Kim Young Dong, Shin Cheol Min, Jeong Woo-Jin, Kim Yang Jin, Yoon Hyuk, Park Young Soo, Kim Nayoung, Lee Dong Ho
Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
Departments of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
J Neurogastroenterol Motil. 2022 Oct 30;28(4):599-607. doi: 10.5056/jnm21235.
BACKGROUND/AIMS: To evaluate the usefulness of gastroesophageal reflux disease questionnaire (GerdQ) and reflux symptom index (RSI) for diagnosis of gastroesophageal reflux disease (GERD) in patients with suspected laryngopharyngeal reflux (LPR) symptoms (cough, hoarseness, globus, and throat pain).
A total of 98 patients with LPR symptoms were incorporated from either gastroenterology or otorhinolaryngology clinic. Patient's laryngoscopic findings were graded by reflux finding score (RFS), and RFS ≥ 7 was considered as positive LPR. Erosive esophagitis on endoscopy or abnormal results on ambulatory impedance-pH monitoring were used as diagnostic criteria for GERD. Esophageal motor function was evaluated using high-resolution esophageal manometry.
Ninety-three (94.9%) of the 98 subjects were diagnosed as LPR by RFS, but only 15 (15.3%) had GERD. For GerdQ, the cutoff value of 9 showed the highest area under curve (AUC) to diagnose GERD by receiver operating curve analysis (AUC = 0.565); the sensitivity, specificity, positive predictive value, and negative predictive value were unsatisfactory (50.0%, 70.7%, 22.6%, and 89.2%, respectively.) RSI also showed poor performance in diagnosing GERD; the cutoff value of 25 showed the highest yield (AUC = 0.581); the sensitivity, specificity, positive predictive value, and negative predictive value were 42.9%, 79.3%, 26.1%, and 89.0%, respectively. Ineffective esophageal motility was frequently observed (69 of 98, 70.4%), but there was no difference in esophageal motility parameters between GERD and non-GERD patients.
In patients with LPR symptoms, significant discrepancies are observed between laryngoscopic diagnosis and GERD. In this population, neither GerdQ nor RSI is useful in diagnosing GERD.
背景/目的：评估胃食管反流病问卷（GerdQ）和反流症状指数（RSI）在诊断疑似喉咽反流（LPR）症状（咳嗽、声音嘶哑、咽部异物感和咽痛）患者的胃食管反流病（GERD）中的作用。
从胃肠病科或耳鼻咽喉科门诊纳入98例有LPR症状的患者。通过反流发现评分（RFS）对患者的喉镜检查结果进行分级，RFS≥7被认为是LPR阳性。内镜下糜烂性食管炎或动态阻抗-pH监测结果异常用作GERD的诊断标准。使用高分辨率食管测压评估食管运动功能。
98名受试者中有93名（94.9%）通过RFS诊断为LPR，但只有15名（15.3%）患有GERD。对于GerdQ，通过受试者工作曲线分析，诊断GERD的截断值为9时曲线下面积（AUC）最高（AUC = 0.565）；敏感性、特异性、阳性预测值和阴性预测值均不理想（分别为50.0%、70.7%、22.6%和89.2%）。RSI在诊断GERD方面表现也不佳；截断值为25时诊断效率最高（AUC = 0.581）；敏感性、特异性、阳性预测值和阴性预测值分别为42.9%、79.3%、26.1%和89.0%。经常观察到食管运动功能无效（98例中有69例，70.4%），但GERD患者和非GERD患者之间的食管运动参数没有差异。
在有LPR症状的患者中，喉镜诊断和GERD之间存在显著差异。在这一人群中，GerdQ和RSI在诊断GERD方面均无作用。
