Restech’s Superior Performance
The Restech pH system is the only minimally invasive, in-office, outpatient test–a simple, reliable solution to assess reflux in your patients. It does not require anesthesia, insertion deep into the esophagus, or any additional placement procedures. Restech’s pH sensor is unique in its ability to accurately function anywhere in the aerodigestive tract (from the esophagus to the nasopharynx) reporting precise values of both liquid and aerosol (vapor) from pH 1–10. Bench testing at Vanderbilt University revealed time to reach equilibrium pH (seconds) was significantly faster (P < 0.001) with Restech’s oropharyngeal probe than the conventional probe in both liquid AND vapor phases.
Scatterplot of pH readings of six solutions obtained by Restech probe compared with a glass electrode used as gold standard.
Yuskel E, Vaezi M, Garrett, G. An oropharyngeal pH monitoring device to evaluate patients with chronic laryngitis. Neurogastroenterol Motil. 2013 May;25(5).
Scatterplot Adapted from: Choi J, Loke C, Waddell J, Lyons K, Kieser J, Farella M. Continuous measurement of intra-oral pH and temperature: development, validation of an appliance and a pilot study. J Oral Rehabil. 2015 Aug;42(8):563-70.
Researchers at University of Southern California (USC), Vanderbilt University, Emory and Medical College of Georgia have published normative data providing a framework for evaluation of oropharyngeal pH values.
USC’s team led by Tom DeMeester, MD (developer of the gold standard DeMeester Score for gastroesophageal reflux) established the RYAN Score for extraesophageal reflux disease. Normal oropharyngeal pH is 7.2, with abnormal thresholds at 5.5 upright and 5.0 supine.
Normal pH study
Abnormal pH study
Graph created by Restech’s DataView software, illustrating disease thresholds for laryngopharyngeal reflux (red).
Ayazi S, Lipham J, Hagen J, et al. A new technique for measurement of pharyngeal pH: normal and discriminating pH threshold. J Gastrointest Surg. 2009 Aug; 13(8): 1422-9.
Chheda N, Seybt M, Schade R, Postma G. Normal Values for Pharyngeal pH Monitoring. Ann Otol Rhinol Laryngol. 2009 Mar;118(3): 166-71.
Sun G, Muddana S, Slaughter J, et al. A New pH Catheter for Laryngopharyngeal Reflux: New Values. Laryngoscope. 2009 Aug;119(8):1639-43.
Optimizing Reflux Therapy
Medications are commonly prescribed after a proper diagnosis of a disease based on patient symptoms and diagnostic testing. Objective testing is particularly important for chronic diseases that could require months or years of medical therapy. The Restech pH probe is the only method indicated to test for acid reflux in the airway.
Clinical trials suggest abnormal oropharyngeal pH values can be improved with proper PPI and H2 blocker therapy dosage. A negative oropharyngeal pH study guides the physician to other etiologies, rather than the continued pursuit of the acid reflux paradigm.
With a simple test, you can properly assess your patient’s reflux and prescribe an individualized treatment plan based on objective data to target therapy of PPIs, H2 Blocker, diet restrictions, or anti-reflux surgery.
In some cases, PPI’s appear to solve the problem. In others, they may just mask the symptoms. In a study of 43 patients, response to therapy varied widely. With a simple test, you can properly assess your patient’s reflux and prescribe an individualized treatment plan based on objective data to target therapy of PPIs, H2 Blocker, diet restrictions, or anti-reflux surgery.
Figure based on results from: Waxman, 2014.
Waxman J, Yalamanchali S, Valle ES, Pott T, Friedman M. Effects of Proton Pump Inhibitor Therapy for Laryngopharyngeal Reflux on Posttreatment Symptoms and Hypopharyngeal pH. Otolaryngol Head Neck Surg. 2014;150: 1010-1017.
Friedman M, Maley A, Kelley K, Pulver T, et al. Impact of pH monitoring in laryngopharyngeal reflux treatment: improved compliance and symptom resolution. Otolaryngol Head Neck Surg. 2011 Apr;144(4):558-62.
When compared to traditional esophageal pH technology, Restech’s predictive value of anti-reflux surgical outcomes was much greater.
Restech’s oropharyngeal test provides a 90% Positive Predictive Value (PPV), compared to traditional esophageal pH testing, with a 50% PPV.
Restech’s oropharyngeal test provides a 70% Negative Predictive Value (NPV), compared to traditional esophageal pH testing’s 40% NPV.
In patients with extraesophageal reflux symptoms, proximal esophageal pH monitoring failed to identify half of the patients who had a successful outcome after antireflux surgery. In contrast, an abnormal Restech pH test was present in 90 % of patients with a successful outcome. Further, a negative Restech study more reliably indicated the absence of reflux-induced extraesophageal symptoms.
Worrell S, DeMeester S, Greene C, Oh D, Hagen J. Pharyngeal pH monitoring better predicts a successful outcome for extraesophageal reflux symptoms after antireflux surgery.
Surg Endosc. 2013 Nov;27(11):4113-8
Patient Symptoms (RSI - RFS) / OropH Values
Empiric treatment with medication has long been the standard diagnostic tool for extraesophageal reflux. This approach has recently been challenged by new studies showing the potential collateral damage of anti-reflux drugs and a placebo effect to positively impact symptoms. Given the multifactorial nature of extraesophageal reflux, symptoms are not always a good indication of how well the reflux is being controlled or managed.
No significant difference in presenting symptoms, symptom duration, or severity scores in the patients that had negative vs. positive oropharyngeal pH studies. Furthermore, severity or duration of hoarseness, globus, or throat clearing does not reliably predict presence of reflux.
Beaver M, Karow C. Clinical utility of 24 hour pharyngeal pH monitoring for hoarseness. J Laryngol Voice. 2012;2:60-3
Data from a sleep study combined with Restech’s pH reflux graph provides a powerful illustration of the patient’s sleep experience. A simple test performed in conjunction with a sleep study can elevate the ability of the clinician to practice evidence-based medicine. In a study with 235 patients, reflux was detected in 113 (48%) patients. The pattern of reflux observed only in the supine position was 62 (55%). Sequential overnight oropharyngeal pH monitoring before and after head-of-bed elevation was obtained in 13 individuals with supine-only reflux; 10 subjects demonstrated significant improvement, 8 of whom demonstrated complete resolution of supine reflux.
This study provides new evidence that reflux frequently occurs in the supine position and that 6 inches of head-of-the bed elevation is effective in reducing supine LPR.
Scott D, Simon R. Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux–Effect of Head-of-Bed Elevation on Supine Reflux. J. Allergy Clin. Immunol. 2015 May-Jun;3(3):356-61.
The minimally invasive nature of Restech's pH probe, along with its soft, pliable polymer, makes it the ideal reflux testing tool for pediatrics patients. Treatment should start with a proper diagnosis, Restech pH probe is the only way to accurately test the real time reflux pattern in children.
Pediatric Case study series
Pediatric Normative Dataset – Normal Values of Oropharyngeal pH Monitoring for Detection of Laryngopharyngeal Reflux in Children. NASPGHAN Annual Meeting. Oct 8-11, 2015. Dr Patrick Jones and Dr Joseph Croffie. Indiana School of Medicine.
Normal Values of Oropharyngeal pH Monitoring for Detection of Laryngopharyngeal Reflux in Children. NASPGHAN Annual Meeting. Oct 8-11, 2015. Dr Patrick Jones and Dr Joseph Croffie. Indiana School of Medicine.