Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2016; 22(40): 8991-8998
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8991
Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus
Sandro Passaretti, Giorgia Mazzoleni, Cristian Vailati, Pier Alberto Testoni
Sandro Passaretti, Giorgia Mazzoleni, Cristian Vailati, Pier Alberto Testoni, Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
Author contributions: Passaretti S designed the study, analyzed manometric data and did the statistical analysis; Mazzoleni G did examinations, analyzed pH-metric data and wrote the paper; Vailati C did examinations and collected data; Testoni PA revised the manuscript; all authors approved the final version.
Institutional review board statement: The study was reviewed and approved by the medical ethics committee of San Raffaele Scientific Institute.
Informed consent statement: All study participants provided informed written consent prior to enrollment.
Conflict-of-interest statement: All authors have no competing financial, professional or personal interests that might have influenced the performance or presentation of the study.
Data sharing statement: The technical appendix, statistical code and dataset are available from the corresponding author at Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sandro Passaretti, MD, Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Telephone: +39-02-26432756 Fax: +39-02-26432504
Received: June 6, 2016
Peer-review started: June 11, 2016
First decision: July 29, 2016
Revised: August 29, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: October 28, 2016

To investigate the relationship between pathological oropharyngeal (OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes.


In this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease (GERD). We enrolled only patients with a reflux symptom index (RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal high-resolution manometry (HRM). Patients were divided into two groups on the basis of a normal or pathological pH-metric finding (Ryan Score) and all manometric characteristics of the two groups were compared.


We examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure (median 71 mmHg vs 126 mmHg, P = 0.004) and the median proximal contractile integral (median 215.5 cm•mmHg•s vs 313.5 cm•mmHg•s, P = 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mmHg isobaric contour (38.7% vs 15.38%, P < 0.0001).


In patients with suspected GERD-related extra-esophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility.

Keywords: Esophagus, Motility, Oropharyngeal reflux, Gastroesophageal reflux disease, High resolution manometry, pH-metry

Core tip: A new oropharyngeal (OP) pH probe now available is more sensitive than traditional pH sensors for faithfully monitoring the pH of OP reflux, and the latest high-resolution esophageal manometry offers a major advance in defining esophageal motility abnormalities compared to conventional manometry. This study compares these two techniques, for the first time, and indicates that in patients with extra-esophageal syndromes pathological OP acid exposure is associated with weaker proximal esophageal motility.