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“持续性咽喉症状”与“喉咽反流”:一项精细化临床状况的横断面研究。

'Persistent throat symptoms' versus 'laryngopharyngeal reflux': a cross-sectional study refining the clinical condition.

机构信息

Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK james.o'

Department of Otolaryngology - Head and Neck Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.

出版信息

BMJ Open Gastroenterol. 2022 Mar;9(1). doi: 10.1136/bmjgast-2021-000850.


DOI:10.1136/bmjgast-2021-000850
PMID:35338049
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8961157/
Abstract

OBJECTIVE: Many patients are assessed for chronic symptoms including: dysphonia, 'globus', throat clearing, postnasal secretions and cough; commonly grouped together and attributed to 'laryngopharyngeal reflux'. This study aimed to explore a clinical trial's baseline dataset for patterns of presenting symptoms, which might provide a more rational basis for treatment. DESIGN: Baseline data were analysed for participants entering the Trial Of Proton-Pump Inhibitors in Throat Symptoms: age, body mass index, Reflux Symptom Index, Comprehensive Reflux Symptom Score, Laryngopharyngeal Reflux-Health-related Quality of Life questionnaire and Reflux Finding Score (RFS-endoscopic examination). The relationships between the questionnaires and demographic factors were assessed. Exploratory factor analysis (EFA) was conducted on individual symptom items in the combined questionnaires. The EFA factors were applied to a Cluster Analysis of participants, to explore the presence of identifiable patient. RESULTS: Throat clearing and globus were the highest ranked scores in the 344 participants. Increasing age was inversely associated with symptom severity (p<0.01). There was no relationship between the RFS and any of the three questionnaires. EFA resulted in a seven-factor model with clinically meaningful labels: voice, cough, gastrointestinal symptoms, airway symptoms and dysphagia, throat clearing, lump in throat, and life events. Cluster analysis failed to demonstrate any clinically meaningful clusters of patients. CONCLUSION: This study offers a framework for future research and demonstrates that individual symptoms cannot be used to group patients. The analysis supports the use of a broad 'umbrella' term such as persistent throat symptoms. TRIAL REGISTRATION NUMBER: ISRCTN38578686.

摘要

目的:许多患者会出现慢性症状,包括:声音嘶哑、“异物感”、清嗓、鼻后滴注和咳嗽,这些症状通常被归为“咽喉反流”。本研究旨在探索一项临床试验的基线数据集,以了解症状的表现模式,这可能为治疗提供更合理的依据。

设计:分析进入咽喉症状质子泵抑制剂试验的参与者的基线数据,包括年龄、体重指数、反流症状指数、综合反流症状评分、咽喉反流相关生活质量问卷和反流发现评分(内镜检查)。评估问卷与人口统计学因素之间的关系。对联合问卷中的个体症状项目进行探索性因子分析(EFA)。EFA 因素应用于参与者的聚类分析,以探索是否存在可识别的患者群体。

结果:在 344 名参与者中,清嗓和异物感的评分最高。年龄越大,症状严重程度呈负相关(p<0.01)。RFS 与三个问卷均无相关性。EFA 得出了一个具有临床意义标签的七因子模型:声音、咳嗽、胃肠道症状、气道症状和吞咽困难、清嗓、喉咙有异物感和生活事件。聚类分析未能证明患者存在任何有临床意义的聚类。

结论:本研究为未来的研究提供了框架,并表明个体症状不能用于对患者进行分组。该分析支持使用广泛的“伞状”术语,如持续性咽喉症状。

试验注册号:ISRCTN38578686。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1569/8961157/1ead21819614/bmjgast-2021-000850f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1569/8961157/1ead21819614/bmjgast-2021-000850f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1569/8961157/1ead21819614/bmjgast-2021-000850f01.jpg

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'Persistent throat symptoms' versus 'laryngopharyngeal reflux': a cross-sectional study refining the clinical condition.

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[2]
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[3]
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[4]
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[6]
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[8]
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引用本文的文献

[1]
Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms.

BMJ Open Gastroenterol. 2023-11-23

本文引用的文献

[1]
Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT.

Health Technol Assess. 2021-1

[2]
Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial.

BMJ. 2021-1-7

[3]
Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta-analysis.

Laryngoscope. 2019-5

[4]
Reflux and Voice Disorders: Have We Established Causality?

Curr Otorhinolaryngol Rep. 2016-9

[5]
Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

Eur Arch Otorhinolaryngol. 2017-2

[6]
TOPPITS: Trial Of Proton Pump Inhibitors in Throat Symptoms. Study protocol for a randomised controlled trial.

Trials. 2016-4-1

[7]
What's in a Label? Is Diagnosis the Start or the End of Clinical Reasoning?

J Gen Intern Med. 2016-4

[8]
Medically Unexplained Symptoms: an acceptable term?

Br J Pain. 2015-5

[9]
Body mass index association with functional gastrointestinal disorders: differences between genders. Results from a study in a tertiary center.

J Gastroenterol. 2016-4

[10]
Lifestyle Intervention in Gastroesophageal Reflux Disease.

Clin Gastroenterol Hepatol. 2016-2

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