口咽、食管同步Dx-pH检测研究咽喉反流性疾病

采用口咽、食管同步Dx-pH检测探讨咽喉反流性疾病（LPRD）与胃食管反流病（GERD）的关系。     

口咽pH监测技术在咽喉反流性疾病诊断中的应用

咽喉反流性疾病越来越普遍和受到重视,但是咽喉反流的诊断和机制存在很多争议,目前即使作为诊断金标准的24小时多通道腔内阻抗联合pH监测也存在很多问题,本文就一种新型的口咽监测技术做一综述.     

Pediatric gastroesophageal reflux and laryngopharyngeal reflux

Pediatric gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR) have gained better recognition over the past few years. GER and LPR usually present as regurgitation, emesis, epigastric pain, failure to thrive, esophagitis, or stricture. Many patients suffer respiratory disorders associated with reflux. Classification of reflux, pathophysiology, manifestations of reflux, diagnosis, and management of the disease are discussed in this article.     

Association of laryngopharyngeal symptoms with gastroesophageal reflux disease

OBJECTIVES: The prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal disorders is probably greater than realized. STUDY DESIGN: Prospective study. METHODS: To investigate the incidence of gastroenterological diseases including GERD in patients complaining of nonspecific laryngopharyngeal symptoms, laryngological examinations and gastroenterological evaluation with esophagogastroduodenoscopy were performed in 30 patients who refused to undergo 24-hour pH monitoring. Therapeutic intervention by behavioural and dietary modifications, antireflux medication, and eradication of Helicobacter pylori were assessed for changes in laryngeal findings and relief of symptoms. RESULTS: Posterior laryngitis was present in 26 patients and in 19 of them was accompanied by erythema and edema of the interarytenoid region. Gastroenterological diseases such as GERD (43%), hiatal hernia (43%), and Helicobacter pylori-positive antrum gastritis (23%) were confirmed in 22 (73%) cases by esophagogastroduodenoscopy and histological examination of biopsy specimens. Medical antireflux treatment and eradication of Helicobacter pylori resulted in a remarkably therapeutic success rate of 90% because there was resolution of laryngopharyngeal symptoms and laryngeal findings in 20 of 22 patients with gastroenterological diseases for the mean follow-up period of 8 months. CONCLUSIONS: Laryngopharyngeal symptoms can be predictors of gastroesophageal diseases and GERD because the most frequent underlying cause is supposed to be associated with posterior laryngitis. Medical antireflux treatment is effective for relief of symptoms and mucosal healing of posterior laryngitis.     

咽喉反流与变应性鼻炎的相关性研究

目的 咽喉反流（LPR）与变应性鼻炎（AR）临床表现常类似,本研究的目的是探讨这两种疾病的相关性。方法 纳入2019年6月—2020年6月就诊的72例疑似LPR患者,根据24hDx-pH监测结果将患者分为LPR阳性组和LPR阴性组,用AR表评分（SFAR）（SFAR≥7分）诊断AR,探讨Dx-pH与SFAR评分的相关性及进行LPR阳性与LPR阴性组中AR患病率的比较。结果 72例疑似LPR患者有40例AR患者,LPR阳性组（32例）中有22例AR患者,LPR阴性组（40例）中有18例AR患者,LPR阳性组的SFAR评分显著高于LPR阴性组（P<0.05）,LPR阳性组中AR患病率更高（P<0.05）。结论 LPR阳性组患者SFAR评分更高,LPR与AR可能具有相关性。     

咽喉反流与声带息肉之间的相关性研究

目的探讨咽喉反流与声带息肉之间的关系。方法选取2010年3月～2011年3月手术后经病理确诊的声带息肉患者15例,术后经患者同意行24 h双探头pH监测观察咽喉反流及胃食管反流与声带息肉的关系。结果 15例患者进行监测,咽喉部反流阳性6例(40%),食管反流阳性1 3例(8 6.6 7%),两者均阳性6例(4 0%)。在6例咽喉部反流阳性患者中,5例(8 3.3 3%)反流症状数量表阳性,4例(66.67%)反流检查计分阳性;13例食管反流阳性的患者中9例(69.23%)反流症状数量表阳性,11例(84.62%)反流检查计分阳性。结论上消化道及咽喉反流在声带息肉的发生、发展中可能起到一定的作用,胃反流物刺激可能是声带息肉发生的直接病因或是诱因之一。     

胃食管反流病与喉癌关系的Meta分析

目的 用Meta分析方法评价胃食管反流病与喉癌之间的关系。 方法 计算机检索Pubmed、Embase、Web of Knowledge、CBM和CNKI数据库,文献检索起至时间从建库到2015年5月止,收集公开发表的所有关于胃食管反流病与喉癌关系的病例对照研究,按纳入和排除标准筛选文献并评价纳入研究质量,应用RevMan 5.3和Stata13.1软件进行Meta分析,根据异质性检验结果选择模型并合并效应量OR值,并评价发表偏倚和敏感性分析。 结果 共纳入13个病例对照研究,Meta分析结果显示,喉癌组胃食管反流病的阳性率显著高于对照组［OR=2.68, 95%CI(1.94,3.70),P<0.000 01］。 结论 胃食管反流病可能是喉癌发生的一种危险因素。但是,考虑到研究间的异质性,还需设计更好的研究来进一步证明本Meta分析结论。     

Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux

OBJECTIVE: Laryngopharyngeal reflux (LPR) is a syndrome associated with a constellation of symptoms usually treated by ENT surgeons. It is believed to be caused by the retrograde flow of stomach contents into the laryngopharynx, this being a supra-esophageal manifestation of gastroesophageal reflux disease (GERD). It has been cited that LPR and GERD can be considered separate entities. Our hypothesis was that LPR is a supra-esophageal manifestation of GERD and therefore that patients with GERD should have a degree of symptoms suggestive of LPR because of the reflux of the gastric contents. We examined a population of patients with both upper gastrointestinal endoscopy and symptom-proven GERD and, using a questionnaire, looked at their existing symptoms to help assess the prevalence of LPR. We also looked at whether, with more severe GERD (suggestive of increased gastric content reflux), the degree of symptoms suggestive of LPR would be increased, as would be expected. METHODS: A population of patients with endoscopically proven GERD were recruited and divided into groups depending on the severity of their reflux disease. A questionnaire was then administered that examined both LPR and GERD scoring criteria. The relationship between GERD and LPR was then analyzed. RESULTS: We recruited 1,383 subjects with GERD; those with severe GERD had significantly higher LPR scores compared with those with mild (P < .01), moderate (P < .05), or inactive disease (P < .001). CONCLUSIONS: The condition of LPR is likely to represent a supra-esophageal manifestation of GERD. This study examined a large number of patients with endoscopically proven GERD and has demonstrated a correlation between the severity of GERD and the prevalence of LPR. LPR and GERD are common and interlinked conditions. The subsequent prevalence of LPR in the population with GERD is therefore likely to be dramatically underestimated.     

反流性咽喉炎与胃食管反流病的关系研究

目的 :探讨反流性咽喉炎与胃食管反流病 (GRED)发生的关系。方法 :对 130例顽固的慢性咽喉炎患者行胃镜检查或 2 4h食管 pH监测 ,将检测的GRED随机分为两组 ,治疗组 :应用抑胃酸药、促动力药和清热解毒治疗 ;对照组 :单用清热解毒的咽喉炎药 ,对两组咽喉部症状缓解及内镜下病理改善情况进行统计学比较。结果 :检出GRED 45例 (34 .6 % ) ,反流性咽喉炎的体征多样化 ,治疗组 2 3例 ,有效率 91.3% (2 1例 ) ,对照组 2 2例 ,有效率 13.6 % (3例 ) ,P <0 .0 1。结论 :GRED是导致反流性咽喉炎的重要病因 ,抑酸剂与促动力药、清热解毒药合用 ,可缓解或改善反流性咽喉炎的症状和病理。     

Association between laryngopharyngeal reflux disease and autonomic nerve dysfunction

European Archives of Oto-Rhino-Laryngology - To assess autonomic nerve function in patients with laryngopharyngeal reflux disease (LPRD) and determine the correlation between LPRD and autonomic...     

Esophageal motor function in laryngopharyngeal reflux is superior to that in classic gastroesophageal reflux disease.

Laryngopharyngeal reflux (LPR) in otolaryngology patients appears to be different from classic gastroesophageal reflux disease (GERD). In particular, esophagitis and its principal symptom, heartburn, considered the diagnostic sine qua non of GERD, are often absent in LPR. It has therefore been postulated that LPR patients have superior esophageal function. Esophageal acid clearance (EAC) is a measure of the ability of the esophagus to restore neutral pH after reflux events have occurred. It is considered an excellent overall measure of esophageal function. The mean EAC can be calculated from 24-hour pH monitoring data. A comparison of EAC in patients with GERD and LPR has not been previously reported. To compare the EAC of 1) patients with LPR alone, 2) patients with GERD alone, 3) patients with both LPR and GERD, and 4) patients without either LPR or GERD, we studied 200 otolaryngological patients who had undergone 24-hour double-probe (simultaneous pharyngeal and distal esophageal) pH monitoring, 50 in each group. The subgrouping of each patient was determined by previously established pH monitoring criteria. We defined GERD as abnormal esophageal reflux and LPR as abnormal pharyngeal reflux. The patients with GERD had a mean (+/-SD) EAC of 1.44 +/- 1.2 minutes, and those with LPR had a mean EAC of 1.00 +/- 1.00 minutes (p < .05). The patients with both GERD and LPR had a mean EAC of 1.53 +/- 1.01 minutes. The patients without reflux had a mean EAC of 0.53 +/- 0.38 minutes. We conclude that patients with LPR have significantly better EAC than those with GERD. These data suggest that patients with LPR have superior esophageal function. This finding may clarify our understanding of the differences in mechanisms, symptoms, and incidence of esophagitis in patients with LPR and GERD.     

咽喉反流性疾病的诊断和治疗

近20年越来越多的临床实践和实验研究证明胃内容物反流至咽、喉部是引起喉部疾患的重要致病因素之一,国外耳鼻咽喉头颈外科学者对其进行了详细的研究.国内虽有综述介绍,但对咽喉反流性疾病的临床和基础研究很少[1-4],很多医师对该病还不了解或知之甚少.