Case 2
A 15-year-old patient with severe asthma was addressed to the reflux clinic to exclude ear, nose and throat disorders that may worsen asthma. The symptoms of the patient consisted of chronic cough, throat clearing and globus sensation. The fiberoptic examination reported edema and erythema of the posterior commissure. According to the clinical findings, HEMII-pH was performed to exclude the LPR diagnosis. The placement of the HEMII-pH catheter (Versaflex-Z®, Medtronic, Europe) and the characteristics of the device were similar to those reported in the first case. The patient had belching, nausea and several vomiting episodes during the probe placement. During the 24-hour testing, the patient reported many heartburn and belching episodes, which were not reported in the initial clinical picture. The removal of the probe was associated with nose pain and the physician found a folded probe (above Z5 segment; Figure 3). Tracing revealed parasites in the distal impedance segment throughout the 24-hour testing period. According to the tracing, the probe was probably folded during the vomiting episodes (placement time) and the related retrograde esophageal contraction. The rest of the recording confirmed the nonacid LPR diagnosis. The patient consent was obtained.