以顽固性咽炎为主要表现的胃食管反流病临床分析

目的探讨并分析以顽固性咽炎症状为主要表现的胃食管反流病（GERD）的临床诊断和治疗。方法对成都市第六人民医院2010年2月一2012年12月79例诊断为慢性顽固性咽炎且经耳鼻喉科标准治疗无效，喉镜检查明确有咽炎表现的患者进行反流性疾病诊断问卷评分并行常规胃镜检查，患者按纳入顺序奇偶数分为治疗组（40例）和对照组（39例）分别进行治疗。治疗组使用埃索美拉唑40mg，1次／d，治疗12周；对照组使用硫糖铝混悬液15mL，2次／d，治疗12周。治疗第4、8、12周为3个观察点，分别记录临床症状积分、咽部炎症改变，治疗结束所有患者均复查胃镜，记录食管黏膜愈合情况。结果治疗组治疗后第4、8、12周的症状积分较治疗前明显下降，差异有统计学意义（P〈0．05），对照组治疗前后症状积分也有下降，但差异无统计学意义（P〉0．05）；治疗组与对照组治疗后症状积分比较差异有统计学意义（P〈0．05）；两组治疗后对咽部局部炎症的有效率分别为83．9％、41．4％，差异有统计学意义（P〈0．05）。结论部分不典型的GERD常以顽固性咽炎的症状为主要表现，临床上长期不愈的顽固性咽炎患者应排除有无GERD；埃索美拉唑治疗可显著改善顽固性咽炎症状和减轻局部炎症表现。

Clinical Analysis of Gastroesophageal Reflux Disease Manifested Mainly as Stubborn Pharyngitis

Objective To explore and analyze the clinical diagnosis and treatment of gastroesophageal reflux disease （GERD） which is manifested mainly as stubborn pharyngitis. Methods From February 2010 to December 2012, 79 eases were diagnosed as stubborn pharyngitis and otolaryngology standard treatment was invalid. GERD questionnaire ratings and conventional endoscopy were performed for patients with obvious manifestations of stubborn pharyngitis shown on the laryngoscopy. They were randomly divided into treatment group （n=40） and control group @=39）. Patients in the treatment group accepted esomeprazole 40 mg, qd, for 12 weeks; and patients in the control group had sucralfate suspension 15 mL bid for 12 weeks. At the three observation points which are 4, 8, and 12 weeks after treatment began, clinical symptom score and pharyngeal inflammatory changes were recorded, and at the end of the treatment, all patients underwent endoscopy, and esophageal mueosal healing was observed. Results There was no significant difference between the two groups of patients in terms of general data. After the treatment, the symptom scores were significantly decreased in the treatment group at the three observation points （P 〈 0.05）. The same situation happened also in the control group, but the difference was not significant （P 〉 0.05）. The symptom scores between the two groups after treatment were significantly different （P 〈 0.5）. And the effective rate for local pharyngeal infection was 83.9% and 41.4% in the treatment group and the control group respectively （P 〈 0.05）. Conclusions Some atypical GERDs feature by the symptoms of stubborn pharyngitis. Clinically, patients with long-term stubborn pharyngitis should be screened to exclude the possibility of GERD. esomeprazole therapy can significantly improve the pharyngitis symptoms and relieve local inflammation.