Gelardi M, Ciprandi G
Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
Ospedale Policlinico San Martino, Genoa, Italy
J Biol Regul Homeost Agents. 2018;32(1 Suppl. 2):41-47.
Gastroesophageal reflux (GER) is a common disease usually limited to the oesophagus. Laryngopharyngeal reflux (LPR) is an inflammatory reaction of the mucosa of pharynx, larynx, and other associated upper respiratory organs, caused by a reflux of stomach contents outside the oesophagus. LPR is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated sometimes empirically and without a correct diagnosis. However, there is disagreement between specialists about its definition and management: gastroenterologists consider LPR to be a substantially rare manifestation of gastroesophageal reflux disease (GERD), whereas otolaryngologists believe that LPR is an independent, but common in their practice, disorder. Patients suffering from LPR firstly consult their general practitioners, but a multidisciplinary approach may be fruitful to define a unified strategy based on specific medications and behavioural changes. The present Supplement would review the topic, considering LPR and GER characteristics, pathophysiology, diagnostic work-up, and new therapeutic strategies also comparing different specialist points of view and patient populations. In particular, new insights derive from an interesting gel compound, containing magnesium alginate and E-Gastryal® (hyaluronic acid, hydrolysed keratin, Tara gum, and Xantana gum). In particular, two very large Italian surveys were conducted in real-world setting, such as outpatient clinics. The most relevant outcomes are presented and discussed in the current Issue. Actually, laryngopharyngeal reflux (LPR) is considered an extraesophageal manifestation of the gastroesophageal reflux disease (GERD). Both GERD and its extraesophageal manifestation are very common in clinical practice. Both disorders have a relevant burden for the society: about this topic most of pharmaco-economic studies were conducted in the United States. In population-based studies, 19.8% of North Americans complain of typical symptoms of GERD (heartburn and regurgitation) at least weekly (1). Also in the late 1990s, GERD accounted for $9.3 to $12.1 billion in direct annual healthcare costs in the United States, higher than any other digestive disease. As a result, acid-suppressive agents were the leading pharmaceutical expenditure in the United States. The prevalence of GERD in the primary care setting becomes even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD is also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits (2, 3) Extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years.
胃食管反流(GER)是一种常见疾病,通常局限于食管。咽喉反流(LPR)是指胃内容物反流至食管外,引起咽部、喉部及其他相关上呼吸道器官黏膜的炎症反应。LPR被认为是一种相对较新的临床病症,有大量临床表现,有时治疗缺乏正确诊断,仅凭经验。然而,专家们对其定义和管理存在分歧:胃肠病学家认为LPR是胃食管反流病(GERD)的一种极为罕见的表现形式,而耳鼻喉科医生则认为LPR是一种独立病症,在他们的临床实践中较为常见。LPR患者首先会咨询全科医生,但多学科方法可能有助于基于特定药物和行为改变来制定统一策略。本增刊将回顾该主题,考虑LPR和GER的特征、病理生理学、诊断检查以及新的治疗策略,同时比较不同专家观点和患者群体。特别是,一种有趣的凝胶化合物带来了新见解,该化合物含有海藻酸镁和E-Gastryal®(透明质酸、水解角蛋白、刺云实胶和黄原胶)。特别是,在现实环境(如门诊诊所)中进行了两项非常大型的意大利调查。当前这期呈现并讨论了最相关的结果。实际上,咽喉反流(LPR)被认为是胃食管反流病(GERD)的食管外表现形式。GERD及其食管外表现形式在临床实践中都非常常见。这两种病症对社会都有相当大的负担:关于这个主题,大多数药物经济学研究是在美国进行的。在基于人群的研究中,19.8%的北美人至少每周抱怨有GERD的典型症状(烧心和反流)(1)。同样在20世纪90年代末,GERD在美国每年的直接医疗费用达93亿至121亿美元,高于任何其他消化系统疾病。因此,抑酸剂是美国主要的药物支出。当考虑到在美国,每年有460万次门诊就诊主要是因为GERD,而910万次就诊的前三位诊断中包括GERD时,GERD在初级保健环境中的患病率就更加明显了。GERD也是门诊护理就诊中最常列为首位的胃肠道诊断(2,3)。反流的食管外表现形式,包括LPR、哮喘和慢性咳嗽,据估计在就诊后的第一年每位患者的直接医疗费用为5438美元,5年的费用为13700美元。