胃食管反流与慢性咽喉炎

胃食管反流(gestroesophageal renux，GER)是指胃内容物通过下食管括约肌向食管的逆行性运动。由胃食管反流引起的症状或组织病理学改变，即胃食管反流病(gastroesophageal reflux disease，GERD)。胃食管反流有复杂的病理特点，可引起多种临床症状。食管症状(典型表现)主要为胸骨后烧灼感和反酸等。食管外症状主要表现在呼吸系统，引起上呼吸道、肺、头颈等部位的症状和疾病(非典     

老年人胃食管反流性咽喉炎30例临床分析

目的 探讨老年人胃食管反流性咽喉炎的诊治方法.方法 采用喉镜、胃镜和24h食管pH值监测明确诊断,并分析30例老年人胃食管反流性咽喉炎患者经抑酸药和胃肠动力药治疗前后的症状、喉镜和胃镜检查结果的改变情况.结果 30例老年人胃食管反流性咽喉炎患者经抑酸药和胃肠动力药治疗后有效率为93.33%.结论 喉镜、胃镜和24h食管pH值监测有助于明确老年人胃食管反流性咽喉炎的诊断,采用抑酸药和胃肠动力药治疗本病有效.     

病理性胃食管反流与慢性咽喉炎的关系

胃食管反流(GER)本属生理现象,系自发性或吞咽引发的食管下端括约肌松弛所致,健康人在饭后3小时内可见到1-4次GER,如超过生理量即属病理性胃食管反流(PGER),对耳鼻咽喉的影响已有记载。耳鼻咽喉科门诊常见咽喉不适感病人,多笼统诊断为慢     

中西医结合治疗胃食管反流性咽喉炎

目的 探讨胃食管反流性咽喉炎的治疗方法 .方法 根据胃食管反流性咽喉炎的症状、体征、间接喉镜、胃镜检查确诊病例50例,给予法莫替丁、甲氧氯普胺(胃复安)、乌干胶囊、山参花茶、联合治疗3个月以上,进行治疗前后疗效对比观察.结果 50例患者中45例反酸、嗳气、声嘶、咽异物感、慢性咳嗽、清嗓子、咽喉分泌物多等症状基本消失或有明显减轻.间断喉镜检查咽喉部病变基本消失或明显减轻.治疗后复查胃镜,胃黏膜充血、水肿、糜烂基本消失.结论 对反流性咽喉炎给予制酸-抗反流-保胃-利咽喉"四位一体"的中西医结合治疗具有良好的疗效.     

清咽滴丸治疗反流性咽喉炎72例疗效观察

目的探讨清咽滴丸配合质子泵抑制剂治疗反流性咽喉炎的临床疗效。方法经咽部检查及胃镜检查确认的反流性咽喉炎患者72例,随机分为观察组和对照组。观察组应用清咽滴丸联合奥美拉唑及新络纳治疗,对照组单纯应用奥美拉唑和新络纳治疗,两组均以4周为一疗程。治疗结束后进行临床疗效对比。结果观察组38例,总有效率92.1%(35/38例);对照组34例,总有效率为47.1%(16/34例)。两组间差异有统计学意义(P<0.01)。结论清咽滴丸联合质子泵抑制剂可有效缓解反流性咽喉炎症状,减轻咽喉部病理变化。     

质子泵抑制剂对胃食管反流性咽喉炎的临床疗效

目的分析质子泵抑制剂治疗胃食管反流性咽喉炎的效果。方法样本区间:2018年6月-2019年6月,研究主体:70例胃食管反流性咽喉炎病例样本,以随机双盲法将样本分组,35例给予铝硫酸镁治疗(对比组),35例加用质子泵抑制剂治疗(研究组),对比分析治疗效果差异性。结果研究组治疗综合有效率97.14%(34/35)比对比组80.00%(28/35)更高,差异显著,P<0.05;治疗前,两组食管pH监测结果对比差异较小,P>0.05,治疗后,研究组pH<4总时间百分率比对比组更低,差异显著,P<0.05。结论针对胃食管反流性咽喉炎患者,加用质子泵抑制剂治疗,可进一步提高临床治疗效果,更好改善食管pH值。     

