Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
Department of Otolaryngology-Head and Neck Surgery, Seoul Veterans Hospital, Seoul, Korea.
JAMA Otolaryngol Head Neck Surg. 2013 Dec;139(12):1291-5. doi: 10.1001/jamaoto.2013.5556.
IMPORTANCE: Several trials on the predictors of response to proton pump inhibitor (PPI) treatment of laryngopharyngeal reflux (LPR) have shown conflicting results. Furthermore, the influence of age in disease severity and response to PPI therapy is unclear. OBJECTIVE: To assess the difference in disease severity and response to PPI therapy according to age in patients with LPR. DESIGN, SETTING, AND PARTICIPANTS: Prospective multicenter study at 3 tertiary medical centers of 264 consecutive patients with LPR who were referred to the otolaryngology clinic from November 2010 to February 2012. INTERVENTIONS: Participants were prescribed 15 mg of lansoprazole (PPI) twice daily for 3 months. MAIN OUTCOMES AND MEASURES: Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and laryngopharyngeal reflux-health-related quality of life (LPR-HRQOL) were collected at baseline and at 1 and 3 months postbaseline. RESULTS: After 3 months, 35 patients were lost to follow-up and excluded; the remaining 229 patients included 135 men and 94 women. The oldest group (60-79 years; n = 111) showed higher baseline RSI (P < .001) and LPR-HRQOL (P < .001) scores than the 18- to 39-year-old (n = 35) and 40- to 59-year-old (n = 83) groups. However, baseline RFS scores showed no significant difference among age groups (P = .44). Within each age group, the RSI, RFS, and LPR-HRQOL improved significantly with PPI therapy (all P < .001); however, no significant difference in improvement of RSI (P = .59), RFS (P = .50), or LPR-HRQOL (P = .09) was seen among the groups. At 3-month follow-up, significantly more responders, defined as those whose RSI score improved by more than 50%, were found in the 18- to 39-year-old and 40- to 59-year-old groups (86% and 75%, respectively) than in the oldest group (57%) (P = .002), but there was no significant difference in proportion of responders among age groups at 1-month follow-up (P = .69). CONCLUSIONS AND RELEVANCE: In patients with LPR, age seems to affect the subjective symptoms and resulting impact on quality of life but not the laryngeal findings. Furthermore, older patients are more likely not to respond to PPI therapy than younger patients.
重要性：几项关于质子泵抑制剂（PPI）治疗喉咽反流（LPR）反应预测因子的试验得出了相互矛盾的结果。此外，年龄对疾病严重程度和 PPI 治疗反应的影响尚不清楚。 目的：评估 LPR 患者中年龄对疾病严重程度和 PPI 治疗反应的影响。 设计、地点和参与者：2010 年 11 月至 2012 年 2 月，在 3 家三级医疗中心的耳鼻喉科诊所，对 264 例连续 LPR 患者进行了前瞻性多中心研究。 干预措施：患者每天服用 15mg 兰索拉唑（PPI），持续 3 个月。 主要观察指标：反流症状指数（RSI）、反流发现评分（RFS）和喉咽反流健康相关生活质量（LPR-HRQOL）在基线和基线后 1 个月和 3 个月时收集。 结果：3 个月后，35 名患者失访并被排除；其余 229 名患者包括 135 名男性和 94 名女性。年龄最大的组（60-79 岁；n=111）的基线 RSI（P<.001）和 LPR-HRQOL（P<.001）评分均高于 18-39 岁（n=35）和 40-59 岁（n=83）组。然而，年龄组之间的基线 RFS 评分无显著差异（P=.44）。在每个年龄组中，RSI、RFS 和 LPR-HRQOL 均随着 PPI 治疗而显著改善（均 P<.001）；然而，在 RSI（P=.59）、RFS（P=.50）或 LPR-HRQOL（P=.09）的改善方面，各组之间均无显著差异。在 3 个月的随访中，18-39 岁和 40-59 岁组中发现更多的 RSI 评分改善超过 50%的应答者（分别为 86%和 75%），而年龄最大组（57%）应答者较少（P=.002），但在 1 个月随访时，年龄组之间应答者的比例无显著差异（P=.69）。 结论和相关性：在 LPR 患者中，年龄似乎影响主观症状和对生活质量的影响，但不影响喉部发现。此外，与年轻患者相比，老年患者对 PPI 治疗的反应性较差。
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