Kaufman J A, Houghland J E, Quiroga E, Cahill M, Pellegrini C A, Oelschlager B K
Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, USA.
Surg Endosc. 2006 Dec;20(12):1824-30. doi: 10.1007/s00464-005-0329-9.
A strong link exists between gastroesophageal reflux disease (GERD) and airway diseases. Surgical therapy has been recommended as it is more effective than medical therapy in the short-term, but there is little data on the effectiveness of surgery long-term. We analyzed the long-term response of GERD-related airway disease after laparoscopic anti-reflux surgery (LARS).
In 2004, we contacted 128 patients with airway symptoms and GERD who underwent laparoscopic antireflux surgery (LARS) between 12/1993 and 12/ 2002. At median follow-up of 53 months (19-110 mo) we studied the effects on symptoms, esophageal acid exposure, and medication use and we analyzed the data to determine predictors of successful resolution of airway symptoms.
Cough, hoarseness, wheezing, sore throat, and dyspnea improved in 65-75% of patients. Heartburn improved in 91% (105/116) of patients and regurgitation in 92% (90/98). The response rate for airway symptoms was the same in patients with and without heartburn. Almost every patient took proton pump inhibitors (PPIs) preoperatively (99%, 127/128) and 61% (n = 78) were taking double or triple dose. Postoperatively, 33% (n = 45) of patients were using daily antiacid therapy but no one was on double dose. The only factor that predicted a successful surgical outcome was the presence of abnormal reflux in the pharynx as determined by 24-hour pharyngeal pH monitoring. One hundred eleven (87%) patients rated their results as excellent (n = 78, 57%) or good (n = 33, 24%).
LARS provides an effective and durable barrier to reflux, and in so doing improves GERD-related airway symptoms in approximately 70% of patients and improves typical GERD symptoms in approximately 90% of patients. Pharyngeal pH monitoring identifies those patients more likely to benefit from LARS, but better diagnostic tools are needed to improve the response of airway symptoms to that of typical esophageal symptoms.
胃食管反流病（GERD）与气道疾病之间存在紧密联系。外科治疗被推荐使用，因为它在短期内比药物治疗更有效，但关于手术长期疗效的数据很少。我们分析了腹腔镜抗反流手术（LARS）后GERD相关气道疾病的长期反应。
2004年，我们联系了128例在1993年12月至2002年12月期间接受腹腔镜抗反流手术（LARS）且有气道症状和GERD的患者。在中位随访53个月（19 - 110个月）时，我们研究了对症状、食管酸暴露和药物使用的影响，并分析数据以确定气道症状成功缓解的预测因素。
65% - 75%的患者咳嗽、声音嘶哑、喘息、咽痛和呼吸困难得到改善。91%（105/116）的患者烧心症状改善，92%（90/98）的患者反流症状改善。有烧心症状和无烧心症状的患者气道症状缓解率相同。几乎每位患者术前都服用质子泵抑制剂（PPIs）（99%，127/128），61%（n = 78）服用双倍或三倍剂量。术后，33%（n = 45）的患者使用每日抗酸治疗，但无人服用双倍剂量。预测手术成功结果的唯一因素是24小时咽pH监测确定的咽部异常反流的存在。111例（87%）患者将其结果评为优秀（n = 78，57%）或良好（n = 33，24%）。
LARS为反流提供了有效且持久的屏障，这样做可使约70%的患者GERD相关气道症状得到改善，约90%的患者典型GERD症状得到改善。咽pH监测可识别出更可能从LARS中获益的患者，但需要更好的诊断工具来提高气道症状对典型食管症状的反应。
