Waxman Jonathan, Yalamanchali Sreeya, Valle Elizabeth Shay, Pott Thomas, Friedman Michael
College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
Otolaryngol Head Neck Surg. 2014 Jun;150(6):1010-7. doi: 10.1177/0194599814525577. Epub 2014 Mar 19.
To determine the effect of twice-daily proton pump inhibitor (PPI) treatment on the relationship between laryngopharyngeal pH environment and symptoms in patients with laryngopharyngeal reflux (LPR).
Retrospective analysis of records from consecutive patients seen at a single clinical site between 2009 and 2012.
Forty-three records of patients diagnosed with LPR who underwent pre- and posttreatment pH studies were included. Prior to treatment, all had a Reflux Symptom Index (RSI) > 13 and an abnormal pH study. Patients were treated for ≥ 4 weeks with twice-daily PPIs. Following treatment, patients completed a second RSI and pH study.
Most patients (67.4%) had symptom normalization; however, most patients (60.5%) did not have pH normalization. For all patients whose symptoms did not normalize, pH scores also did not normalize; 32.6% of patients showed no subjective or objective treatment response. For individuals whose symptoms normalized but whose pH scores did not normalize, there was a significant decrease in upright pH score. For the entire group, pretreatment symptom and upright pH scores were strongly positively correlated. Improvements in symptom and upright pH scores following treatment were moderately positively correlated.
Laryngopharyngeal pH failed to normalize for most individuals after PPI treatment; only pH improvement was necessary for symptom normalization. Many patients had no treatment response. Laryngopharyngeal reflux patients may make up a heterogeneous group, and PPI responsivity may help explain conflicting results from previous studies. Posttreatment pH monitoring is recommended in studies investigating the efficacy of PPI therapy for LPR.
确定每日两次质子泵抑制剂（PPI）治疗对喉咽反流（LPR）患者喉咽pH环境与症状之间关系的影响。
对2009年至2012年在单一临床地点就诊的连续患者的记录进行回顾性分析。
纳入43例诊断为LPR且接受治疗前后pH研究的患者记录。治疗前，所有患者的反流症状指数（RSI）均>13且pH研究异常。患者接受每日两次PPI治疗≥4周。治疗后，患者完成第二次RSI和pH研究。
大多数患者（67.4%）症状恢复正常；然而，大多数患者（60.5%）的pH值未恢复正常。对于所有症状未恢复正常的患者，pH评分也未恢复正常；32.6%的患者未显示主观或客观治疗反应。对于症状恢复正常但pH评分未恢复正常的个体，直立位pH评分显著降低。对于整个组，治疗前症状与直立位pH评分呈强正相关。治疗后症状和直立位pH评分的改善呈中度正相关。
PPI治疗后大多数个体的喉咽pH值未恢复正常；症状恢复正常仅需pH值改善。许多患者无治疗反应。喉咽反流患者可能构成一个异质性群体，PPI反应性可能有助于解释先前研究结果的矛盾之处。在研究PPI治疗LPR疗效的研究中，建议进行治疗后pH监测。