质子泵抑制剂诊断性治疗反流性咽喉炎76例

目的探讨质子泵抑制剂诊断性治疗反流性咽喉炎的疗效。方法 76例疑似反流性咽喉炎患者给予诊断性质子泵抑制剂治疗,并观察其疗效。结果 31例显效,22例有效,23例无效。结论质子泵抑制剂诊断性治疗反流性咽喉炎是一种有效的方法。     

慢性咽喉炎和反流性食管炎的相关性研究

慢性咽喉炎是上呼吸道慢性炎症的一种,多见于成年人,病程长,症状顽固,常反复发作,其症状常表现为咽异物感、晨起干呕、咽部反复发作疼痛、声音嘶哑等。近年来慢性咽喉炎与反流性食管炎的关系日益得到耳鼻咽喉科医师的关注。有学者[1]提     

胃食管反流病的耳鼻咽喉表现

近年来国内外研究资料表明 ,胃食管反流病(gastroesophagealrefluxdisease ,GERD)发病率呈上升趋势 ,GERD将成为本世纪主要胃肠道疾病〔1〕。GERD是指过多的胃、十二指肠内容物反流入食管引起烧灼感、反酸、反食等症状 ,甚至造成食管以炎症为主的病理改变与无内镜下食管炎症表现的非糜烂性反流病 (non erosiverefluxdisease,NERD) ;其发病机制可能与下食管括约肌的功能降低 ,特别是一过性下食管括约肌松弛 (transientLESrelax ations)非吞咽性时间延长有关。Fass等〔2〕将其临床表现分为 3型 :典型症状 (烧灼感、反酸、反食 )、不典…     

胃食管返流性咽喉炎36例诊治体会

近年来 ,胃食管返流对咽喉部的影响已越来越受到临床的重视。但在其诊断及治疗上尚未形成一个较为一致的认识。 1 998年 9月以来 ,笔者共诊治此类患者 36例 ,取得了满意效果。现报告如下。1　资料与方法1 .1 　 临床资料本组 36例 ,男 1 6例 ,女 2 0例 ;年龄 30～ 72岁 ,平均 48岁。病史 1个月～ 2年。下咽及胸部烧灼感 2 8例 ,咽异感症 2 4例 ,声嘶 1 2例 ,咳嗽 1 0例 ,咽喉部疼痛 6例。全部病例均有嗳气、返酸等症状。36例均作间接喉镜及胃镜检查 ,咽腔及食管入口均充血 ,其中杓间区充血 1 6例 ,声带后份充血 1 2例。全部病例食管中、下段…     

Association between follicular tracheitis and gastroesophageal reflux

ObjectiveFollicular tracheitis (also known as tracheal cobblestoning) is an entity that is poorly described and of unclear significance. The objective of this study was to better define follicular tracheitis and determine the association between the clinical finding of follicular tracheitis on bronchoscopy and objective evidence of gastroesophageal reflux disease.MethodsRetrospective chart review of children with recurrent croup having undergone a rigid bronchoscopy and an investigation for gastroesophageal reflux between 2001 and 2013.Results117 children with recurrent croup children age 6–144 months were included in the study. Follicular tracheitis was noted on 41% of all bronchoscopies. Fifty-nine percent of all children who underwent bronchoscopy were diagnosed with gastroesophageal reflux on at least one investigation. Forty-nine of 117 children underwent a pH probe study, and 51% were found to have evidence of reflux on this study. Nine children were diagnosed with eosinophilic esophagitis. Three patients underwent a biopsy of the follicular tracheitis lesions, which revealed chronic inflammation. There was no evidence of an association between findings of follicular tracheitis and a positive test for gastroesophageal reflux (p = 0.52) or a positive pH probe study (p = 0.64). There was no association between follicular tracheitis and subglottic stenosis (p = 0.33) or an history of asthma and/or atopy (p = 0.19).ConclusionIn children with recurrent croup, follicular tracheitis remains an unspecific finding associated with an inflammatory disorder of unknown etiology.     

