Drexel University College of Medicine, Philadelphia, Pennsylvania.
Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
J Voice. 2024 May;38(3):746-753. doi: 10.1016/j.jvoice.2021.11.008. Epub 2022 Jan 10.
Laryngopharyngeal reflux (LPR) may cause inflammation of the laryngeal and pharyngeal mucosa. Gastroesophageal reflux disease (GERD) involves retrograde flow of gastric content into the esophagus below the upper esophageal sphincter (UES). The goal of this study was to investigate the esophageal anatomical and manometric variations of the esophagus in patients with LPR and/or GERD.
Adult voice center patients who underwent diagnostic workup for reflux complaints with 24-hour multichannel intraluminal pH-impedance testing and esophageal manometry were included in this retrospective study. Subjects were classified as having LPR (>10 proximal reflux events), LPR + GERD (>10 proximal reflux events plus >73 distal reflux events) or were assigned to a control group (≤10 proximal events and ≤73 distal reflux events) based on pH study results. Anatomic and manometric parameters were evaluated between groups.
There were 169 cases (65 male, 104 female) included in this study. The average age was 50.50 ± 17.29. Subjects in the LPR group had significantly higher UES relaxation pressures and greater UES length compared with the control group. Lower esophageal sphincter relaxation pressure was significantly higher in the control group compared with the LPR group or the GERD + LPR group. Subjects in the GERD + LPR group had a significantly shorter intra-abdominal portion of the lower esophageal sphincter compared with the LPR only group and the control group. Intrabolus pressure was significantly lower in both the LPR group and the LPR + GERD group compared with the control group. Distal wave amplitude was significantly lower in the LPR + GERD group compared to both the LPR group and the control group. The percentage of swallows with incomplete clearance was significantly greater in the LPR + GERD group than both the control group and the LPR group. The LPR group had significantly fewer swallows with incomplete clearance than the control group.
Anatomic and manometric abnormalities are present in subjects with LPR with or without GERD and may contribute to the pathogenesis of reflux disease. Further research is needed to confirm or refute these findings.
喉咽反流（LPR）可能导致喉和咽黏膜炎症。胃食管反流病（GERD）涉及胃内容物通过食管上括约肌（UES）反流至食管下段。本研究旨在探讨 LPR 和/或 GERD 患者食管解剖和测压学变化。
本回顾性研究纳入了因反流症状接受 24 小时多通道腔内 pH-阻抗检测和食管测压检查的成人嗓音中心患者。根据 pH 研究结果，将受试者分为 LPR（>10 次近端反流事件）、LPR+GERD（>10 次近端反流事件+>73 次远端反流事件）或对照组（≤10 次近端事件和≤73 次远端反流事件）。评估各组之间的解剖和测压参数。
本研究共纳入 169 例患者（65 例男性，104 例女性），平均年龄为 50.50±17.29 岁。LPR 组 UES 松弛压力显著高于对照组，UES 长度显著大于对照组。对照组下食管括约肌松弛压力显著高于 LPR 组或 GERD+LPR 组。GERD+LPR 组的食管下括约肌腹内段明显短于 LPR 组和对照组。LPR 组和 LPR+GERD 组的腔内压力均显著低于对照组。LPR+GERD 组的远端波幅明显低于 LPR 组和对照组。LPR+GERD 组不完全清除的吞咽百分比明显高于对照组和 LPR 组。LPR 组不完全清除的吞咽次数明显少于对照组。
有或无 GERD 的 LPR 患者存在解剖和测压学异常，可能导致反流病的发病机制。需要进一步的研究来证实或反驳这些发现。
