Remacle Marc, Lawson Georges
Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Louvain at Mont-Godinne, Yvoir, Belgium.
Curr Opin Otolaryngol Head Neck Surg. 2006 Jun;14(3):143-9. doi: 10.1097/01.moo.0000193189.17225.91.
Laryngopharyngeal reflux should no longer be underestimated because of its negative impact on the lives of patients and its potentially dangerous long-term complications.
Both laryngopharyngeal reflux and gastroesophageal reflux disease are caused by mucosal injury from acid and pepsin exposure, but the esophagus has intrinsic antireflux defenses that prevent mucosal injury (bicarbonate production, mucosal tissue resistance and esophageal motor function with acid clearance) whereas the pharynx and the larynx do not. Symptoms felt to be most related to reflux (>or= 95%) are throat clearing, persistent cough, heartburn/dyspepsia, globus sensation (lump in the throat) and voice-quality change, while the physical examination findings include (>or= 95%) arytenoid erythema, vocal-cord erythema and edema, posterior commissure hypertrophy, and arytenoid edema. In this regard, the reflux symptom index and the reflux finding score are very useful clinical tools. Patients are proposed an empirical therapeutic trial including behavioural and dietary recommendations and a 3-month twice-daily proton-pump inhibitor therapy. The proton-pump inhibitor should be taken 30-60 min before meals. Nonresponders undergo an assessment, ideally based on esogastroduodenoscopy and ambulatory multichannel intraluminal impedance and pH monitoring. Transnasal esophagoscopy in the outpatient setting is a safe alternative. When medical management fails, patients with demonstrable high-volume reflux and lower sphincter incompetence are often candidates for surgical intervention.
The algorithm proposed by Ford has structured and confirmed our attitude on a day-to-day basis.
喉咽反流因其对患者生活的负面影响及其潜在的危险长期并发症，不应再被低估。
喉咽反流和胃食管反流病均由酸和胃蛋白酶暴露导致的黏膜损伤引起，但食管具有防止黏膜损伤的内在抗反流防御机制（碳酸氢盐产生、黏膜组织抵抗力以及具有酸清除功能的食管运动功能），而咽和喉则没有。被认为与反流最相关（≥95%）的症状是清嗓、持续性咳嗽、烧心/消化不良、咽喉部异物感（喉咙有异物）和嗓音质量改变，而体格检查结果包括（≥95%）杓状软骨红斑、声带红斑和水肿、后联合肥大以及杓状软骨水肿。在这方面，反流症状指数和反流发现评分是非常有用的临床工具。建议患者进行经验性治疗试验，包括行为和饮食建议以及为期3个月的每日两次质子泵抑制剂治疗。质子泵抑制剂应在饭前30 - 60分钟服用。无反应者需进行评估，理想情况下基于食管胃十二指肠镜检查以及动态多通道腔内阻抗和pH监测。门诊经鼻食管镜检查是一种安全的替代方法。当药物治疗失败时，有明显大量反流和下括约肌功能不全的患者通常是手术干预的候选者。
福特提出的算法在日常工作中构建并证实了我们的态度。
