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抑酸治疗后有咽喉症状的患者:他们有反流吗?

Patients with throat symptoms on Acid suppressive therapy: do they have reflux?

机构信息

Department of Medicine, Center for Esophageal Disease, New York University School of Medicine, New York, NY 10016, USA.

出版信息

Dig Dis Sci. 2010 Feb;55(2):346-50. doi: 10.1007/s10620-009-0752-1. Epub 2009 Mar 3.

DOI:10.1007/s10620-009-0752-1
PMID:19255848
Abstract

PURPOSE

The aim of this study was to characterize the reflux events in patients with laryngeal symptoms unresponsive to proton pump inhibitor (PPI) therapy.

BACKGROUND

Gastroesophageal reflux disease (GERD) is commonly implicated as the cause of laryngeal symptoms.

METHODS

We retrospectively reviewed the pH/impedance records of 21 patients evaluated for persistent throat symptoms despite PPI therapy. They were compared to 30 others with typical reflux symptoms despite medication.

RESULTS

Five of 21 (24%) patients in the "throat group" had normal reflux values, 13 (62%) continued to have abnormal acid reflux, and three (14%) had abnormal nonacid reflux but normal acid reflux while on medication. These results did not differ from those with typical symptoms unresponsive to medication.

CONCLUSION

In patients with chronic laryngeal symptoms despite PPI therapy, a substantial minority have no reflux at all, but the majority have abnormal amounts of acid reflux despite their taking PPI medication.

摘要

目的

本研究旨在描述经质子泵抑制剂(PPI)治疗后仍有喉部症状的患者的反流事件。

背景

胃食管反流病(GERD)通常被认为是喉部症状的原因。

方法

我们回顾性分析了 21 例经 PPI 治疗后持续性咽喉症状患者的 pH/阻抗记录,并与 30 例有典型反流症状但经药物治疗的患者进行了比较。

结果

在“咽喉组”的 21 例患者中,有 5 例(24%)的反流值正常,13 例(62%)持续存在异常酸反流,3 例(14%)存在异常非酸反流,但在药物治疗时酸反流正常。这些结果与对药物无反应的典型症状患者没有差异。

结论

在经 PPI 治疗后仍有慢性喉部症状的患者中,相当一部分患者根本没有反流,但大多数患者尽管服用了 PPI 药物,仍有异常量的酸反流。

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本文引用的文献

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Limited diagnostic value of laryngopharyngeal lesions in patients with gastroesophageal reflux during routine upper gastrointestinal endoscopy.常规上消化道内镜检查中咽喉部病变在胃食管反流患者中的诊断价值有限。
Am J Gastroenterol. 2007 Apr;102(4):716-22. doi: 10.1111/j.1572-0241.2007.01145.x.
2
ACG practice guidelines: esophageal reflux testing.美国胃肠病学会实践指南:食管反流检测
Am J Gastroenterol. 2007 Mar;102(3):668-85. doi: 10.1111/j.1572-0241.2006.00936.x.
3
Technology review: Esophageal impedance monitoring.技术综述:食管阻抗监测
Am J Gastroenterol. 2007 Jan;102(1):187-94. doi: 10.1111/j.1572-0241.2006.00966.x. Epub 2006 Nov 13.
4
Proton pump inhibitor therapy for suspected GERD-related chronic laryngitis: a meta-analysis of randomized controlled trials.质子泵抑制剂治疗疑似胃食管反流病相关慢性喉炎:一项随机对照试验的荟萃分析
Am J Gastroenterol. 2006 Nov;101(11):2646-54. doi: 10.1111/j.1572-0241.2006.00844.x. Epub 2006 Oct 13.
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Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy.胃食管反流病患者食管pH值-阻抗监测及症状分析:治疗期间与非治疗期间的研究
Am J Gastroenterol. 2006 Sep;101(9):1956-63. doi: 10.1111/j.1572-0241.2006.00711.x. Epub 2006 Jul 18.
6
Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: a controlled study.针对积极抑酸治疗无效的喉咽反流患者进行的手术胃底折叠术:一项对照研究。
Clin Gastroenterol Hepatol. 2006 Apr;4(4):433-41. doi: 10.1016/j.cgh.2006.01.011.
7
Laryngopharyngeal reflux: a cause of faulty phonation or a faulted, phony diagnosis?喉咽反流:发声障碍的一个原因还是一个错误的、虚假的诊断?
Clin Gastroenterol Hepatol. 2006 Apr;4(4):431-2. doi: 10.1016/j.cgh.2006.01.012.
8
Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring.尽管进行了抑酸治疗仍有持续症状的患者的酸反流和非酸反流:一项使用联合动态阻抗-pH监测的多中心研究
Gut. 2006 Oct;55(10):1398-402. doi: 10.1136/gut.2005.087668. Epub 2006 Mar 23.
9
Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians.与胃食管反流相关的慢性喉炎:胃肠病学家与耳鼻喉科医生实践模式差异的前瞻性评估
Am J Gastroenterol. 2006 Mar;101(3):470-8. doi: 10.1111/j.1572-0241.2006.00502.x.
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The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux.心理压力对胃食管反流患者症状严重程度及感知的影响
J Psychosom Res. 2005 Dec;59(6):415-24. doi: 10.1016/j.jpsychores.2005.05.012.