Department of Upper Gastro-Intestinal Surgery, Concord Repatriation General Hospital, Sydney, Australia.
University of Notre Dame Australia, Sydney, Australia.
Esophagus. 2020 Jul;17(3):355-362. doi: 10.1007/s10388-020-00726-9. Epub 2020 Feb 21.
Gastro-esophageal reflux disease (GERD) can present with typical or atypical or laryngo-pharyngeal reflux (LPR) symptoms. Pulmonary aspiration of gastric refluxate is one of the most serious variants of reflux disease as its complications are difficult to diagnose and treat. The aim of this study was to establish predictors of pulmonary aspiration and LPR symptoms.
Records of 361 consecutive patient from a prospectively populated database were analyzed. Patients were categorized by symptom profile as predominantly LPR or GERD (98 GER and 263 LPR). Presenting symptom profile, pH studies, esophageal manometry and scintigraphy and the relationships were analyzed.
Severe esophageal dysmotility was significantly more common in the LPR group (p = 0.037). Severe esophageal dysmotility was strongly associated with isotope aspiration in all patients (p = 0.001). Pulmonary aspiration on scintigraphy was present in 24% of patients. Significant correlation was established between total proximal acid on 24-h pH monitoring and isotope aspiration in both groups (p < 0.01). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (p < 0.01).
Severe esophageal dysmotility correlates with LPR symptoms and reflux aspiration in LPR and GERD. Abnormal proximal acid score on 24-h pH monitoring associated with pulmonary aspiration in reflux patients. Pharyngeal contamination on scintigraphy was the strongest predictor of pulmonary aspiration.
胃食管反流病（GERD）可表现为典型或非典型或喉咽反流（LPR）症状。胃反流物的肺吸入是反流病最严重的变异之一，因为其并发症难以诊断和治疗。本研究的目的是确定肺吸入和 LPR 症状的预测因素。
分析了来自前瞻性填充数据库的 361 例连续患者的记录。根据症状特征将患者分为主要为 LPR 或 GERD（98 例 GER 和 263 例 LPR）。分析了现有的症状特征、pH 研究、食管测压和闪烁扫描以及它们之间的关系。
LPR 组食管运动障碍明显更常见（p = 0.037）。在所有患者中，严重的食管运动障碍与同位素吸入强烈相关（p = 0.001）。闪烁扫描显示 24%的患者存在肺吸入。在两组中，24 小时 pH 监测的总近端酸与同位素吸入之间均建立了显著相关性（p < 0.01）。闪烁扫描上咽曲线升高是同位素吸入的最强预测因子（p < 0.01）。
严重的食管运动障碍与 LPR 和 GERD 中的 LPR 症状和反流吸入相关。24 小时 pH 监测中的近端酸评分异常与反流患者的肺吸入相关。闪烁扫描上的咽部污染是肺吸入的最强预测因子。
