Intraluminal Pharyngeal Impedance After Acid Exposure is Lower in Patients with Posterior Laryngitis

the first 5 min), during 15-min acid exposure (acid, 2-ml HCl 0.1N every 30s for 15 min), and for a 25-min post-acid period (post-acid). PZ was analyzed at the end of baseline and at 5-min intervals along the acid and post-acid periods. Data were compared by the t Test and Spearman rho. Impedance is presented in Ohms (mean±SD). Results. RSI median score was 19 (range 6-22) and abnormal (>13) in 8 cases. Total distal acid exposure (%tot) was greater than 5% in 2 ENT. The number of weakly acid GER was greater than the 75 percentile in 6 ENT. Baseline PZ was similar between controls and ENT (2295±1574 v 2332±565). Baseline PZ correlated negatively with %tot in ENT (r=-0.791, p=0.004, n=11). PZ dropped faster (41% drop at 5-min acid, p=0.0001, v no drop in controls) and deeper in ENT than controls during and after acid exposure (15min acid: 2053±975 v 938±381, p=0.002; 25min post-acid: 1691±654 v 1088±331, p=0.014)(figure). Three controls (30%) had PZ at the ENT range at 15-min acid (figure). PZ did not correlate with EGJ-activity. The count of supine proximal esophageal acid reflux (but not the distal one) increased as the EGJ activity decreased (r=-0.755, p=0.007). HBQOL score correlated positively with the PZ during the post-acid period (25-min post-acid: r=0.774, p=0.005). Conclusions. The ENT pharyngeal mucosa seems to be more vulnerable to acid relative to controls. Pharyngeal baseline impedance in ENT is normal but acid exposure may help depict these patients.

Sa1166 INTRALUMINAL PHARYNGEAL IMPEDANCE AFTER ACID EXPOSURE IS LOWER IN PATIENTS WITH POSTERIOR LARYNGITIS Miguel Angelo N. Souza, Tanila A. Coutinho, Cynthia A. Ponte, Marina A. Nobre, Marcellus Souza, Armenio Aguiar Santos

Sa1167 PHARYNGOLARYNGEAL GERD SYMPTOMS ARE ASSOCIATED WITH LOWER MAXIMAL INSPIRATORY ORAL PRESSURES AND POSSIBLY POORER CRURAL DIAPRAGM FUNCTION Miguel Angelo N. Souza, Ezana S. Borja, Maria Edna Cardoso, Juliete V. Ferreira, Marina A. Nobre, Vicente C. Silva, Marcellus Souza, Armenio Aguiar Santos

Esophageal symptoms and esophagitis are frequently absent in ear, nose and throat acidrelated disease patients (ENT). Only half of these patients have abnormal esophageal pH tests. Intraluminal impedance baseline is low in severe erosive esophagitis and its measurements can be used to evaluate esophageal mucosa integrity in man. The aim of this study is to investigate the effect of pharyngeal acid exposure on intraluminal impedance. Methods. Eleven patients with throat symptoms and laryngoscopy findings related to GER (posterior laryngitis) (mean age 43 y, 4 grade A esophagitis) and 10 healthy subjects (mean age 36y) were enrolled after ethical committee approval (HUWC, Fortaleza, Brazil). Validated questionnaires (RSI and HBQOL) assessed the symptoms and quality of life. The ENT had high-resolution esophageal manometry with inspiratory maneuvers (HRM) to measure EGJactivity (product of the maximal EGJ pressure and the length of its aboral excursion during forceful inhalations through 24cmH2O inspiratory load in mmHg×cm - Souza, NGM, 2016) followed by an ambulatory esophageal impedance-pH study, and the controls had a HRM study. Next, pharyngeal impedance (PZ) was monitored 2 cm proximal to the upper border of upper esophageal sphincter for 15 min before (baseline, 3-ml pH 8 H2O every 30 s for

The crural diaphragm (CD) is a crucial component of the esophagogastric junction (EGJ). There is a functional deficit of the crural diaphragm in GERD. The measurement of the maximal inspiratory oral pressure (maxIP) is a simple way to figure out the diaphragm function. Our goal is to investigate a possible association among maxIP, esophagitis, and GERD symptoms. Methods. 475 patients (Age 43±14y, BMI 27.3±6.9, 154 males) that had upper GI endoscopy in a university hospital were initially enrolled after ethical approval (HUWC, Fortaleza, Brazil). 267 patients suffered from significant systemic comorbidities (CM). Patients with CM or without rapid urease test (RUT) at endoscopy were excluded. The following data refer to the remaining 138 patients (Age 39.9±14.4y, 35 males, BMI 26.8±6.3). 35 patients had esophagitis, 10 had a hiatal hernia (HH), 55 took proton pump inhibitor (PPI). All patients answered two questionnaires: RSI for supraesophageal and RDQ

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AGA Abstracts

AGA Abstracts

above the upper esophageal sphincter (UES) in to the oral cavity, pharynx, upper and lower respiratory tract and leads to pathological changes like e.g. hoarseness, chronic cough, globus pharyngis, laryngitis, pharyngitis, rhinosinusitis, laryngeal tumors, bronchial asthma, COPD, sleep apnea and noncardiac chest pain. Methods: The examinations were carried out using the 24-hour multichannel intraluminal impedance and pH esophageal monitoring (MII-pH) and we evaluated results from 200 patients in two groups. The first group included 100 patients (56 female and 44 male, mean age 47.8 years) with GERD and typical esophageal symptomatology. In the second group were 100 patients ( 56 female, 44 male, mean age 45.8 years) with EER symptoms. We evaluated DeMeester score, the number of reflux episodes by pH (acid, weakly acid and non acid), simultaneously the state of matter (liquid, gas, mixed) and the rate of penetration in the UES area. Results: We found a statistically significant difference (p<0.001) in the value of DeMeester score that were significantly lower in the group with EER (median 21.6 vs. 45 in the GERD group). Further, in the group with EER against the group with GERD we observed significantly less episodes of mixed acid reflux (p<0.05) and total acid reflux (p<0.05) and higher number of mixed weakly acid reflux episodes (p<0.01) gaseous weakly acid reflux episodes (p<0.01) and total weakly acid reflux episodes (p<0.01) and increased total number of gaseous reflux episodes (p<0.05). Furthermore, in the group with EER against the group with GERD we observed significantly higher number of liquid (p<0.05), mixed (p<0.05), gaseous (p<0.001) and overall (p<0.01) reflux episodes in the level of electrode Z1 (UES). Also, we observed an increased fraction of non acid reflux episodes in the group with EER (27% versus 15% of patients with GERD), but without statistical significance (p=0.055). Conclusion: We confirmed our main hypothesis that patients with EER symptoms have more weakly acid reflux episodes and fewer acid reflux episodes compared to a group of patients with classical GERD symptoms while we found minor differences in the frequency of individual components of refluxate. We also observed lower values of DeMeester score, higher number of gaseous reflux episodes and generally significantly higher number of penetration of refluxate of all states of matter to the UES area. These differences can suggest different pathophysiological mechanism of symptoms of EER and GERD and also the necessity of different therapeutic approach to both groups in the future Results