Postma G N, Tomek M S, Belafsky P C, Koufman J A
Center for Voice Disorders, Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1034, USA.
Ann Otol Rhinol Laryngol. 2001 Dec;110(12):1114-6. doi: 10.1177/000348940111001205.
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.
耳鼻喉科患者的喉咽反流（LPR）似乎与典型的胃食管反流病（GERD）有所不同。特别是，食管炎及其主要症状烧心，被认为是GERD的诊断必需条件，但在LPR患者中常常不存在。因此，有人推测LPR患者的食管功能较好。食管酸清除（EAC）是衡量食管在反流事件发生后恢复中性pH能力的指标。它被认为是食管功能的一项出色的综合指标。平均EAC可根据24小时pH监测数据计算得出。此前尚未有关于GERD患者和LPR患者EAC比较的报道。为了比较1）单纯LPR患者、2）单纯GERD患者、3）同时患有LPR和GERD的患者以及4）既无LPR也无GERD的患者的EAC，我们研究了200名接受过24小时双探头（同时监测咽部和食管远端）pH监测的耳鼻喉科患者，每组50人。每位患者的分组依据先前确定的pH监测标准。我们将GERD定义为食管反流异常，将LPR定义为咽部反流异常。GERD患者的平均（±标准差）EAC为1.44±1.2分钟，LPR患者的平均EAC为1.00±1.00分钟（p<0.05）。同时患有GERD和LPR的患者平均EAC为1.53±1.01分钟。无反流患者的平均EAC为0.53±0.38分钟。我们得出结论，LPR患者的EAC明显优于GERD患者。这些数据表明LPR患者具有较好的食管功能。这一发现可能有助于我们更清楚地理解LPR和GERD患者在发病机制、症状及食管炎发生率方面的差异。
