Endoscopic evaluation of swallowing as an alternative to 24-hour pH monitoring for diagnosis of extraesophageal reflux

Patients with symptoms of extraesophageal reflux may not be eager to underg o 24-hour pH probe monitoring for the sake of a definitive diagnosis. It ha s been anecdotally noted that extraesophageal reflux can be detected during an endoscopic swallowing evaluation. The purpose of this pilot study was t o demonstrate that flexible endoscopic evaluation of swallowing with sensor y testing (FEESST) can be implemented to identify and subsequently treat pa tients with extraesophageal reflux. Over a 6-month period, FEESST was prosp ectively performed in 20 healthy control subjects and in 20 patients with d ysphagia. The dysphagic patients did not have a history of stroke or chroni c neurologic disease. Attention was specifically directed toward noting the presence or absence of reflux into the laryngopharynx during the endoscopi c swallowing evaluation. None of the control subjects were noted to have re flux during FEESST, but 18 of the 20 patients with dysphagia were found to have reflux during the evaluation; this difference was statistically signif icant (p < .001, Fisher's exact rest). We conclude that FEESST is useful as a means of diagnosing extraesophageal reflux in patients with dysphagia.