INTRODUCTION Among patients with chronic laryngeal symptoms, ambulatory reflux monitoring off acid suppression is recommended to evaluate for laryngopharyngeal reflux (LPR). However, reflux monitoring systems are diverse in configuration and monitoring capabilities, which present a challenge in creating a diagnostic reference standard in these patients. This study aimed to compare diagnostic yield and performance between reflux monitoring systems in patients with chronic laryngeal symptoms. METHODS This multicenter, international study of adult patients referred for evaluation of LPR over a 5-year period (March 2018-May 2023) assessed and compared diagnostic yield of pathologic gastroesophageal reflux (GER+) on ambulatory reflux monitoring off acid suppression. RESULTS Of 813 patients, 296 (36%) underwent prolonged wireless pH, 532 (65%) underwent 24-hour pH-impedance monitoring, and 15 (2%) underwent both tests. Overall diagnostic yield for GER+ was 36% and greater for prolonged wireless pH compared with that for 24-hour pH-impedance monitoring (50% vs 27%; P < 0.01). Among 15 patients who underwent both prolonged wireless pH and 24-h pH-impedance monitoring, concordance between systems for GER+ was 40%. The most common source of discordance was strong evidence of GER+ across multiple days on prolonged wireless pH compared with no evidence of GER+ on pH-impedance. DISCUSSION In this multicenter international study of patients with chronic laryngeal symptoms referred for LPR evaluation, diagnostic yield of ambulatory reflux monitoring off acid suppression was 36% and rose to 50% when using wireless pH monitoring. In patients referred for chronic laryngeal symptoms, 24-hour pH-impedance monitoring may risk a low negative predictive value in patients with unproven GER+ disease.

中文翻译：

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用于评估慢性喉部症状的动态反流监测系统的诊断率。

简介 对于有慢性喉部症状的患者，建议在酸抑制的情况下进行动态反流监测，以评估咽喉反流（LPR）。然而，反流监测系统的配置和监测功能各不相同，这给为这些患者创建诊断参考标准提出了挑战。本研究旨在比较慢性喉部症状患者的反流监测系统的诊断率和性能。方法 这项多中心、国际研究对转诊接受 LPR 评估的成年患者进行了为期 5 年（2018 年 3 月至 2023 年 5 月）的研究，评估并比较了在酸抑制的动态反流监测下病理性胃食管反流 (GER+) 的诊断率。结果 在 813 名患者中，296 名 (36%) 接受了长时间无线 pH 值检测，532 名 (65%) 名患者接受了 24 小时 pH 阻抗监测，15 名 (2%) 名患者接受了两项测试。与 24 小时 pH 阻抗监测相比，长时间无线 pH 值的 GER+ 总体诊断率为 36%（50% vs 27%；P < 0.01）。在 15 名接受长时间无线 pH 值和 24 小时 pH 阻抗监测的患者中，GER+ 系统之间的一致性为 40%。最常见的不一致来源是在长时间的无线 pH 值上多天存在 GER+ 的有力证据，而在 pH 阻抗上没有 GER+ 的证据。讨论 在这项针对转诊进行 LPR 评估的慢性喉部症状患者的多中心国际研究中，取消酸抑制后动态反流监测的诊断率为 36%，而使用无线 pH 监测时则升至 50%。对于因慢性喉部症状而转诊的患者，对于未经证实的 GER+ 疾病患者，24 小时 pH 阻抗监测可能存在阴性预测值较低的风险。