Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, South Korea.
Laryngoscope. 2010 Jul;120(7):1303-8. doi: 10.1002/lary.20918.
OBJECTIVES/HYPOTHESIS: Laryngopharyngeal reflux (LPR) originates from regurgitation of gastric contents, a mechanism seemingly identical to gastroesophageal reflux disease (GERD). Some researchers postulate a connection between LPR and GERD, whereas some assert LPR is a disease apart from GERD. We examined symptoms of GERD from LPR patients, and performed gastrointestinal endoscopy and transmission electron microscopy (TEM) to evaluate GERD findings from these patients.
Prospective study at an academic tertiary care center.
Control subjects had no symptoms or signs of LPR/GERD. LPR was diagnosed with a Reflux Symptom Index >13 and Reflux Finding Score >7, and were questioned for GERD-related symptoms and examined with esophagogastroduodenoscopy, then allocated into either an LPR without GERD or LPR with GERD group. Esophageal tissues were obtained from the squamocolumnar junction and managed for TEM, and the intercellular space (IS) was measured to find dilatation, a characteristic GERD finding.
About 30% (8/26) of LPR patients showed GERD-related symptoms, connecting LPR with the GERD group. Most of the LPR patients showed grossly normal endoscopic findings. On TEM, IS of control group (n = 15) was measured as 0.35 +/- 0.27 microm, whereas the LPR without GERD group (n = 18) and LPR with GERD group (n = 8) revealed a dilated IS of 0.61 +/- 0.47 microm and 0.95 +/- 0.44 microm, respectively. This difference was statistically significant compared to the control group (P < .05).
The mean IS of LPR was significantly increased, suggesting common pathogenesis between LPR and GERD.
目的/假设：喉咽反流（LPR）源于胃内容物的反流，这一机制似乎与胃食管反流病（GERD）相同。一些研究人员假设 LPR 与 GERD 之间存在联系，而另一些人则认为 LPR 是一种独立于 GERD 的疾病。我们检查了来自 LPR 患者的 GERD 症状，并进行了胃肠内窥镜检查和透射电子显微镜（TEM）检查，以评估这些患者的 GERD 发现。
在学术三级护理中心进行的前瞻性研究。
对照组无 LPR/GERD 症状或体征。LPR 诊断为反流症状指数（RSI）>13 和反流发现评分（RFS）>7，并询问与 GERD 相关的症状，并进行食管胃十二指肠镜检查，然后分为 LPR 无 GERD 或 LPR 伴 GERD 组。从鳞柱状交界处获得食管组织并进行 TEM 处理，测量细胞间隙（IS）扩张，这是 GERD 的特征性发现。
约 30%（8/26）的 LPR 患者出现与 GERD 相关的症状，将 LPR 与 GERD 组联系起来。大多数 LPR 患者的内镜检查结果大致正常。在 TEM 下，对照组（n=15）的 IS 测量值为 0.35±0.27μm，而 LPR 无 GERD 组（n=18）和 LPR 伴 GERD 组（n=8）的 IS 分别为 0.61±0.47μm 和 0.95±0.44μm。与对照组相比，这一差异具有统计学意义（P<.05）。
LPR 的平均 IS 显著增加，提示 LPR 和 GERD 之间存在共同的发病机制。
