Lenderking William R, Hillson Eric, Crawley Joseph A, Moore David, Berzon Richard, Pashos Chris L
Abt Associates Clinical Trials, Cambridge, MA 02138, USA.
Value Health. 2003 Sep-Oct;6(5):560-5. doi: 10.1046/j.1524-4733.2003.65243.x.
Although it is accepted that reflux of stomach acid causes gastroesophageal reflux disease (GERD), it is less well understood that it also contributes to the clinical signs and symptoms of laryngitis in the form of laryngopharyngeal reflux (LPR). Study objectives were to identify what is known about the impact of LPR on health-related quality of life (HRQL) compared with the impact of GERD on HRQL and to assess whether currently available HRQL instruments adequately measure this impact or if a new disease-specific instrument should be recommended.
The authors combined a systematic literature review with prospective patient evaluation via focus groups. The review, using MEDLINE, focused on clinical characteristics and HRQL measurement and impact. Focus groups involving a total of 30 patients with LPR provided input on clinical manifestations of the disease and its HRQL impact.
Information gleaned from the literature indicates that less than 40% of patients presenting with symptoms of laryngitis directly attributable to reflux also report experiencing the classic symptoms of heartburn and acid regurgitation associated with GERD. Reflux laryngitis is thus a distinct clinical entity from GERD and may have a unique impact on HRQL. Although multiple instruments are available to assess the impact of GERD on HRQL, no specific instruments are available for LPR. Focus group discussions identified voice problems, chronic cough, throat clearing, and swallowing difficulties to be key concerns of patients with LPR. These manifestations negatively impact HRQL as described by the focus group participants, notably in role functioning, physical well-being, and emotional well-being.
A disease-specific instrument to assess the impact of LPR on HRQL would contribute to clinical care and the evaluation of new therapies. This instrument would ideally be sensitive to the variety of LPR's symptomatic presentations.
尽管人们公认胃酸反流会导致胃食管反流病（GERD），但对于其以喉咽反流（LPR）形式导致喉炎的临床体征和症状，人们了解较少。研究目的是确定与GERD对健康相关生活质量（HRQL）的影响相比，LPR对HRQL的影响有哪些已知情况，并评估目前可用的HRQL工具是否能充分衡量这种影响，或者是否应推荐一种新的针对特定疾病的工具。
作者将系统文献综述与通过焦点小组进行的前瞻性患者评估相结合。使用MEDLINE进行的综述聚焦于临床特征、HRQL测量及影响。涉及总共30名LPR患者的焦点小组提供了关于该疾病临床表现及其对HRQL影响的信息。
从文献中收集的信息表明，出现直接归因于反流的喉炎症状的患者中，不到40%也报告有与GERD相关的典型烧心和反酸症状。因此，反流性喉炎是一种与GERD不同的临床实体，可能对HRQL有独特影响。尽管有多种工具可用于评估GERD对HRQL的影响，但尚无针对LPR的特定工具。焦点小组讨论确定声音问题、慢性咳嗽、清嗓和吞咽困难是LPR患者的主要关注点。正如焦点小组参与者所述，这些表现对HRQL有负面影响，尤其是在角色功能、身体健康和情绪健康方面。
一种评估LPR对HRQL影响的针对特定疾病的工具将有助于临床护理和新疗法的评估。该工具理想情况下应对LPR的各种症状表现敏感。
