Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan; Science College of Tunghai University, Taichung, Taiwan.
Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Speech-Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan.
Clin Gastroenterol Hepatol. 2020 Jun;18(7):1466-1474.e4. doi: 10.1016/j.cgh.2019.08.064. Epub 2019 Sep 20.
BACKGROUND & AIMS: Patients with isolated laryngopharyngeal reflux symptoms (LPRS) defined as those without concomitant typical reflux symptoms (CTRS) are clinically challenging to manage due to unclear pathophysiology. We investigated esophageal physiology in patients with isolated LPRS and their response to proton-pump inhibitors (PPI) therapy.
This is a multi-center observational study conducted in referral hospitals in Taiwan. Patients with predominant LPRS, but without common non-reflux causes, underwent esophageal manometry, 24-hr ambulatory esophagopharyngeal pH testing, and Bernstein test, followed by a 12-week esomeprazole 40 mg twice-daily treatment. Participants with pathological reflux were divided into the isolated LPRS group (ie, LPRS without CTRS, n = 40) and the CTRS group (ie, LPRS with CTRS, n = 66). Participants without pathological reflux or esophagitis (n = 132) served as the nonreflux controls.
The PPI-responsiveness was similar between the isolated LPRS group and CTRS group (63% vs 57%, P = .8), but lower in the nonreflux controls (32%, P = .005). Despite similar distal esophageal acid exposure time (P = .7) when compared to those with CTRS, the isolated LPRS group had a lower prevalence of both positive Bernstein test (P = .001) and ineffective esophageal motility disorder (P = .03), and fewer pharyngeal acid reflux episodes (P < .0001).
Our findings indicate similar distal esophageal acid exposure and PPI-responsiveness between LPRS patients with and without CTRS. The lack of CTRS in the isolated LPRS group is likely due to esophageal acid hyposensitivity and fewer pharyngeal acid reflux episodes, thus implicating distinct pathophysiology of isolated LPRS from those with CTRS.
孤立性喉咽反流症状（LPRS）患者定义为无典型反流症状（CTRS）的患者，由于发病机制不明确，临床管理极具挑战性。我们研究了孤立性 LPRS 患者的食管生理学及其对质子泵抑制剂（PPI）治疗的反应。
这是一项在台湾转诊医院进行的多中心观察性研究。以 LPRS 为主，但无常见非反流原因的患者接受食管测压、24 小时动态食管 pH 监测和 Bernstein 测试，随后进行为期 12 周的埃索美拉唑 40mg 每日两次治疗。有病理反流的参与者分为孤立性 LPRS 组（即无 CTRS 的 LPRS，n=40）和 CTRS 组（即有 CTRS 的 LPRS，n=66）。无病理反流或食管炎的参与者（n=132）作为无反流对照组。
孤立性 LPRS 组与 CTRS 组的 PPI 反应率相似（63% vs 57%，P=.8），但无反流对照组较低（32%，P=.005）。尽管与有 CTRS 的患者相比，远端食管酸暴露时间相似（P=.7），但孤立性 LPRS 组阳性 Bernstein 测试（P=.001）和无效食管动力障碍（P=.03）的发生率较低，且咽部酸反流次数较少（P<.0001）。
我们的研究结果表明，有无 CTRS 的 LPRS 患者的远端食管酸暴露和 PPI 反应率相似。孤立性 LPRS 组缺乏 CTRS 可能是由于食管酸低敏性和咽部酸反流次数减少，这表明孤立性 LPRS 的发病机制与有 CTRS 的患者不同。
