pH probes. (1,2,12) The available normative data for reflux in the esophagus are derived from standard distal probe pl

30、acement 5 cm above the lower esophageal sphincter lower esophageal sphinctern.A ring of smooth muscle fibers at the junction of the esophagus and stomach. Also called cardiac sphincter. (LES). Even small degrees of variance from this position can result in significant changes in the results obtained

31、 from the esophageal pH probe. If the probe is not in the proper position, no reliable conclusions regarding esophageal acid exposure data can be made. Using visual placement to position the proximal probe in the hypopharynx (just above the UES) is an accurate method (figure 3). (12,13) However, whe

32、n one does so, the fixed distance between the proximal and distal sensors of the probe means that the distal probe is placed in an unknown position in reference to the LES. (12) Therefore, the esophageal acid exposure data cannot be interpreted as normal or abnormal. Manometry not only accurately locates the UES and LES, but it also allows for evalua