Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, Thessaloniki, Greece.
Second Department of Internal Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
Eur Arch Otorhinolaryngol. 2011 Aug;268(8):1169-1174. doi: 10.1007/s00405-011-1572-4. Epub 2011 Mar 25.
We conducted a pH-monitoring study to determine the prevalence of pathologic gastroesophageal reflux (GER+) and laryngopharyngeal reflux (LPR+) in patients with resected benign true vocal fold lesions (TVFLs) and positive reflux finding score (RFS). We compared our findings with those of patients with typical GER disease (GERD) symptoms and normal laryngoscopy. In the group of patients with TVFLs, we compared the pH-monitoring findings of smokers with those of non-smokers. Seventy-two [females 32, mean (SD) age 49.3 (13.1) years] patients with resected TVFLs (polyps: 32, nodules: 20, Reinke's edema: 12, granulomas: 4, leukoplakia: 4) and 24 [females 14, mean (SD) age 42.2 (13.4) years] patients with typical GERD symptoms, who served as controls for the hypopharyngeal measurements, underwent 24-h double probe, hypopharyngeal and distal esophageal, ambulatory pH monitoring. Thirty-eight (52.8%) patients with TVFLs had GER+ and 52 (72.2%) had LPR+. More laryngopharyngeal reflux episodes (LPREs) were detected in patients with TVFLs compared to those with GERD (P < 0.001). With respect to the specific TVFLs, 12 (37.5%) patients with polyps had GER+ and 24 (75%) had LPR+, 6 (30%) patients with nodules had GER+ and 12 (60%) had LPR+, 6 (50%) patients with Reinke's edema had GER+ and 8 (66.7%) had LPR+ and all the patients with granuloma or leucoplakia had both GER+ and LPR+. Twenty (55.6%) of the 36 smokers and 32 (88.9%) of the 36 non-smokers with TVFLs had LPR+ (P = 0.003), while GER+ was recorded in 16 (44.4%) smokers and 22 (61.1%) non-smokers (P = 0.238). Smokers had significantly less LPREs (P < 0.001). In conclusion, 24-h double probe pH monitoring may detect GER+ and/or LPR+ in a substantial proportion of patients with resected TVFLs and positive RFS. Our study suggests that LPR+ is more prevalent in patients with TVFLs compared with typical GERD patients and that non-smokers with TVFLs are more likely to have LPR+ than smokers with TVFLs.
我们进行了一项 pH 监测研究，以确定切除良性真声带病变（TVFL）且反流发现评分（RFS）阳性的患者中病理性胃食管反流（GER+）和喉咽反流（LPR+）的患病率。我们将我们的发现与具有典型 GER 疾病（GERD）症状和正常喉镜的患者进行了比较。在 TVFL 患者组中，我们比较了吸烟者和非吸烟者的 pH 监测结果。72 名[女性 32 名，平均（SD）年龄 49.3（13.1）岁]接受 TVFL 切除术的患者（息肉：32 例，结节：20 例，Reinke 水肿：12 例，肉芽肿：4 例，白斑：4 例）和 24 名[女性 14 名，平均（SD）年龄 42.2（13.4）岁]具有典型 GERD 症状的患者作为下咽测量的对照，进行了 24 小时双探头、下咽和远端食管、动态 pH 监测。38 名（52.8%）TVFL 患者存在 GER+，52 名（72.2%）存在 LPR+。与 GERD 患者相比，TVFL 患者的喉咽反流次数（LPREs）更多（P<0.001）。就特定的 TVFL 而言，12 名（37.5%）息肉患者存在 GER+，24 名（75%）存在 LPR+，6 名（30%）结节患者存在 GER+，12 名（60%）存在 LPR+，6 名（50%）Reinke 水肿患者存在 GER+和 8 名（66.7%）存在 LPR+，所有肉芽肿或白斑患者均存在 GER+和 LPR+。36 名吸烟者中有 20 名（55.6%）和 36 名非吸烟者中有 32 名（88.9%）存在 LPR+（P=0.003），而吸烟者中 GER+的记录为 16 名（44.4%）和 22 名（61.1%）非吸烟者（P=0.238）。吸烟者的 LPREs 明显较少（P<0.001）。总之，24 小时双探头 pH 监测可能会在切除的 TVFL 且 RFS 阳性的患者中检测到 GER+和/或 LPR+。我们的研究表明，与典型 GERD 患者相比，LPR+在 TVFL 患者中更为常见，与 TVFL 患者相比，非吸烟者更有可能存在 LPR+。
