Diagnostic Value Of24-hour Combined Esophageal Multichannel Intralumminal Impedance And Ph Monitoring Of Atypical Gastroesophageal Reflux Disease In Globus Patients

Background and Aims:The aim of this article is to investigate the reflux profile of patients with atypical GERD among globus patients, through the aid of24-hour combined multichannel intraluminal impedance-pH (MII-pH) monitoring technique, and to provide scientific basis for clinical treatment.Materials and Methods:Retrospectively analyzed31cases with sumptom of globus with no organic diseases under upper endoscopy and laryngoscope, they all underwent24-hour ambulatory combined impedance-pH studies, esophageal manometry in the gastrointestinal function room of our hospital between September2010and February2012. The cases corresponded criterias of MII-pH were included to GERD+group, and the left to GERD-group. Reflux profile was compared in two groups.Results:A total of17patients (54.8%) had pathological findings in any method. The highest diagnostic yield was achieved by24h MII-pH measurement (54.8%). followed by solely impedance measurement (41.9%), distal pH-metry (35.4%), and proximal pH-metry (9.6%). There were more upright percentage time of esophageal pH value below4.total percentage time of esophageal pH value below4, acid reflux episodes over5minutes, acid clearance time, time of longest acid episode, episodes of liquid reflux, acid reflux at the distal and proximal esophagus and weakly acid reflux at the proximal esophagus in GERD+group than that in GERD-group (p<0.05). In terms of acidity of refluxate, the percentage of acid reflux in GERD+group was the highest, which was44.3%. However, the percentage of weakly acid reflux in GERD-group was the highest, which was72.2%. There was significant difference among percentage of acid, weakly acid and weakly alkaline reflux in2groups (χ2=115.446, P=0.000). Concerning the composition of refluxate, patients in GERD+group had highest proportion of liquid reflux, which was36.5%, whereas patients in GERD-group had highest proportion of mixed reflux, which was43.3%. There was no significant difference among the proportion of liquid and mixed reflux of2groups (χ2=13.938,P=0.001).The proportion of proximal reflux in GERD+group was41.4%and29.4%in GERD-group， There was significant difference among the proportion of proximal reflux of2groups (χ2=19.084, P=0.000).Conclusions:Combining impedance and pH monitoring improves the detection and characterization of atypical GERD among globus patients. Acid reflux was predominant in GERD+group, while weakly reflux was predominant in GERD-group.The frequency and proportion of proximal reflux were predominant in GERD+group than GERD-group, which might be evaluation indicator in degree of reflux. Twenty-four-hour MⅡ-pH monitoring would have More have clinical application value in atypical GERD patients in chronic globus than traditional pH monitoring.