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。     

阻塞性睡眠呼吸暂停低通气综合征与胃食管反流病发生的相关性研究

目的 探讨胃食管反流病(gastroesophageal reflux disease,GERD)与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的关系.方法 分析43例怀疑咽喉反流病患者的高精度食管压力检测、24 h食管双极阻抗pH监测、便携式多道睡眠监测数据,根据各检测结果进行分组,比较组间各测量指标差异,研究两疾病的相互关系.结果 全体受试者中,可诊为GERD的14例(32.6％),可诊为OSAHS的26例(60.5％),同时患有OSAHS和GERD者10例,占OSAHS患者人数的38.5％,占GERD患病人数的71.4％.在仅患有OSAHS组、仅患有GERD组、同时患有GERD和OSAHS组以及阴性对照组之间,体质量指数(BMI)和下食管括约肌(lower esophageal sphincter,LES)残余压差异有统计学意义(P值均＜0.05),但未发现LES残余压与两疾病严重程度的线性相关关系.在OSAHS患者中,呼吸暂停低通气指数(AHI)与DeMeester评分(r =0.457)、远端食管酸暴露时间百分比(r=0.491)呈正相关趋势(P值均＜0.05).在GERD患者中,未发现反流指标与睡眠指标和食管功能指标的线性相关关系.同时患有OSAHS和GERD组内未见反流指标、睡眠指标、食管功能指标的线性相关关系(P值均＞0.05).结论 GERD与OSAHS在发病率、疾病的严重程度方面有一定的相互影响,反酸可能加重OSAHS患者的病情,两种疾病可能在食管功能,特别是在LSE肌张力的调节上有一定的相关关系.     

全天咽喉pH检测在诊断反流性咽喉部疾病中的作用

目的探讨24h咽喉pH检测在咽喉反流性疾病诊断中的价值。方法选取2006年8月至10月于北京同仁医院就诊由同一医师诊断可疑有反流性咽喉炎患者50例，征得患者同意后以就诊时间为配伍因素，按区组随机排列方法采用半随机分组。第一组25例患者均行24h咽喉pH检测，筛选出阳性患者作为试验组接受奥美拉唑抗酸治疗；第二组25例患者直接给予相同药物及剂量的试验性抗酸治疗作为对照组。服药3个月后进行随访，根据反流症状评分对比治疗前后效果，以主观症状评估总分下降≤4分为治疗无效，〉4分为有效。结果行24h咽喉pH检测的25例患者中有病理性咽喉部反流者17例，阳性率为68.0％（17／25）。24h平均总反流次数（35．71±41．70）次（x±s，以下同），总反流时间（35．71±33．19）min，总反流指数即每小时反流次数（1．53±1．73）次／h，每次反流平均时间（1．12±0．91）min。抗酸治疗前试验组症状评估总分平均（14．88±4．11）分，对照组总分平均（13．00±4．17）分，组间差异采用t检验，无统计学意义（P〉0．05）。在抗酸治疗3个月后随访，试验组有效率为82．4％（14／17），对照组失访2例，其余患者治疗有效率为52．2％（12／23）。试验组症状评估总分平均下降（7．47±3．18）分，对照组症状评估总分下降（3．96±4．25）分，总分差值比较，差异有统计学意义（P〈0．01）。结论24h咽喉pH检测作为诊断咽喉反流性疾病的金标准，可以作为临床中可疑咽喉反流患者的确诊检查手段，并可大大提高抗酸治疗的有效性，值得在临床普遍开展和推广。     

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.     

