Prediction of the Response to Proton Pump Inhibitor Treatment Using Wireless Ambulatory pH Monitoring in Patients with Globus Sense

Hea Jung Sung; Woo Chul Chung; Ji Woong Roh; Sooa Choi; Yoon Goo Kang; So Lim Hong; Kang Won Cho

doi:10.4166/kjg.2015.65.2.85

Journal List > Korean J Gastroenterol > v.65(2) > 1007401

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Sung, Chung, Roh, Choi, Kang, Hong, and Cho: Prediction of the Response to Proton Pump Inhibitor Treatment Using Wireless Ambulatory pH Monitoring in Patients with Globus Sense

Original Article

Korean J Gastroenterol 2015;65(2):85-89.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.2.85

Prediction of the Response to Proton Pump Inhibitor Treatment Using Wireless Ambulatory pH Monitoring in Patients with Globus Sense

Hea Jung Sung, Woo Chul Chung, Ji Woong Roh, Sooa Choi, Yoon Goo Kang, So Lim Hong, Kang Won Cho

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Woo Chul Chung, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Jungbu-daero, Paldal-gu, Suwon 442-723, Korea. Tel: +82-31-249- 7138, Fax: +82-31-253-8898, E-mail: jwchulkr@catholic.ac.kr

Received 4 November 2014 Accepted 16 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat and a commonly encountered clinical condition. We aim to evaluate the prevalence of gastroesophageal reflux disease (GERD) and to determine the parameters for predicting the response to treatment with proton pump inhibitor (PPI) using wireless pH monitoring in patients with globus sense.

Methods

We retrospectively reviewed the medical records of 37 patients with atypical GERD symptoms. A total of 27 patients with dominant globus sense were enrolled. Endoscopic examination and 48-hour wireless esophageal pH monitoring were performed, and the patients underwent a therapeutic trial of full dose PPIs daily over a period of 4 weeks.

Results

Both typical and atypical GERD symptoms co-existed in 14 patients (51.9%, 14/27). According to ROME III criteria, 19 patients (70.4%, 19/27) were diagnosed as GERD. Twelve patients (44.4%, 12/27) were PPI responders. A significant difference in the frequency of symptom index (+) or symptom associated probability (+) was observed between the PPI responder group and the non-responder group (p<0.01).

Conclusions

In patients with globus sense, 70.4% were diagnosed with GERD. Symptom index/symptom associated probability in wireless ambulatory pH monitoring was a good objective parameter for PPI responder.

Keywords: Gastroesophageal reflux, Globus, Esophageal pH monitoring

References

1. Lee BE, Kim GH. Globus pharyngeus: a review of its etiology, diagnosis and treatment. World J Gastroenterol. 2012; 18:2462–2471.

2. Koufman JA, Belafsky PC, Bach KK, Daniel E, Postma GN. Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. Laryngoscope. 2002; 112:1606–1609.

3. Yi CH, Liu TT, Chen CL. Atypical symptoms in patients with gastroesophageal reflux disease. J Neurogastroenterol Motil. 2012; 18:278–283.

4. Oh JH, Choi MG, Park JM, et al. The clinical characteristics of gastroesophageal reflux disease in patients with laryngeal symptoms who are referred to gastroenterology. Dis Esophagus. 2013; 26:465–469.

5. Oridate N, Takeda H, Asaka M, et al. Acid-suppression therapy offers varied laryngopharyngeal and esophageal symptom relief in laryngopharyngeal reflux patients. Dig Dis Sci. 2008; 53:2033–2038.

6. Kahrilas PJ, Smout AJ. Esophageal disorders. Am J Gastroenterol. 2010; 105:747–756.

7. Dore MP, Pedroni A, Pes GM, et al. Effect of antisecretory therapy on atypical symptoms in gastroesophageal reflux disease. Dig Dis Sci. 2007; 52:463–468.

8. de Bortoli N, Nacci A, Savarino E, et al. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related? World J Gastroenterol. 2012; 18:4363–4370.

9. Vaezi MF, Richter JE, Stasney CR, et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope. 2006; 116:254–260.

10. Noordzij JP, Khidr A, Evans BA, et al. Evaluation of omeprazole in the treatment of reflux laryngitis: a prospective, placebo-controlled, randomized, double-blind study. Laryngoscope. 2001; 111:2147–2151.

11. Khalil HS. The diagnosis and management of globus: a per-spective from the United Kingdom. Curr Opin Otolaryngol Head Neck Surg. 2008; 16:516–520.

12. Qua CS, Wong CH, Gopala K, Goh KL. Gastro-oesophageal reflux disease in chronic laryngitis: prevalence and response to acid-suppressive therapy. Aliment Pharmacol Ther. 2007; 25:287–295.

13. Tokashiki R, Funato N, Suzuki M. Globus sensation and increased upper esophageal sphincter pressure with distal esophageal acid perfusion. Eur Arch Otorhinolaryngol. 2010; 267:737–741.

14. Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005; 294:1534–1540.

15. Cho YK, Choi MG, Lim CH, et al. Diagnostic value of the PPI test for detection of GERD in Korean patients and factors associated with PPI responsiveness. Scand J Gastroenterol. 2010; 45:533–539.

16. Taghavi SA, Ghasedi M, Saberi-Firoozi M, et al. Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole. Gut. 2005; 54:1067–1071.

17. Bajbouj M, Becker V, Neuber M, Schmid RM, Meining A. Combined pH-metry/impedance monitoring increases the diagnostic yield in patients with atypical gastroesophageal reflux symptoms. Digestion. 2007; 76:223–228.

Table 1.

Baseline Characteristics of the Enrolled Patients

Characteristic	GERD (n=19)	Non-GERD (n=8)	p-value ^a
Sex (M : F)	11 : 8	4 : 4	0.775
Age (yr)	52.8±11	53.7±10	0.440
Typical symptom (heartburn or acid regurgitation)	12 (63.2)	2 (25.0)	0.187
PPI response	10 (52.6)	2 (25.0)	0.070
Pathologic esophageal acid reflux	11 (57.9)	0	-
SI/SAP positive	14 (73.7)	0	-

Values are presented as n only, mean±SD, or n (%).

GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor; SI, symptom index; SAP, symptom associated probability.

^a GERD vs. non-GERD, Mann Whitney U-test.

Table 2.

Factors and Improvement of Globus Symptoms Affecting Proton Pump Inhibitor (PPI) Response

Variable	PPI response(+) (n=12, 44.4%)	PPI response(−) (n=15, 55.6%)	p-value ^a
GERD	10 (83.3)	9 (60.0)	0.187
SI/SAP positive	10 (83.3)	4 (26.7)	0.003
Pathologic esophageal acid reflux	4 (33.3)	7 (46.7)	0.484
The presence of typical symptoms (heartburn, acid regurgitation)	7 (58.3)	7 (46.7)	0.547

Values are presented as n (%).

GERD, gastroesophageal reflux disease.

^a PPI response(+) vs. PPI response(−), Fisher's exact test.

TOOLS

Similar articles