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      Utilidade do registro do pH em parte proximal do esôfago Translated title: Usefulness of proximal esophageal pH monitoring

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          Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux.

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            The proximal probe in esophageal pH monitoring: development of a normative database.

            Healthy volunteers without symptoms of either gastroesophageal reflux or laryngopharyngeal reflux and without abnormalities on laryngologic examination were recruited for esophageal pH monitoring. Thirty subjects underwent ambulatory 24-hour double-channel pH probe monitoring to establish normative data for the upper probe, which was positioned just above the upper esophageal sphincter. Data were analyzed excluding meal periods plus 2 minutes of postprandial time. The mean, standard deviation, median, and 95th percentile were calculated for various reflux parameters for the following intervals: total study duration, upright time, supine time, and postprandial time. Normal subjects display physiologic reflux above the upper esophageal sphincter (median one event, 95th percentile 6.9 events), and 80.4% of these events occur in the upright position. The reflux area index (RAI) appears to be the most useful parameter to measure laryngopharyngeal reflux severity.
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              Proximal sensor data from routine dual-sensor esophageal pH monitoring is often inaccurate.

              Dual-sensor esophageal pH monitoring is routinely used to diagnose GERD. However, the proximal sensor may not be in proximal esophagus in patients with shortened esophagi. Our objective was to determine how often the proximal sensor was misplaced and to determine the effect on pH monitoring. Superior margins of the upper and lower esophageal sphincters (UES and LES) were determined prospectively in consecutive patients. Dual sensors were placed 20 and 5 cm above the LES with a fixed 15-cm spacing pH catheter. Patients were classified into subgroups based on the actual location of the proximal sensor. In 661 patients, the proximal pH sensor was in the hypopharynx in 9% of patients, within the UES in 36%, and in the proximal esophagus in 55%. Spearman's correlation for acid exposure was very good between the dual sensors when the proximal sensor was in the proximal esophagus (R = 0.76) but was poor when the proximal sensor was misplaced in the hypopharynx (R = 0.28). The proximal sensor was misplaced in 45% of patients undergoing dual-sensor esophageal pH monitoring. It is important to locate the UES by manometry before interpreting the proximal esophageal pH data.
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                Author and article information

                Journal
                ag
                Arquivos de Gastroenterologia
                Arq. Gastroenterol.
                Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. (São Paulo, SP, Brazil )
                0004-2803
                1678-4219
                June 2011
                : 48
                : 2
                : 89-90
                Affiliations
                [01] Ribeirão Preto SP orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Departamento de Clínica Médica Brasil
                Article
                S0004-28032011000200001 S0004-2803(11)04800200001
                10.1590/S0004-28032011000200001
                ec9e0f8e-bdc9-4792-b88a-e61abba6b76c

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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