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Objective: : To investigate the relationship between esophagoscopic findings and total acid reflux time in the upper esophagus in the patients of laryngopharyngeal reflux disease (LPRD), and to evaluate whether pH<5 holding time is appropriate for diagnosing LPRD., Method: : Esophagoscopy and 24-h pH monitoring in the upper esophagus were performed in 29 patients suspected of LPRD and 19 healthy volunteers participated as controls. The total acid reflux times below pH 4 and 5 in the upper esophagus were compared between the LPRD group and the controls. The LPRD group was divided into LPRD with reflux esophagitis (RE) and LPRD without RE, and the total acid reflux times below pH 4 and 5 of these two groups were compared., Results: : Eight of the 29 (27.6%) LPRD patients had reflux esophagitis. The LPRD group showed a significantly longer acid reflux time than the control group at pH below 5 (P=0.009) but not at pH below 4 (P=0.48). The LPRD with RE had significantly longer acid reflux times below both pH 4 and 5 in the upper esophagus compared to those of the LPRD without RE. The P values using a cut-off value of pH 5 were smaller than that of pH 4 in all statistical results., Conclusion: : The LPRD patients showed significantly longer acid reflux time in the upper esophagus than the control group. In the LPRD group, the LPRD with RE patients had more frequent acid exposure in the upper esophagus than the LPRD without RE. A pH level of 5 could be appropriate as a cutoff level for the diagnosis of LPRD in upper esophagus pH monitoring.

Substance P (SP)-, calcitonin gene-related polypeptide (CGRP)-, and vasoactive intestinal polypeptide (VIP)-immunoreactive (IR) nerve fibers were observed in the epithelium of the canine subglottic region. To investigate the morphological differences among SP-, CGRP-, and VIP-IR nerve fibers in the epithelium, this study was performed by using immunohistochemical staining and electron microscopy, after which the origins of the nerve fibers were examined by denervation of the bilateral superior and inferior laryngeal nerves. SP- and CGRP-IR nerve fibers entered the epithelium through the basement membrane, ascended among the basal and ciliated cells, and reached under the epithelial junctional complex to terminate with varicosities. Furthermore, subsurface cistern-like structures or bouton en passant type synapse-like structures were observed among some varicosities of these nerve fibers and ciliated cells in the epithelial apical portion. On the other hand, VIP-IR nerve fibers entered through the basement membrane, and terminated with varicosities at the height of the middle portion of the subglottic epithelium. The varicosities of the VIP-IR nerve fibers were larger, and these varicosities had a greater number of synaptic vesicles than the SP- or CGRP-IR nerve fibers. After section of the bilateral superior and inferior laryngeal nerves, the SP- and CGRP-IR nerve fibers disappeared, while the VIP-IR nerve fibers were not affected. The density and distribution pattern of VIP-IR nerve fibers clearly differed from the SP- and CGRP-IR nerve fibers of sensory origin.(ABSTRACT TRUNCATED AT 250 WORDS)