Korsunsky Sydney R A, Camejo Leonel, Nguyen Diep, Mhaskar Rahul, Chharath Khattiya, Gaziano Joy, Richter Joel, Velanovich Vic
USF Health Morsani College of Medicine, Tampa, FL, USA.
University of South Florida, Tampa, FL, USA.
J Gastrointest Surg. 2023 Apr;27(4):658-665. doi: 10.1007/s11605-022-05574-9. Epub 2023 Jan 18.
To describe the clinical evaluation course, treatments, and outcomes of patients with a primary complaint of hoarseness due to suspected laryngopharyngeal reflux (LPR).
A retrospective chart review was conducted of patients with a primary complaint of hoarseness with acid reflux as the suspected cause at a single institution between October 2011 and March 2020 who underwent clinical evaluation, treatment, and follow-up. Data collected included diagnostic procedures and treatments received, subjective symptom outcomes, and final diagnosis as determined by the treating physician.
A total of 134 patients met the inclusion criteria. Videostroboscopy was the most performed procedure (n = 59, 44%) followed by endoscopy (n = 38, 28%) and pH monitoring (n = 28, 21%). Three patients were removed for statistical analysis of treatment differences and outcomes due to variant treatment plans. Most patients received sole medical management (n = 86, 66%), 7 patients received only voice therapy (5%), and 10 patients underwent surgical management (8%). Several patients received combined medical management and voice therapy (n = 21, 16%). Final diagnoses included gastroesophageal reflux disease (GERD) (25%), followed by multifactorial causes (17%) and dysphonia with unclear etiology (13%). Among all patients, 82 (61%) reported symptom improvement. Twenty-eight patients were diagnosed with LPR or LPR with GERD (21%), and 22 reported symptom improvement (79%). There was a statistically significant relationship between a final diagnosis with a reflux component and symptom improvement (p = .038). There was no statistically significant difference between treatment types and symptom outcomes both within the total patient population (p = .051) and patients diagnosed with a reflux condition (p = .572).
LPR remains a difficult diagnosis to establish and represents a minority of patients with voice complaints. Despite varying evaluation and treatment modalities, most patients with LPR improved during their treatment and evaluation period without a clear association with any specific type of treatment. Further studies should explore diagnostic criteria for LPR, the necessary and efficient clinical evaluation to establish a diagnosis, and possible beneficial treatments.
描述以疑似喉咽反流（LPR）导致的声音嘶哑为主诉的患者的临床评估过程、治疗方法及结果。
对2011年10月至2020年3月期间在单一机构就诊的、以声音嘶哑为主诉且怀疑酸反流为病因的患者进行回顾性病历审查，这些患者均接受了临床评估、治疗及随访。收集的数据包括诊断程序和接受的治疗、主观症状结果以及治疗医生确定的最终诊断。
共有134例患者符合纳入标准。视频频闪喉镜检查是最常进行的检查（n = 59，44%），其次是内镜检查（n = 38，28%）和pH监测（n = 28，21%）。由于治疗方案不同，3例患者被排除用于治疗差异和结果的统计分析。大多数患者仅接受药物治疗（n = 86，66%），7例患者仅接受嗓音治疗（5%），10例患者接受手术治疗（8%）。部分患者接受了药物治疗和嗓音治疗联合治疗（n = 21，16%）。最终诊断包括胃食管反流病（GERD）（25%），其次是多因素病因（17%）和病因不明的发音障碍（13%）。所有患者中，82例（61%）报告症状改善。28例患者被诊断为LPR或合并GERD的LPR（21%），其中22例报告症状改善（79%）。最终诊断有反流成分与症状改善之间存在统计学显著相关性（p = 0.038）。在总患者群体中（p = 0.051）以及诊断为反流性疾病的患者中（p = 0.572），治疗类型与症状结果之间均无统计学显著差异。
LPR仍然是一个难以确诊的疾病，且在声音问题患者中占少数。尽管评估和治疗方式各异，但大多数LPR患者在治疗和评估期间症状有所改善，且与任何特定治疗类型无明确关联。进一步的研究应探索LPR的诊断标准、用于确诊的必要且有效的临床评估方法以及可能有益处的治疗方法。
