Dr. Garnett Presents: Hyperacidity and the Irritated Airway

8/27/18 10:19 AM / by Bree Gorman, MPH

University of Kansas Voice and Swallow Center Director, David Garnett MD, FACS delivers keynote presentation in China: "Hyperacidity and the Irritated Airway"

Journeying from Kansas to Zhengzhou, China to share his expertise on reflux and the airway, Dr. David Garnett delivered his talk, entitled “Hyperacidity and the Irritated Airway.”  This information was welcomed by Chinese otolaryngology key opinion leaders. Brandon Wang, Restech’s Director of Asian Market Development and Chinese native, accompanied Dr. Garnett and provided further introduction of Restech’s new Mederi-RF therapeutic product lines.

China conference 2018

Dr. Garnett’s lecture covered a thorough review of the reflux landscape -- symptoms, empiric treatment, use and controversy of PPIs, and the often confusing and sometimes contradicting collection of published U.S. clinical data. This set the foundation for a common understanding of the elements and pathophysiology of reflux disease.

Dr. Garnett has been utilizing the Restech pH system for nearly a decade to definitively diagnose suspected reflux patients. He explained his simple, yet effective approach to reflux which he categorizes in four parts:

Assessment: Begin with a proper workup, utilizing the Restech pH probe to objectively measure hyperacidity of the airway. Utilizing an objective baseline establishes a reference for any future assessment, progress, or lack thereof.

Evaluation: When analyzing pH study results, including meal periods in the calculations can provide valuable information on the probable activity or reactivation of enzymes such as pepsin. Although the widely practiced procedure is to exclude meal periods when calculating DeMeester and RYAN scores, contrary to this practice, Dr. Garnett points to evidence published documenting the effects of diet on health, including the possibility of local damage from abnormal pH exposure (e.g. dental literature on the effect of carbonated beverages on dental enamel). Assessing the meal periods and pH levels of the food ingested can add insight to formulating a treatment plan; triggers to reflux or acidic food can be managed differently than gastric reflux.

Based on Garnett’s years of experience with extraesophageal reflux, he believes the question should not only be “does the patient have reflux?” but “does the patient have hyperacidity of the airway?”. In considering the broader picture, this increases validity for altering standard protocol in which meal data is redacted from the pH study analysis.

Area Under the Curve (AUC) theory: The concept of AUC is "Time versus Amount: Is moving your hand quickly through a candle flame equal to holding your hand in or near the flame for a long period of time?"

In the past: Clinicians looked at ALL the acid that occurs below a certain level (5.5), which provided one number for the entire 24 hour period. This method correlated to patient symptoms. The higher the number, the more acid per unit time, the worse patient's symptoms tended to be.

In the future: Clinicians are beginning to focus on analysis of specific sets of time. For example, what is the AUC (total acid exposure) for just meal periods? For just supine periods? If the number is high for meals, focus on treating just the meals, or encouraging behavioral changes related to food intake. If high exposure occurs only at night, focus on nocturnal control. With this approach, not only do we know if there's high amount of acid, we also know when it is, so we can tailor the treatment to what the individual patient is experiencing.

Garnett presenting

Targeted Treatment: With detailed pH study information, we can establish the best, most individualized treatment plan. Knowing if acid is even present, how much, and at what time(s) is acid exposure the worst helps determine the most appropriate treatment pathway.

Garnett’s systematic approach to patients with airway irritation symptoms begins with objective data to identify and treat the cause. This eliminates empiric therapy, reduces treatment costs and potential caustic side effects, and expedites the path to healing. This method of analysis enables greater precision for treatment with faster and more complete resolution.

Ms. Liu, CEO of Restech’s commercialization partner in China, stated “Shanxi Divine Technology introduced Dx-pH Measurement system and Stretta/Secca procedures from Restech. We combined the diagnosis and treatment; we are at the forefront of the diagnosis and treatment of reflux disease”.

Restech CEO Debra Krahel commented “Shanxi Divine are perfect partners for Restech’s pH system and Stretta product adoption in China. We are working together to bridge the cultural divide through the common language of medicine. Medicine is truly the platform of humanity and the common denominator for caring and compassion in our world. I am humbled and honored to play a part in sharing these technologies that further the diagnosis and treatment of reflux disease. We are grateful for this opportunity to work and learn from our colleagues in China.”


Restech | Mederi-RF provides the simplest, most accurate reflux monitoring system on the market. The pH test results assist physicians in developing a personalized, targeted treatment plan for their patients. Our newly acquired Stretta therapeutic device delivers non-ablative radio frequency energy to the lower esophageal sphincter muscle, adding strength and stability to effectively reduce reflux and significantly improve symptoms.


Bree Gorman, VP Marketing
Restech | Mederi-RF

Topics: Laryngopharyngeal reflux, pH testing, ENT

Bree Gorman, MPH

Written by Bree Gorman, MPH

The Restech Blog

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We're here to answer your questions about reflux. More specifically, diagnostic and therapeutic approaches to laryngopharyngeal reflux (LPR). Restech's pH system provides real-time pH data to help you develop the most targeted reflux treatment plan possible.


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