Software improvement for evaluation of laryngopharyngeal pH testing(Restech)——a comparison between Data View 3 and 4

BACKGROUND When gastroesophageal reflux contents reach above the upper esophageal sphincter,patients may,in addition to typical reflux symptoms,present with atypical,extraesophageal symptoms related to laryngopharyngeal reflux(LPR).Surgical treatment of LPR has shown to lead to 70%symptom improvement,however no gold standard for the diagnosis of LPR exists.In 2007,the Restech Dx-pH was released as a valid method to measure acid exposure above the upper esophageal sphincter.Recently,a new software update was introduced for analysis of measured pH data and calculation of composite scores.The effect of the changes applied to the new software version have not yet been analyzed.AIM To compare results generated by Data View 3 to the most recently released Data View 4.METHODS All patients with gastroesophageal reflux disease symptoms were seen in a specialized surgical outpatient clinic for gastrointestinal function testing.Retrospective chart review was performed of all patients presenting with suspected gastroesophageal reflux disease and extraesophageal reflux symptoms,who underwent laryngopharyngeal pH monitoring using the Restech Dx-pH system(Respiratory Technology Corp.,Houston,TX,United States)and simultaneous esophageal pH monitoring.Data View 3 and Data View 4 were used to evaluate Restech studies obtained.Diary entries such as mealtimes,supine and upright periods,and symptoms were entered manually to ensure accuracy and precise conversion of data between both software versions.Paired t test was performed for statistical analysis of results.RESULTS A total of 174 patients(63.8%female)met inclusion criteria,all suffering from extraesophageal reflux symptoms as well as typical gastroesophageal reflux disease symptoms.Mean RYAN score upright was 48.77 in Data View 3 compared to 22.17 in Data View 4,showing a significant difference(~aP=0.0001).Similar results were shown for supine period(mean RYAN Score Data View 35.29 vs 1.42 in Data View 4,~cP=0.0001).For upright periods 80 patients showed a decrease of value of the RYAN score with a mean of-58.9(mean 51.1%decrease).For supine position 25 patients showed a decrease of value of the RYAN score with a mean of-15.13[range(-153.44)–(-0.01)],which equals a mean decrease of value of 44.5%.Ten patients showed no oropharyngeal acid exposure in Data View 3,but mild/moderate(n=7)or severe(n=3)acid exposure in Data View 4.Correlation with positive esophageal pH measurement was improved in all 10 patients.CONCLUSION Results of both software versions cannot be compared to each other.However,our data suggests that Data View 4 may be an improvement of the Restech pH measurement in the evaluation of LPR.