• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

Tips for Managing Gastroesophageal Reflux

by Thomas R. Collins • March 15, 2017

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

She recommends reserving pH impedance testing until after testing for other upper airway inflammatory causes. “Your initial evaluation is gong to dictate that next step,” she said.

You Might Also Like

  • Gastroesophageal Reflux Management
  • What Is the Best Test for Pediatric Gastroesophageal Reflux Disease?
  • Laryngologists v. Non-Laryngologist Treatment of Laryngopharyngeal Reflux
  • Reviewers ID Reflux Disease Clinical Guidelines
Explore This Issue
March 2017

Joel Blumin, MD, chief of the division of laryngology and professional voice at the Medical College of Wisconsin in Madison, said patient preference has to be factored into the extent of testing and treatment. For example, some patients may come in only to rule out cancer, and their evaluation should be tailored with that in mind.

Peter Doble, MD, an otolaryngologist at Sawtooth Surgery Center in Twin Falls, Idaho, said he is not quick to order pH impedance testing, largely due to the rural demographics and cost-conscious nature of his patients. “I reserve testing for people who aren’t responding to any treatment modality,” he said. “I find testing to be an inadequate tool for me. … If the argument were, ‘This test is successful in making a diagnosis 85% of the time,’ then maybe we’d sell that. But if there’s more of an ‘if’ factor than that—and I think there is—it’s a very difficult sale.”

If pH impedance testing is reserved for those refractory to treatment, how is that measured? Dr. Dailey wondered. “I’m pretty sure we don’t have either a cut-off, or certainly not a uniform cut-off, as a field to be able to determine what constitutes failure,” he said. “So it seems like there’s a lot of variability, probably, if I had to guess, in terms of when to apply so-called ‘advanced testing’ and when not to.”

Interpretation

Dr. Blumin said that when performing impedance testing, symptom association to reflux events is not always easy to interpret. There are subtleties involved when trying to correlate a reflux event with a given symptom such as cough. When they do coincide, he said, “It’s nice when it happens.”

Dr. Doble said that a patient with long-time cough who takes a PPI every day might be difficult to assess. “I might stop PPIs for 30 to 45 days to see if symptoms change or worsen,” he said. If the symptoms are unchanged, he would look into other causes.

Dr. Garrett said that when considering a Nissen procedure to try to surgically correct reflux, it’s important to remember that it is generally more effective in patients who have been better responders to acid-suppression therapy and have some true GERD-type symptoms, such as heartburn.

Panelists generally agreed that pH impedance testing is a good idea after surgical procedures for reflux to quantify how well patients respond. An audience member even said that post-op findings from this test led one of the surgeons at his center to refine the technique.

Pages: 1 2 3 | Single Page

Filed Under: Features Tagged With: gastroesophageal reflux, Laryngopharyngeal reflux, LPR, Triological Society Combined Sections MeetingIssue: March 2017

You Might Also Like:

  • Gastroesophageal Reflux Management
  • What Is the Best Test for Pediatric Gastroesophageal Reflux Disease?
  • Laryngologists v. Non-Laryngologist Treatment of Laryngopharyngeal Reflux
  • Reviewers ID Reflux Disease Clinical Guidelines

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Do you use AI-powered scribes for documentation?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • How to: Positioning for Middle Cranial Fossa Repair of Superior Semicircular Canal Dehiscence

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Endoscopic Ear Surgery: Advancements and Adoption Challenges 

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • The Importance of Time Away
    • Endoscopic Ear Surgery: Advancements and Adoption Challenges 
    • Reflections from a Past President of the Triological Society
    • ENT Surgeons Explore the Benefits and Challenges of AI-Powered Scribes: Revolutionizing Documentation in Healthcare
    • How To: Open Expansion Laryngoplasty for Combined Glottic and Subglottic Stenosis

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939