Poelmans J, Feenstra L, Tack J
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium.
Dig Dis Sci. 2005 May;50(5):824-32. doi: 10.1007/s10620-005-2647-0.
Gastroesophageal reflux (GER), through the occurrence of gastroesophagopharyngeal reflux (GEPR), is an established cause of several otorhinolaryngological (ORL) manifestations. It has been suggested that unexplained excessive throat phlegm might also be a manifestation of GER, but formal evidence is lacking. The aim of the present study was to investigate the prevalence of GER as well as duodenogastroesophageal reflux (DGER) in consecutive patients with chronic complaints of excessive throat phlegm. Fifty-nine consecutive patients with chronic unexplained excessive throat phlegm, transparent in 33 patients (TTP) and yellow in 26 patients (YTP), underwent gastrointestinal endoscopy, 24-hr dual esophageal pH monitoring, and fiberoptic DGER monitoring. Proximal esophageal DGER monitoring was performed in seven YTP patients and analysis of bile acids in throat phlegm was performed on 16 samples. The effect of high-dose acid suppressive therapy was evaluated at 2-week intervals. Endoscopy and pH monitoring established a diagnosis of pathological GER in 75% of the patients. Pathological DGER was present in 56% of the patients and this was associated with YTP. Proximal DGER exposure was high in all investigated subjects and chemical analysis revealed a median bile acid concentration of 0.184 microM in nine YTP samples and no detectable bile acids in seven TTP samples. After a median of 4 weeks of acid suppressive therapy, most patients improved and 61% became asymptomatic. YTP patients were more likely to require maintenance acid suppressive therapy than TTP patients. Unexplained excessive throat phlegm is a sign suggestive of GER and GEPR, and unexplained yellow throat phlegm a sign suggestive of duodenogastroesophagopharyngeal reflux (DGEPR).
胃食管反流（GER）通过胃食管咽反流（GEPR）的发生，是多种耳鼻喉科（ORL）表现的既定病因。有人提出，不明原因的咽喉部痰液过多也可能是GER的一种表现，但缺乏正式证据。本研究的目的是调查连续出现慢性咽喉部痰液过多症状的患者中GER以及十二指肠胃食管反流（DGER）的患病率。59例连续出现慢性不明原因咽喉部痰液过多的患者，其中33例痰液透明（TTP），26例痰液黄色（YTP），接受了胃肠内镜检查、24小时双通道食管pH监测以及纤维光学DGER监测。对7例YTP患者进行了食管近端DGER监测，并对16份样本进行了咽喉部痰液胆汁酸分析。每隔2周评估高剂量抑酸治疗的效果。内镜检查和pH监测确诊75%的患者存在病理性GER。56%的患者存在病理性DGER，且这与YTP相关。所有研究对象的食管近端DGER暴露率都很高，化学分析显示，9份YTP样本中胆汁酸浓度中位数为0.184微摩尔/升，7份TTP样本中未检测到胆汁酸。在接受中位数为4周的抑酸治疗后，大多数患者病情改善，61%的患者无症状。YTP患者比TTP患者更有可能需要维持抑酸治疗。不明原因的咽喉部痰液过多是GER和GEPR的提示征象，不明原因的黄色咽喉部痰液是十二指肠胃食管咽反流（DGEPR）的提示征象。
