Formánek Martin, Jančatová Debora, Komínek Pavel, Tomanová Radoslava, Zeleník Karol
Department of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic.
Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic.
Clin Transl Gastroenterol. 2017 Oct 26;8(10):e123. doi: 10.1038/ctg.2017.49.
Recently, a 24-h impedance was used to detect laryngopharyngeal reflux (LPR). However, not every case of LPR is pathological. Thus, pathological pharyngeal impedance values need to be clearly established to diagnose pathological LPR. The aim of our study was to establish pathological 24-h pharyngoesophageal impedance/pH values for the diagnosis of LPR.
The study was conducted in a tertiary care setting. A total of 30 patients who were referred to microlaryngoscopy for a laryngeal pathology that might be caused by LPR were included in this prospective study. All patients were off proton-pump inhibitor therapy. The 24-h pharyngoesophageal impedance-pH monitoring was performed 1 day before surgery. A biopsy of laryngeal tissue was obtained during microlaryngoscopy and was analyzed by immunohistochemistry to detect pepsin. The patients were divided into two groups: pepsin negative and pepsin positive (which indicated pathological LPR). The results of 24-h multichannel intraluminal impedance-dual-channel pH monitoring were compared between the groups. The number of LPR episodes in the pepsin-positive group was analyzed to establish a cutoff value for pathological LPR.
There were 18 participants in the pepsin-negative group and 12 in the pepsin-positive group. The median total pharyngeal refluxes detected were two (0-5) in the pepsin-negative group and 14 (6-39) in the pepsin-positive group (P<0.001), although the groups were otherwise homogeneous. There was a statistically significant difference in the number of all types of refluxes between groups. Six or more pharyngeal refluxes were the cutoff for the presence of pepsin in the laryngeal mucosa and, thereby, for the diagnosis of relevant/pathological LPR.
Six or more pharyngeal reflux episodes registered during the 24-h impedance/pH monitoring seem to be the cutoff for diagnosing pathological LPR. Therefore, it is possible to suggest establishing this value as the pathological impedance value indicating pathological LPR. These results must be interpreted with caution due to the small sample size.
最近，24小时阻抗检测被用于检测喉咽反流（LPR）。然而，并非每一例LPR都是病理性的。因此，需要明确病理性咽阻抗值以诊断病理性LPR。我们研究的目的是确定用于诊断LPR的病理性24小时咽食管阻抗/pH值。
本研究在三级医疗机构进行。共有30例因可能由LPR引起的喉部病变而被转诊至显微喉镜检查的患者纳入本前瞻性研究。所有患者均停用质子泵抑制剂治疗。在手术前1天进行24小时咽食管阻抗-pH监测。在显微喉镜检查期间获取喉部组织活检标本，并通过免疫组织化学分析检测胃蛋白酶。患者分为两组：胃蛋白酶阴性组和胃蛋白酶阳性组（提示病理性LPR）。比较两组24小时多通道腔内阻抗-双通道pH监测结果。分析胃蛋白酶阳性组的LPR发作次数以确定病理性LPR的临界值。
胃蛋白酶阴性组有18名参与者，胃蛋白酶阳性组有12名。胃蛋白酶阴性组检测到的咽反流总数中位数为2次（0-5次），胃蛋白酶阳性组为14次（6-39次）（P<0.001），尽管两组在其他方面具有同质性。两组之间所有类型反流的次数存在统计学显著差异。6次或更多次咽反流是喉黏膜中存在胃蛋白酶的临界值，从而也是诊断相关/病理性LPR的临界值。
24小时阻抗/pH监测期间记录到6次或更多次咽反流发作似乎是诊断病理性LPR的临界值。因此，可以建议将该值确定为指示病理性LPR的病理性阻抗值。由于样本量小，这些结果必须谨慎解释。
