Diagnosis and Treatment of Extraesophageal Reflux Disease

Diagnosis and Treatment of Extraesophageal Reflux Disease Rachel Rosen, MD Aerodigestive Center (ADC) Center for Motility and Functional Gastrointesti...
Author: Silvia Marshall
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Diagnosis and Treatment of Extraesophageal Reflux Disease Rachel Rosen, MD Aerodigestive Center (ADC) Center for Motility and Functional Gastrointestinal Disorders

Sinusitis 4 .2%

Otitis 2.1% Dental erosion 40.2°/o Apparent life threatening event 20% Asthma 13.2%

Pneumonia 6 .3% Bronchiectasis 1%

General respiratory symptoms 57.7%

The uphill battle……. Goldski et al Pediatrics 2010

symptoms Nelson et al J Med Economic 2009

Mechanisms of Reflux Related Respiratory Disease • Neurally Mediated • Microaspiration

Making the diagnosis • • • • • •

Total reflux burden? Acid vs. non-acid? Symptom correlation? Distal Reflux Burden? Proximal Reflux burden? Esophagitis? Lung biomarkers?

pH probe •Pharyngeal pH monitoring •pH-MII •Cough catheters •Cough microphon e •Biomarkers

Pharyngeal pH Monitoring

MII‐pH with  corresponding  Restech event Oropharyngeal pH drop >10%  corresponds with MII‐pH  changes

Correlation of Changes in Oropharyngeal pH with MII Events Chiou et al Neurogastro 2011

100 No Correspondin g MII-pH event Assoc w/ NonAcid GER

80 60 40 20 0 >10% pH pH pH pH Drop

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