Evaluation of pH-impedance testing in diagnosis of patients with suspected extra-oesophageal manifestations of gastroesophageal reflux disease

Introduction: Combined multichannel intraluminal impedance and pH-metry (MII-pH) is a technique that enables monitoring of gastroesophageal reflux disease (GERD) independently of its acidity.

Aim: To investigate the utility of MII-pH testing among patients with suspected GERD with atypical symptoms.

Material and methods: Thirty-two consecutive patients underwent gastroscopy and MII-pH testing to evaluate the cause of atypical symptoms presumed due to GERD. Among them, 19 patients with unexplained chronic cough, sore throat, globus and hoarse voice were included in group 1 – laryngological symptoms. Videolaryngoscopic examination was used to document reflux-related laryngitis. Group 2 – miscellaneous symptoms – included 13 patients with nausea, chronic burning in the mouth and throat, belching, dyspnoea, wheezing and upper abdominal discomfort.

Results: In group 1, with laryngological symptoms, 32%, 16%, and 16% of patients were found to have symptoms of acid reflux, non-acid reflux or both, respectively. Eight patients (42%), who did not show any changes in videolaryngoscopy, had MII-pH documented acid reflux. Application of MII-pH allowed the relation between laryngeal symptoms and acid reflux to be confirmed in 1/3 of all examined patients. In group 2, with miscellaneous symptoms, acid reflux was found in 3 patients (23%) and non-acid GER in 2 patients (15%). The majority of patients (62%) from the group with miscellaneous symptoms did not have GER.

Conclusions: MII-pH testing is useful in determining whether gastroesophageal reflux occurs in patients with atypical symptoms. MII-pH testing was useful in redirecting the management of patients who did not have reflux as the cause of their symptoms.