Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
Am J Gastroenterol. 2023 May 1;118(5):786-793. doi: 10.14309/ajg.0000000000002151. Epub 2022 Dec 14.
Laryngopharyngeal reflux (LPR) is a clinical conundrum without a diagnostic gold standard. The Esophageal Hypervigilance and Anxiety Scale (EHAS) is a questionnaire designed for cognitive-affective evaluation of visceral sensitivity. We hypothesized that esophageal hypervigilance and symptom-specific anxiety have an etiopathological role in generation of LPR symptoms, especially when gastroesophageal reflux disease (GERD) cannot explain these symptoms.
Consecutive patients with LPR and/or GERD symptoms lasting >3 months were prospectively enrolled and characterized using the Reflux Symptom Index, GERD questionnaire, and EHAS. Eligible patients with negative endoscopy underwent 24-hour impedance-pH monitoring off acid suppression for phenotyping GERD and assessment of reflux burden, using conventional metrics (acid exposure time and number of reflux episodes) and novel metrics (mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index).
Of 269 enrolled patients (mean age 47.1 years, 21-65 years, 60.6% female), 90 patients were with concomitant GERD and LPR symptoms, 32 patients were with dominant LPR symptoms, 102 patients were with dominant GERD symptoms, and 45 were controls. Patients with concomitant GERD and LPR symptoms had higher EHAS than those with dominant GERD symptoms and controls ( P ≤ 0.001); patients with dominant LPR symptoms had higher EHAS than controls ( P = 0.007). On Pearson correlation, EHAS positively correlated with the Reflux Symptom Index.
Esophageal hypervigilance and symptom-specific anxiety may be more important than reflux burden in LPR symptom perception.
喉咽反流（LPR）是一种缺乏诊断金标准的临床难题。食管高敏和焦虑量表（EHAS）是一种用于评估内脏敏感性的认知-情感问卷。我们假设食管高敏和症状特异性焦虑在 LPR 症状的产生中具有病因学作用，尤其是当胃食管反流病（GERD）无法解释这些症状时。
连续纳入有 LPR 和/或 GERD 症状持续>3 个月的患者，采用反流症状指数、GERD 问卷和 EHAS 进行前瞻性特征描述。经内镜检查排除阳性的患者在停用抑酸剂 24 小时后进行阻抗-pH 监测，以表型 GERD 和评估反流负担，使用传统指标（酸暴露时间和反流次数）和新型指标（夜间平均基线阻抗和反流后吞咽诱发蠕动波指数）。
在 269 名入组患者中（平均年龄 47.1 岁，21-65 岁，60.6%为女性），90 名患者同时有 GERD 和 LPR 症状，32 名患者主要有 LPR 症状，102 名患者主要有 GERD 症状，45 名患者为对照组。同时有 GERD 和 LPR 症状的患者 EHAS 高于主要有 GERD 症状的患者和对照组（P≤0.001）；主要有 LPR 症状的患者 EHAS 高于对照组（P=0.007）。在 Pearson 相关性分析中，EHAS 与反流症状指数呈正相关。
食管高敏和症状特异性焦虑可能比反流负担在 LPR 症状感知中更重要。
