Oridate Nobuhiko, Nishizawa Noriko, Fukuda Satoshi
Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Japan.
Curr Opin Otolaryngol Head Neck Surg. 2008 Dec;16(6):498-502. doi: 10.1097/MOO.0b013e328313bb69.
The etiology of globus is multifactorial and its management is controversial. Recent findings in the etiology and diagnosis of globus are discussed, and a subjective opinion on its management is presented.
Although there is considerable debate concerning the role of gastroesophageal reflux disease (GERD) in patients with globus, the globus symptom score has been shown to be significantly higher in patients with GERD than in those without GERD. This definite association between GERD and globus leads to the practical division of patients with globus into two groups: the GERD/laryngopharyngeal reflux (LPR)-induced and non-GERD/LPR groups. When the presence of GERD or LPR or both is established in patients with globus, management of this condition should be considered. Owing to limitations in the technology for the detection of GERD/LPR, precise discrimination between the two groups is still difficult. For practical purposes, empirical approaches for targeting GERD in patients with globus appear to be justified. A 24 h pH-metry/multichannel intraluminal impedance test may increase the detection of reflux events in patients with globus.
A practical approach for dividing patients with globus into GERD/LPR-induced and non-GERD/LPR groups is introduced.
癔球症的病因是多因素的，其治疗存在争议。本文讨论了癔球症病因和诊断方面的最新研究结果，并对其治疗提出了主观观点。
尽管关于胃食管反流病（GERD）在癔球症患者中的作用存在大量争论，但研究表明，GERD患者的癔球症症状评分显著高于无GERD的患者。GERD与癔球症之间的这种明确关联导致临床上将癔球症患者分为两组：GERD/喉咽反流（LPR）诱发组和非GERD/LPR组。当癔球症患者确诊存在GERD或LPR或两者皆有时，应考虑对这种情况进行治疗。由于GERD/LPR检测技术的局限性，目前仍难以精确区分这两组患者。从实际应用角度出发，针对癔球症患者采用经验性抗GERD治疗似乎是合理的。24小时食管pH监测/多通道腔内阻抗测试可能会提高癔球症患者反流事件的检出率。
本文介绍了一种将癔球症患者分为GERD/LPR诱发组和非GERD/LPR组的实用方法。
