Geterud Ake, Bove Mogens, Ruth Magnus
Department of Otolaryngology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
Laryngoscope. 2003 Dec;113(12):2201-5. doi: 10.1097/00005537-200312000-00030.
OBJECTIVES/HYPOTHESIS: Gastroesophageal reflux disease has in recent years been linked to a variety of extraesophageal conditions including laryngeal cancer. However, whether a causal relationship exists is still under debate. The present study aimed to compare the occurrence and severity of gastroesophago-hypopharyngeal reflux in patients with laryngeal cancer with those of healthy volunteers.
Prospective, controlled study. METHODS Forty-one consecutive patients with newly diagnosed laryngeal cancer were examined by esophageal manometry and an ambulatory, 24-hour, double-probe pH monitoring. Their results were compared with those of 40 healthy volunteers.
Hypopharyngeal acid exposure was registered mainly in the upright body position. A pathological acid exposure, as compared with the upper levels of normality among the healthy volunteers, was found in the hypopharynx in six (16%) patients with laryngeal cancer and in the distal esophagus in 10 (25%) patients. Pathological acid exposure in either location was found in 15 (37%) patients and in both locations in 1 (3%) patient. However, the mean acid exposure time and the mean value of the number of reflux events did not differ significantly between cancer patients and control subjects at either location. The exclusion of meal periods from the analysis did not alter these observations. Nonsmoking cancer patients (n = 5) and nonsmoking control subjects (n = 36) had similar acid exposure both in the hypopharynx and in the distal esophagus.
The present results do not support gastroesophago-hypopharyngeal reflux as being an independent risk factor for laryngeal cancer.
目的/假设：近年来，胃食管反流病已与包括喉癌在内的多种食管外疾病相关联。然而，因果关系是否存在仍存在争议。本研究旨在比较喉癌患者与健康志愿者胃食管下咽反流的发生率和严重程度。
前瞻性对照研究。方法：对41例新诊断的喉癌患者进行食管测压和24小时动态双探头pH监测。将他们的结果与40名健康志愿者的结果进行比较。
下咽酸暴露主要发生在直立体位。与健康志愿者的正常上限相比，6例（16%）喉癌患者在下咽部发现病理性酸暴露，10例（25%）患者在食管远端发现病理性酸暴露。15例（37%）患者在任一部位发现病理性酸暴露，1例（3%）患者在两个部位均发现病理性酸暴露。然而，癌症患者和对照组在任一部位的平均酸暴露时间和反流事件数的平均值均无显著差异。分析中排除进餐期并未改变这些观察结果。不吸烟的癌症患者（n = 5）和不吸烟的对照受试者（n = 36）在下咽部和食管远端的酸暴露情况相似。
目前的结果不支持胃食管下咽反流是喉癌的独立危险因素。
