Ahmad Ijaz, Batch A J G
Department of Otolaryngology, Birmingham City Hospital, Birmingham, UK.
J Laryngol Otol. 2004 Jan;118(1):25-30. doi: 10.1258/002221504322731583.
Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms; and the constellation of symptoms has been called laryngopharyngeal reflux. This is a prospective study in a cohort of patients with various throat symptoms suggestive of laryngopharyngeal reflux (LPR) who underwent flexible oesophago-gastroscopy, as a principal investigation. The aims were to look at the most reliable symptom(s) and sign(s), the diagnostic role of flexible oesophago-gastroscopy and the treatment response in these patients. The endoscopy score of 0 to 3 was based on endoscopic findings and the treatment response was measured from 0 to 100 per cent improvement of symptoms, as described by the patients. There were a total of 303 patients, 174 females and 129 males with ages ranging from 19 to 88 years. Seventy-five per cent had had symptoms for more than a year. Fifteen per cent were smokers. Globus, voice change, sore throat, dysphagia and cough were the predominant symptoms. Most patients, however, presented with a complex of various other secondary symptoms. The endoscopic findings were abnormal in 98 per cent of patients. Apart from the finding of non-specific hyperaemia, usually of the posterior larynx (13 per cent), lesions of the larynx and vocal folds were surprisingly uncommon. Proton pump inhibitors (PPI) were prescribed in 90 per cent of patients. A total of 233 (76.8 per cent) responded to treatment. The improvement of symptoms ranged from 25 per cent in 36 (23 per cent), 50 per cent in 60 (20 per cent), 75 per cent in 59 (19 per cent) and 100 per cent in 78 (26 per cent) patients. Accumulative analysis of variance showed a significant difference between treatment responders and non-responders (p <0.04). In a logistic regression model patients with globus, voice change and gastric prolapse were more likely to respond to treatment (p <0.04). It can be concluded that voice change, sore throat, globus and cough choking are the most reliable symptoms of laryngopharyngeal reflux. Voice change and globus symptoms can be of predictive value in terms of successful treatment response. Flexible oesophago-gastroscopy (FOG) is a simple, safe and reliable way of assessment in these cases and treatment with PPI can be effective in the majority of patients.
胃酸反流的耳鼻喉科表现包括一系列咽喉症状；这些症状组合被称为咽喉反流。这是一项针对一组有各种提示咽喉反流（LPR）的咽喉症状患者的前瞻性研究，主要检查方法是进行可弯曲食管胃镜检查。目的是找出最可靠的症状和体征、可弯曲食管胃镜检查的诊断作用以及这些患者的治疗反应。内镜检查评分从0到3，基于内镜检查结果，治疗反应则根据患者描述的症状改善程度从0%到100%进行衡量。共有303例患者，其中女性174例，男性129例，年龄在19至88岁之间。75%的患者症状持续超过一年。15%的患者吸烟。咽部异物感、声音改变、咽痛、吞咽困难和咳嗽是主要症状。然而，大多数患者还伴有各种其他继发症状。98%的患者内镜检查结果异常。除了通常在后喉部出现的非特异性充血（13%）外，喉部和声带病变出人意料地并不常见。90%的患者使用了质子泵抑制剂（PPI）。共有233例（76.8%）患者对治疗有反应。症状改善情况为：36例（23%）患者改善25%，60例（20%）患者改善50%，59例（19%）患者改善75%，78例（26%）患者改善100%。方差累积分析显示治疗有反应者和无反应者之间存在显著差异（p<0.04）。在逻辑回归模型中，有咽部异物感、声音改变和胃脱垂的患者更有可能对治疗有反应（p<0.04）。可以得出结论，声音改变、咽痛、咽部异物感和咳嗽窒息是咽喉反流最可靠的症状。声音改变和咽部异物感症状对于治疗成功反应具有预测价值。可弯曲食管胃镜检查（FOG）在这些病例中是一种简单、安全且可靠的评估方法，PPI治疗对大多数患者有效。
