Department of Otolaryngology - Head and Neck Surgery.
Division of Medicine - Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Dis Esophagus. 2019 Apr 1;32(4). doi: 10.1093/dote/doy072.
Laryngopharyngeal reflux (LPR) is a clinical entity diagnosed by history laryngoscopic findings that has a variable response to empiric proton-pump inhibitor (PPI) therapy. While the reflux finding score (RFS), an endoscopic scoring scheme, has been advanced as a measure of LPR, it has not been externally validated against symptom severity in practice. Extralaryngeal pharyngeal endoscopic findings may have diagnostic utility but remain underexplored. This study assesses the correlation between extralaryngeal findings and (1) 24-hour oropharyngeal pH & (2) PPI response in patients with suspected LPR. Subjects presented to a tertiary care center with laryngeal symptoms ≥1 month and reflux symptom index (RSI) ≥13. Following baseline questionnaires, laryngoscopy, and a 24-hour oropharyngeal pH probe study, subjects were prescribed 8-12 week omeprazole trials. Baseline endoscopic findings were scored in a blinded fashion using the RFS and extralaryngeal score criteria, summatively the 'ELS.' PPI response was defined as ≥50% improvement in RSI. Thirty-three subjects with flexible endoscopic recordings completed baseline and follow-up questionnaires. The cohort's baseline mean RSI was 23.0 ± 7.2 with a ΔRSI = 9.8 after PPI therapy. The baseline RFS score averaged 5.3 ± 2.7. 45% of our subjects was found to be PPI responsive. The Cohen's kappa for the ELS but not the RFS was significant. There were no significant differences between the RFS (P = 0.10) or ELS (P = 0.07) for PPI responders & nonresponders. Oropharyngeal pH measures did not correlate with the RFS or ELS. In conclusion, endoscopic scores of laryngeal and extralaryngeal findings did not predict PPI response or oropharyngeal acid exposure in suspected LPR.
喉咽反流（LPR）是一种通过病史和喉镜检查发现的临床病症，其对经验性质子泵抑制剂（PPI）治疗的反应存在差异。虽然反流发现评分（RFS）作为一种衡量 LPR 的指标已被提出，但它尚未在实践中针对症状严重程度进行外部验证。喉外咽部的内镜检查结果可能具有诊断价值，但仍未得到充分探索。本研究评估了喉外发现与（1）24 小时咽喉 pH 值和（2）疑似 LPR 患者对 PPI 反应之间的相关性。研究对象因喉部症状持续≥1 个月和反流症状指数（RSI）≥13 而就诊于三级保健中心。在基线问卷调查、喉镜检查和 24 小时咽喉 pH 探头研究后，为研究对象开处 8-12 周的奥美拉唑试验。以盲法方式使用 RFS 和喉外评分标准对基线内镜检查结果进行评分，总分为“ELS”。PPI 反应定义为 RSI 改善≥50%。33 名具有灵活内镜记录的研究对象完成了基线和随访问卷调查。该队列的基线平均 RSI 为 23.0±7.2，PPI 治疗后 RSI 差值为 9.8。基线 RFS 评分为 5.3±2.7。45%的研究对象对 PPI 有反应。ELS 的 Cohen's kappa 有显著意义，但 RFS 无显著意义。PPI 反应者和无反应者的 RFS（P=0.10）或 ELS（P=0.07）无显著差异。咽喉 pH 值测量与 RFS 或 ELS 均无相关性。结论：喉和喉外内镜评分不能预测疑似 LPR 患者对 PPI 的反应或咽喉部酸暴露情况。
