Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, Japan.
Minimally Invasive Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, Japan.
Surg Endosc. 2018 May;32(5):2409-2419. doi: 10.1007/s00464-017-5940-z. Epub 2017 Dec 7.
Clinical characteristics of laryngopharyngeal reflux (LPR) in Japanese population remain unclear, and its treatment outcome is suboptimal. The objectives of this study were to evaluate Japanese patients with LPR symptoms using hypopharyngeal multichannel intraluminal impedance (HMII) and to assess the outcome of antireflux surgery (ARS).
Subjects included patients who had LPR symptoms for > 12 weeks or laryngoscopic findings suggestive of LPR and underwent laryngoscopy and esophageal testing including HMII. Abnormal proximal exposure (APE) was defined as LPR ≥ 1/day and/or full column reflux (FCR) (reflux 2 cm distal to the upper esophageal sphincter) ≥ 5/day on HMII. Patients with APE were offered ARS and the outcome of ARS was objectively assessed using Reflux Symptom Index (RSI).
From July 2015 to September 2016, 52 patients with LPR symptoms (28 men, 24 women, median BMI 22.3) underwent HMII, and 38 patients (73%) had APE. Of them, 29 (76%) patients were not obese (BMI < 25) and 19 (50%) patients had a negative DeMeester score. Approximately one-third of LPR and FCR events were non-acid in the distal esophagus. A positive symptom-association probability was seen only in 18 patients (35%). Mild esophagitis and hiatal hernia were found in 5 (10%) and 23 (48%) patients, respectively. All 12 patients (100%) who had undergone ARS were able to discontinue PPI and had a significant improvement in the RSI scores postoperatively (22.9 ± 10.0 vs. 6.8 ± 6.8, p < .001).
APE was frequently observed in Japanese patients with LPR symptoms. Obesity and esophagitis were uncommon in this population. Since a large number of patients with APE had negative DeMeester score and proximal reflux events were often non-acid, a conventional pH monitoring is insufficient. HMII is crucial to evaluate patients with LPR symptoms as the documentation of APE is a key for successful outcome of ARS.
喉咽反流（LPR）在日本人群中的临床特征尚不清楚，其治疗效果也不理想。本研究的目的是使用下咽多通道腔内阻抗（HMII）评估有 LPR 症状的日本患者，并评估抗反流手术（ARS）的治疗效果。
研究对象包括有 LPR 症状超过 12 周或有喉镜下 LPR 表现的患者，并进行喉镜检查和食管检查，包括 HMII。近端暴露（APE）异常定义为 HMII 上 LPR≥1/天和/或全柱反流（FCR）（反流距离食管上括约肌 2cm 处）≥5/天。对有 APE 的患者提供 ARS，并使用反流症状指数（RSI）客观评估 ARS 的治疗效果。
2015 年 7 月至 2016 年 9 月，52 例有 LPR 症状的患者（28 名男性，24 名女性，中位 BMI 为 22.3）接受了 HMII 检查，其中 38 例（73%）存在 APE。其中，29 例（76%）患者不肥胖（BMI<25），19 例（50%）患者的德梅斯特评分阴性。在远端食管，约有三分之一的 LPR 和 FCR 事件是非酸性的。只有 18 例（35%）患者的症状关联概率呈阳性。5 例（10%）患者有轻度食管炎，23 例（48%）患者有食管裂孔疝。所有接受 ARS 的 12 例患者（100%）均能够停止使用质子泵抑制剂（PPI），术后 RSI 评分显著改善（22.9±10.0 与 6.8±6.8，p<0.001）。
在有 LPR 症状的日本患者中，经常观察到 APE。肥胖和食管炎在该人群中并不常见。由于大量 APE 患者的德梅斯特评分阴性，近端反流事件常为非酸性，常规 pH 监测不充分。HMII 对于评估有 LPR 症状的患者非常重要，因为 APE 的记录是 ARS 成功治疗的关键。
