Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France.
Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
Otolaryngol Head Neck Surg. 2022 Nov;167(5):852-859. doi: 10.1177/01945998221075009. Epub 2022 Feb 1.
To investigate the features of patients with laryngopharyngeal reflux (LPR) who did not respond to medical treatment.
Prospective uncontrolled study.
Multicenter study.
Patients with LPR at 24-hour HEMII-pH monitoring (hypopharyngeal-esophageal multichannel intraluminal impedance-pH) were prospectively recruited from 3 European university centers. Patients were treated with 3- to 6-month medication (proton pump inhibitor and alginate) and categorized as mild to moderate responders, high responders, or nonresponders according to Reflux Symptom Score (RSS) changes at 6 months posttreatment. The predictive value of the following outcomes was studied: epidemiologic data, HEMII-pH, gastrointestinal endoscopy findings, baseline RSS and Reflux Sign Assessment, and early therapeutic response (6-week RSS).
A total of 148 patients completed the evaluations, accounting for 40 mild to moderate responders (20%-60% RSS changes), 76 high responders (>60% RSS changes), and 32 nonresponders. Nonresponders presented more often with hiatal hernia and lower esophageal sphincter insufficiency when compared with mild to moderate and high responders ( = .032). Baseline otolaryngologic, digestive, and respiratory RSS and the number of pharyngeal reflux events at the HEMII-pH were predictive of the 6-month therapeutic response ( < .05). The early therapeutic response (6 weeks posttreatment) was predictive of the 6-month treatment response.
Hiatal hernia and baseline and 6-week RSS were the most predictive indicators of therapeutic effectiveness in patients with LPR.
研究对药物治疗无反应的喉咽反流（LPR）患者的特征。
前瞻性非对照研究。
多中心研究。
通过 24 小时 HEMII-pH 监测（咽食管多通道腔内阻抗-pH），前瞻性招募来自 3 个欧洲大学中心的 LPR 患者。患者接受 3 至 6 个月的药物治疗（质子泵抑制剂和藻酸盐），并根据治疗后 6 个月反流症状评分（RSS）的变化分为轻度至中度反应者、高度反应者或无反应者。研究了以下结果的预测价值：流行病学数据、HEMII-pH、胃肠道内窥镜检查结果、基线 RSS 和反流征象评估以及早期治疗反应（6 周 RSS）。
共有 148 例患者完成了评估，其中 40 例为轻度至中度反应者（RSS 变化 20%-60%），76 例为高度反应者（RSS 变化>60%），32 例为无反应者。与轻度至中度和高度反应者相比，无反应者更常出现食管裂孔疝和下食管括约肌功能不全（=0.032）。基线耳鼻喉科、消化科和呼吸 RSS 以及 HEMII-pH 中的咽部反流事件次数与 6 个月的治疗反应相关（<0.05）。早期治疗反应（治疗后 6 周）预测 6 个月的治疗反应。
食管裂孔疝和基线及 6 周 RSS 是预测 LPR 患者治疗效果的最具预测性指标。