阻塞性睡眠呼吸暂停低通气综合征与胃食管反流关系的研究

目的 研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与胃食管反流(gastroesophageal reflux,GER)的关系.方法 76例OSAHS患者行多道睡眠监测及夜间远端食管pH监测.评估OSAHS患者GER的发生率.对其中32例合并GER并适宜手术的OSAHS患者行悬雍垂腭咽成形术等手术治疗,术后6个月复查多道睡眠监测及远端食管pH值,对比术前、术后呼吸暂停低通气指数(AHI)、微觉醒指数(micro-arousal index,MAI)、最低动脉血氧饱和度(lowest SaO2,LSaO2)、远端食管酸化指数(pH index,pHI)及食管酸暴露时间(acid contact time,ACT)百分比,并进行相关性分析.结果 76例OSAHS患者AHI为(38.6±29.5)次/h(x±s,下同),伴发GER 48例(占63.2%).32例合并GER的OSAHS患者术前及术后6个月AHI分别为(51.2±23.1)和(17.3±10.3)次/h;MAI为(38.3±21.4)和(14.5±10.0)次/h;LSaO2为(0.698±0.107)和(0.858±0.076);pHI为(12.5±6.6)和(6.3±4.2)次/h;ACT百分比为(10.3±5.2)%和(4.5±2.9)%,配对t检验差异均有统计学意义(t值分别为10.95、7.82、15.97、6.12、7.62,P值均<0.001).术后较术前AHI、MAI减少值与pHI的减少存在相关性(r值分别为0.775和0.764,P值均<0.001);AHI、MAI改善程度与ACT百分比减少存在相关性(r值分别为0.607和0.730,P值均<0.001).结论 OSAHS患者较易发生夜间GER,对OSAHS的治疗在显著降低AHI、MAI的同时也明显改善了GER,提示夜间胃食管反流的发生与呼吸及睡眠紊乱有关.     

Association of reflux symptom index scores with gastroesophageal flap valve status

Objective

Gastroesophageal reflux disease is a chronic symptom of mucosal damage caused by gastric acid reflux. Impaired gastroesophageal flap valve (GEFV) is one of the common etiologic factors of gastroesophageal reflux. The aim of this study was to investigate the association between GEFV, RSI, and GER in patients who underwent gastroesophageal endoscopy.

Methods

Two hundred and fifty seven consecutive patients with reflux symptoms (151 men and 106 women, mean age was 50.22 years) who underwent routine upper gastrointestinal endoscopy were enrolled to our study. GEFV was graded as I through IV according to the Hill's classification. Symptoms of laryngopharyngeal and upper gastrointestinal disease and endoscopic severity of esophageal injury were correlated with GEFV status. The GEFV was classified into two groups: normal GEFV group (grade I) and the abnormal GEFV group (grades II–III and IV). The reflux symptom index (RSI) was used as a diagnostic tool for LPR.

Results

Age, male gender, and body mass index were significantly related to an abnormal GEFV. The rate of abnormal grades of GEFV (Grade II + III + IV) was 31%. Age of normal and abnormal grades of GEFV (49.0/50.8 vs 52.9) and values of BMI (26.2/26.7 vs 26.5) were similar. RSI scores were correlated with gastroesophageal flap valve grades but RSI scores were not correlated with Los Angeles gastroesophageal reflux (GER) Classification. Moreover, gastroesophageal reflux grade of Los Angeles Classification was positively correlated with gastroesophageal flap valve grades.

Conclusion

Endoscopic grading of GEFV is a simple and useful technique which may provide an accurate diagnosis of laryngopharyngeal and gastroesophageal reflux. Also, reflux symptom index (RSI) is a simple, economic and noninvasive diagnostic tool for gastroesophageal reflux. However, in this research, we did not find any correlation between reflux symptom index and degree of esophageal mucosal injury which was classified according to LA classification.     

Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children

The hallmark of gastroesophageal reflux disease (GERD) is an increased exposure of esophageal and laryngeal mucosa to gastric juice. This exposure can cause complications such as chronic laryngitis or chronic respiratory diseases. We report our experience in managing three pediatric patients with severe recurrent juvenile laryngeal papillomatosis (JLP) associated with GERD. All patients showed a high rate of recurrence requiring multiple laser surgeries. Systemic αinterferon therapy over a period of more than 1 year and photodynamic therapy with dihematoporphyrin produced no improvement. However, after therapy for GERD, the rate of recurrence of JLP decreased significantly. Although the course of respiratory papillomatosis is known to fluctuate, our findings suggest that gastroesophageal reflux may have a role in aggravating papillomatosis. Received: 22 September 1998 / Accepted: 12 November 1998