Making Sense of Reflux Testing

PROGRAM DESCRIPTION: “I still don’t know what to do with my LPR patients who don’t respond to acid blockers.” This is a common problem facing many otolaryngologists. Due to the lack of availability of and lack of a widespread understanding of what test is best and how to interpret those tests, empiric proton pump inhibitor (PPI) therapy to treat presumed Laryngopharyngeal reflux disease (LPR) remains standard of care. Empiric and ongoing PPI therapy is the primary driver of the billions of healthcare dollars spent to diagnose and treat LPR (or symptoms attributed to LPR). While empiric trials will continue to play a role in LPR care, increasing patients' and clinicians' trepidation of PPI medication side effects leave otolaryngologists with a need for newer approaches to suspected LPR patients that are based more on the pH and proximal extent of the reflux. Hypopharyngeal-esophageal multichannel intraluminal impedance testing with dual pH sensor (HEMII-pH) testing HEMII-pH testing and high-resolution esophageal manometry (HRM) can guide a more effective management plan for patients with LPR. This course will cover the benefits and shortcomings of the current, objective, available diagnostic modalities used to evaluate patients for suspected LPR including impedance-pH, capsule pH, pharyngeal pH, and traditional dual pH probes. The lecture will provide most detail of HEMII-pH and HRM and how its interpretation influences LPR treatment options.

OUTCOME OBJECTIVE 1: Identify current available modalities of objective reflux testing including their individual advantages and disadvantages.

OUTCOME OBJECTIVE 2: Recognize the difference between acid and non-acid reflux (including the role of pepsin) and why and how this influences treatment choices

OUTCOME OBJECTIVE 3: Apply one’s understanding of reflux and decide on which objective reflux test to order and how to interpret HEMII-pH data

BACKGROUND STATEMENT: Otolaryngologists are at the forefront of LPR treatment but come up short in diagnostic options when PPIs fail. Knowing the tests to order for a suspected LPR patient, what to ask from your GI in their result reports and personally interpreting the data are helpful skills for the otolaryngologist.