2004 Volume 55 Issue 5 Pages 414-422
We reported three cases of laryngopharyngeal reflux disease (LPRD) which were resistant to antiacid therapy by H2 receptor antagonist (H2RA) or proton pump inhibitors (PPI). The significance of evaluating drug efficacy by tetra-probe 24-hour pH monitoring was also shown (The proximal probe was placed in the hypopharynx, just above the upper esophageal sphincter; a second in the middle esophagus; a third a few centimeters above the lower esophageal sphincter; and a distal sensor in the stomach).
One LPRD case was administered Famotidine (40 mg/day), one Omeprazole (10 mg/day), and one Lansoprazole (30 mg/day). Tetra-probe 24-hour pH monitoring revealed that these antiacid medicines were not successful in reducing gastric acid levels, and gastroesophageal and laryngopharyngeal refluxes were in evidence. It should be noted that there are cases of LPRD which are resistant to antiacid therapy, even though the patients take antiacid medicine. When an H2RA is shown to be unsuccessful in reducing gastric acid levels, LPRD patients require a PPI. When a PPI is still not successful in reducing gastric acid levels, another PPI is recommended.
As the pH of the four sensors could be monitored simultaneously, gastric acid levels and gastroesophaqeal and laryngopharyngeal refluxes could be easily examined. The pH-metry revealed the gastric acid levels and patterns of reflux, enabling the relationship between the four sensor locations to be well documented on the pH tracing. Tetraprobe 24-hour pH monitoring has become one of the most reliable functional examinations in evaluating drug efficacy for LPRD.
