Oelschlager Brant K, Eubanks Thomas R, Maronian Nicole, Hillel Allen, Oleynikov Dmitry, Pope Charles E, Pellegrini Carlos A
Swallowing Center, and the Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.
J Gastrointest Surg. 2002 Mar-Apr;6(2):189-94. doi: 10.1016/s1091-255x(01)00070-1.
Pharyngeal pH monitoring and laryngoscopy are routinely used to diagnose gastroesophageal-laryngeal reflux as a cause of respiratory symptoms. Although their use seems intuitive, their ultimate diagnostic value is yet to be defined. We studied 10 asymptomatic (control) subjects and 76 patients with respiratory symptoms. Both patients and control subjects were given a symptom questionnaire. Each underwent direct laryngoscopy using the reflux finding score (RFS) to grade laryngeal injury, esophageal manometry, and 24-hour esophagopharyngeal pH monitoring. The patients were then classified as RFS+, if the score was greater than 7, and pharyngeal reflux (PR)+, if they had more than one episode of PR detected during pH monitoring. The most common symptoms reported by patients were hoarseness (87%), cough (53%), and heartburn (50%). Control subjects had a significantly lower RFS (2.1 vs. 9.6, P < 0.01) and fewer episodes of PR (0.2 vs. 3.4, P < 0.01), than patients. None of the control subjects had more than one episode of PR during a 24-hour period. Fifty patients (66%) were RFS+ and 26 (34%) were RFS-. Thirty-two patients (42%) were PR+ and 44 (58%) were PR-. Fifteen patients had a normal RFS and no PR (group I = RFS-/PR-). Forty patients had discordance between the laryngoscopic findings and the pH monitoring (group II = RFS-/PR+ or RFS+/PR-). Twenty-one patients had both an abnormal RFS and PR (group III = RFS+/PR+). Patients in group III had significantly higher heartburn scores and distal esophageal acid exposure. Eighty-three percent of patients in group III but only 44% in group I improved their respiratory symptoms as a result of antireflux therapy. An abnormal PR or RFS differentiates patients with laryngeal symptoms from control subjects. Agreement between PR and RFS helps establish or refute the diagnosis of gastroesophageal reflux as a cause of laryngeal symptoms. Patients who are RFS+ and PR- may have laryngeal injury from another source, whereas patients who are RFS- and PR+ may not have acid entering the larynx, despite the presence of PR. Patients who are RFS+ and PR+ have more severe gastroesophageal reflux disease and their reflux causes laryngeal damage. Laryngoscopy and pharyngeal pH monitoring should be considered complementary studies in establishing the diagnosis of laryngeal injury induced by gastroesophageal reflux. ( J GASTROINTEST SURG 2002;6:189-194.)
咽pH监测和喉镜检查常用于诊断胃食管-喉反流，作为呼吸道症状的一个病因。尽管其应用看似直观，但其最终的诊断价值仍有待确定。我们研究了10名无症状（对照）受试者和76名有呼吸道症状的患者。患者和对照受试者均接受了症状问卷调查。每个人都接受了直接喉镜检查，使用反流发现评分（RFS）对喉损伤进行分级、食管测压以及24小时食管咽pH监测。然后，如果评分大于7，患者被分类为RFS阳性，如果在pH监测期间检测到不止一次咽反流（PR）发作，则被分类为咽反流（PR）阳性。患者报告的最常见症状是声音嘶哑（87%）、咳嗽（53%）和烧心（50%）。对照受试者的RFS显著低于患者（2.1对9.6，P<0.01），PR发作次数也更少（0.2对3.4，P<0.01）。在24小时期间，没有一名对照受试者有不止一次PR发作。50名患者（66%）为RFS阳性，26名（34%）为RFS阴性。32名患者（42%）为PR阳性，44名（58%）为PR阴性。15名患者RFS正常且无PR（I组=RFS阴性/PR阴性）。40名患者的喉镜检查结果与pH监测结果不一致（II组=RFS阴性/PR阳性或RFS阳性/PR阴性）。21名患者RFS和PR均异常（III组=RFS阳性/PR阳性）。III组患者的烧心评分和远端食管酸暴露显著更高。III组中83%的患者但I组中只有44%的患者因抗反流治疗而呼吸道症状得到改善。异常的PR或RFS可将有喉症状的患者与对照受试者区分开来。PR和RFS之间是否一致有助于确定或排除胃食管反流作为喉症状病因的诊断。RFS阳性且PR阴性的患者可能有来自其他来源的喉损伤，而RFS阴性且PR阳性的患者尽管存在PR，可能没有酸进入喉部。RFS阳性且PR阳性的患者有更严重的胃食管反流病，且他们的反流会导致喉损伤。在确定胃食管反流引起的喉损伤的诊断时，应将喉镜检查和咽pH监测视为互补性检查。（《胃肠外科杂志》2002年；6：189 - 194。）
