Shaker Reza, Bardan Eytan, Gu Chengming, Kern Mark, Torrico Laura, Toohill Robert
Dysphagia Institute, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
Laryngoscope. 2003 Jul;113(7):1182-91. doi: 10.1097/00005537-200307000-00014.
OBJECTIVES/HYPOTHESIS: Determination of intrapharyngeal distribution of gastric acid refluxate is needed to better understand the pathogenesis of reflux-attributed aerodigestive tract disorders. The aims of the study were to determine intrapharyngeal distribution of gastric acid refluxate and to determine whether this distribution can better differentiate patients from control subjects compared with data obtained from a single hypopharyngeal site.
We prospectively studied 10 healthy volunteers, 12 patients with reflux laryngitis, and 15 patients with vasomotor rhinitis using a concurrent dual pharyngeal/dual esophageal pH recording technique. We determined the hypopharyngeal and oropharyngeal pH profile, including number, duration, and distribution of reflux events irrespective of and in correlation with intraesophageal pH profile using four different pH thresholds.
Few drops in pharyngeal pH were found to be true reflux events based on their correlation with esophageal pH events. For the pharyngeal pH threshold criterion of a drop to 4.0 or less, 6 of 12 patients with reflux laryngitis, 5 of 15 patients with vasomotor rhinitis, and 2 of 10 normal control subjects exhibited a total of 25 (range, 1-5) distal pharyngeal acid reflux events. Overall, 34% of these events reached the oropharyngeal pH recording site. Between-group comparison for all levels of pH threshold criteria did not show any significant difference of reflux parameters in the hypopharyngeal or in the oropharyngeal sites among the studied groups.
Reflux of gastric acid into the pharynx may extend to the region of the oropharynx in both patients and control subjects. Overall distribution of acid refluxate to the oropharynx is low but as groups is similar between healthy individuals and patients with reflux laryngitis and those with vasomotor rhinitis. Parameters of oropharyngeal acid reflux such as number and duration do not differentiate patients from control subjects.
目的/假设：为了更好地理解反流性上消化道疾病的发病机制，需要确定胃酸反流物在咽内的分布情况。本研究的目的是确定胃酸反流物在咽内的分布，并确定与从下咽单一部位获得的数据相比，这种分布是否能更好地区分患者与对照者。
我们采用同步双咽/双食管pH记录技术，对10名健康志愿者、12名反流性喉炎患者和15名血管运动性鼻炎患者进行了前瞻性研究。我们确定了下咽和口咽的pH曲线，包括反流事件的数量、持续时间和分布，无论其与食管内pH曲线是否相关，均使用四种不同的pH阈值进行分析。
基于与食管pH事件的相关性，发现咽内pH值的少量下降是真正的反流事件。对于pH值降至4.0或更低的咽pH阈值标准，12名反流性喉炎患者中的6名、15名血管运动性鼻炎患者中的5名和10名正常对照者中的2名共出现了25次（范围为1-5次）下咽远端酸反流事件。总体而言，这些事件中有34%到达了口咽pH记录部位。在所研究的组中，对于所有pH阈值标准水平，组间比较在下咽或口咽部位的反流参数方面均未显示出任何显著差异。
胃酸反流至咽部在患者和对照者中均可延伸至口咽区域。酸反流物到口咽的总体分布较低，但在健康个体、反流性喉炎患者和血管运动性鼻炎患者之间相似。口咽酸反流的参数，如数量和持续时间，并不能区分患者与对照者。
