Weber R K, Jaspersen D, Keerl R, Eikermann M, Mösges R
HNO-Klinik, Städtisches Klinikum Karlsruhe gGmbH.
Laryngorhinootologie. 2004 Mar;83(3):189-95. doi: 10.1055/s-2004-814279.
It is increasingly suggested that there may be a connection between gastrooesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) and chronic sinusitis. We therefore wished to establish whether the literature contains sufficient evidence to support this assumption.
We performed a search in Medline (PubMed) and EMBASE with the key words "GERD, GER, reflux, sinusitis, chronic sinusitis". The literature obtained was assessed with regard to the reported results and their evidence levels. The level of evidence was classified according to the usual levels I - IV, only levels Ia or Ib being considered sufficient evidence for a knowledge gain confirmed by therapeutic trials.
A total of 77 references were found in Medline and 142 in EMBASE. A large number of these were narrative review articles addressing the connection between GERD or sinusitis and asthma or GERD or sinusitis and chronic cough. Only 12 papers and one case report dealt more or less directly with the question of a connection between chronic sinusitis and reflux. None of the studies could be classed as evidence level I (randomised controlled trials), ten were classed as level III studies, one as level IIb and one as level IV.
The existing studies do not allow us to pinpoint LPR (and even less so GERD) as a clear-cut factor in the aetiopathogenesis of chronic sinusitis. However, despite all their deficiencies and limitations the studies nevertheless do show that reflux into the pharynx and nasopharynx is possible. This reflux (= LPR) can lead to chronic inflammation which can be successfully treated with antireflux therapy with proton pump inhibitors. Quantification of the association is not currently possible. An above-average proportion of the patients with chronic rhinosinusitis appear to have GERD/LPR. However the prevalence of GERD in the population is generally high. It has not yet been established with sufficient certainty whether the LPR must be regarded as a causative factor, whether it exacerbates or chronifies the disease or whether it is merely an epi-phenomenon which does not require specific treatment. To answer this important question we need prospective randomised controlled studies which will provide evidence of sufficient quality. These should be conducted with the help of standardised documentation.
越来越多的人认为胃食管反流病（GERD）或咽喉反流（LPR）与慢性鼻窦炎之间可能存在联系。因此，我们希望确定文献中是否包含足够的证据来支持这一假设。
我们在Medline（PubMed）和EMBASE中进行了检索，关键词为“GERD、GER、反流、鼻窦炎、慢性鼻窦炎”。根据报告的结果及其证据水平对获得的文献进行评估。证据水平按照通常的I - IV级进行分类，只有Ia级或Ib级被认为是治疗试验证实的知识增益的充分证据。
在Medline中总共找到77篇参考文献，在EMBASE中找到142篇。其中大量是叙述性综述文章，讨论GERD或鼻窦炎与哮喘之间的联系，或GERD或鼻窦炎与慢性咳嗽之间的联系。只有12篇论文和1例病例报告或多或少直接涉及慢性鼻窦炎与反流之间的关系问题。没有一项研究可归类为证据水平I（随机对照试验），10项归类为III级研究，1项为IIb级，1项为IV级。
现有研究无法让我们明确将LPR（GERD更是如此）确定为慢性鼻窦炎病因发病机制中的一个明确因素。然而，尽管所有研究都存在缺陷和局限性，但它们确实表明反流至咽部和鼻咽部是可能的。这种反流（=LPR）可导致慢性炎症，质子泵抑制剂抗反流治疗可成功治疗这种炎症。目前无法对这种关联进行量化。慢性鼻-鼻窦炎患者中GERD/LPR的比例高于平均水平。然而，人群中GERD的患病率总体较高。LPR是否必须被视为致病因素、它是否会加重或使疾病慢性化，或者它仅仅是一种无需特殊治疗的附带现象，目前尚未有足够的确切定论。为了回答这个重要问题，我们需要前瞻性随机对照研究，这些研究将提供足够质量的证据。这些研究应借助标准化文档进行。
