Department of Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia.
School of Medicine, University of Notre Dame, Sydney, NSW, Australia.
Lung. 2021 Apr;199(2):139-145. doi: 10.1007/s00408-021-00432-y. Epub 2021 Mar 9.
Previously described methodologies for detecting laryngopharyngeal reflux (LPR) have limitations. Symptoms alone are non-diagnostic, and pH-impedance studies have poor sensitivity. Pulmonary micro-aspiration is under-recognised in LPR and gastro-esophageal reflux disease (GERD). The present study aimed to describe the results of a modified technique for scintigraphic reflux studies in two groups with severe reflux: those with typical reflux symptoms and those with laryngopharyngeal manifestations of reflux.
A prospective database of severely symptomatic, treatment-resistant reflux patients was grouped based upon predominant symptom profile of typical GERD or LPR. All patients underwent reflux scintigraphy. Results were obtained for early scintigraphic reflux contamination of the pharynx and proximal esophagus, and delayed contamination of the pharynx and lungs after 2 h.
187 patients were studied (82 GERD, 105 LPR). The LPR patients were predominantly female (70.5% vs. 56.1%; p = 0.042) and older than the GERD group (median age 60 years vs. 55.5 years; p = 0.002). Early scintigraphic reflux was seen at the pharynx in 89.2% (GERD 87.7%, LPR 90.4%; p = 0.133), and at the proximal esophagus in 89.7% (GERD 88.9%, LPR 90.4%; p = 0.147). Delayed contamination of the pharynx was seen in 95.2% (GERD 93.9%, LPR 96.2%; p = 0.468). Delayed pulmonary aspiration was seen in 46% (GERD 36.6%, LPR 53.3%; p = 0.023).
Reflux scintigraphy demonstrated a high rate of reflux-related pulmonary aspiration. Contamination of the proximal esophagus and pharynx was observed frequently in both groups of severe disease. The likelihood of pulmonary aspiration and potential pulmonary disease needs to be entertained in severe GERD and LPR.
先前描述的检测喉咽反流（LPR）的方法存在局限性。仅症状是非诊断性的，而 pH 阻抗研究的敏感性较差。在 LPR 和胃食管反流病（GERD）中，肺微吸入未被充分认识。本研究旨在描述两种严重反流患者组中改良闪烁反流研究的结果：一组以典型反流症状为主，另一组以反流的喉咽表现为主。
一组严重、治疗抵抗的反流患者的前瞻性数据库根据典型 GERD 或 LPR 的主要症状特征进行分组。所有患者均接受反流闪烁研究。获得了早期闪烁反流对咽部和近端食管的污染以及 2 小时后咽部和肺部的延迟污染的结果。
研究了 187 例患者（82 例 GERD，105 例 LPR）。LPR 患者主要为女性（70.5% vs. 56.1%；p=0.042），且年龄大于 GERD 组（中位数年龄 60 岁 vs. 55.5 岁；p=0.002）。89.2%（GERD 为 87.7%，LPR 为 90.4%；p=0.133）的患者在咽部可见早期闪烁反流，89.7%（GERD 为 88.9%，LPR 为 90.4%；p=0.147）的患者在近端食管可见早期闪烁反流。95.2%（GERD 为 93.9%，LPR 为 96.2%；p=0.468）的患者咽部可见延迟性污染。46%（GERD 为 36.6%，LPR 为 53.3%；p=0.023）的患者可见延迟性肺吸入。
反流闪烁研究显示反流相关肺吸入的发生率较高。两组严重疾病患者均经常观察到近端食管和咽部的污染。在严重 GERD 和 LPR 中，需要考虑肺吸入和潜在的肺部疾病的可能性。
