Burton Leticia, Falk Gregory L., Baumgart Karl, Beattie John, Simpson Scott, Van der Wall Hans
University of Notre Dame, CNI Molecular Imaging, Sydney, Australia
Concord Hospital and University of Sydney, Sydney Heartburn Clinic, Sydney, Australia
Mol Imaging Radionucl Ther. 2020 Feb 17;29(1):7-16. doi: 10.4274/mirt.galenos.2019.30085.
The role of gastroesophageal reflux disease (GERD) in the aetiology of laryngopharyngeal reflux (LPR) is poorly understood and remains a controversial issue. The 24-hour impedance monitoring has shown promise in the evaluation of LPR but is problematic in pharyngeal recording. We have shown the utility of scintigraphic studies in the detection of LPR and lung aspiration of refluxate. Correlative studies were obtained in patients with a strong history of LPR and severe GERD.
A highly selected sequential cohort of patients with a high pre-test probability of LPR/severe GERD who had failed maximal medical therapy were evaluated with 24-hour impedance/pH, manometry and scintigraphic reflux studies.
The study group comprised 34 patients (15 M, 19 F) with a mean age of 56 years (range: 28-80 years). The majority had LPR symptoms (mainly cough) in 31 and severe GERD in 3. Impedance bolus clearance and pH studies were abnormal in all patients in the upright and supine position. A high rate of non-acid GERD was detected by impedance monitoring. LOS tone and ineffective oesophageal clearance were found in the majority of patients. Scintigraphic studies showed strong correlations with impedance, pH and manometric abnormalities, with 10 patients showing pulmonary aspiration.
Scintigraphic studies appear to be a good screening test for LPR and pulmonary aspiration as there is direct visualisation of tracer at these sites. Impedance studies highlight the importance of non-acidic reflux and bolus clearance in the causation of cough and may allow the development of a risk profile for pulmonary aspiration of refluxate.
胃食管反流病（GERD）在喉咽反流（LPR）病因学中的作用尚未完全明确，仍是一个有争议的问题。24小时阻抗监测在评估LPR方面显示出一定前景，但在咽部记录方面存在问题。我们已经证明了闪烁扫描研究在检测LPR和反流物肺吸入方面的实用性。对有强烈LPR病史和严重GERD的患者进行了相关研究。
对一组经过严格筛选、LPR/严重GERD预测试概率高且最大药物治疗失败的患者进行了24小时阻抗/pH监测、测压和闪烁扫描反流研究。
研究组包括34例患者（15例男性，19例女性），平均年龄56岁（范围：28 - 80岁）。大多数患者有LPR症状（主要是咳嗽）3例，严重GERD 3例。所有患者在直立和仰卧位时阻抗团块清除和pH研究均异常。通过阻抗监测检测到高比例的非酸性GERD。大多数患者存在下食管括约肌张力和无效食管清除。闪烁扫描研究显示与阻抗、pH和测压异常有很强的相关性，10例患者显示有肺吸入。
闪烁扫描研究似乎是LPR和肺吸入的良好筛查试验，因为可以直接在这些部位可视化示踪剂。阻抗研究突出了非酸性反流和团块清除在咳嗽病因中的重要性，并可能有助于建立反流物肺吸入的风险概况。
