Tseng Wen-Hsuan, Hsu Wei-Chung, Yang Tsung-Lin, Hsiao Tzu-Yu, Wu Jia-Feng, Lee Hui-Chuan, Wang Hsiu-Po, Wu Ming-Shiang, Tseng Ping-Huei
Departments of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
J Neurogastroenterol Motil. 2023 Jul 30;29(3):314-325. doi: 10.5056/jnm22099.
BACKGROUND/AIMS: Laryngeal symptoms are largely treated with empiric proton pump inhibitor (PPI) therapy if no apparent pathology shown on ear, nose, and throat evaluation and reflux-related etiologies are suspected. However, treatment response remains unsatisfactory. This study aimed to investigate the clinical and physiological characteristics of patients with PPI-refractory laryngeal symptoms.
Patients with persistent laryngeal symptoms despite PPI treatment for ≥ 8 weeks were recruited. A multidisciplinary evaluation comprising validated questionnaires for laryngeal symptoms (reflux symptom index [RSI]), gastroesophageal reflux disease symptoms, psychological comorbidity (5-item brief symptom rating scale [BSRS-5]) and sleep disturbance (Pittsburgh sleep quality index [PSQI]), esophagogastroduodenoscopy, ambulatory impedance-pH monitoring, and high-resolution impedance manometry were performed. Healthy asymptomatic individuals were also recruited for comparison of psychological morbidity and sleep disturbances.
Ninety-seven adult patients and 48 healthy volunteers were analyzed. The patients had markedly higher prevalence of psychological distress (52.6% vs 2.1%, < 0.001) and sleep disturbance (82.5% vs 37.5%, < 0.001) than the healthy volunteers. There were significant correlations between RSI and BSRS-5 scores, and between RSI and PSQI scores ( = 0.26, = 0.010, and = 0.29, = 0.004, respectively). Fifty-eight patients had concurrent gastroesophageal reflux disease symptoms. They had more prominent sleep disturbances (89.7% vs 71.8%, < 0.001) than those with laryngeal symptoms alone but similar reflux profiles and esophageal motility.
PPI-refractory laryngeal symptoms are mostly associated with psychological comorbidities and sleep disturbances. Recognition of these psychosocial comorbidities may help optimize management in these patients.
背景/目的：如果在耳鼻喉科评估中未发现明显病变且怀疑有反流相关病因，喉部症状大多采用经验性质子泵抑制剂（PPI）治疗。然而，治疗反应仍不尽人意。本研究旨在调查PPI难治性喉部症状患者的临床和生理特征。
招募了尽管接受PPI治疗≥8周仍有持续性喉部症状的患者。进行了多学科评估，包括用于评估喉部症状的有效问卷（反流症状指数[RSI]）、胃食管反流病症状、心理合并症（5项简明症状评定量表[BSRS-5]）和睡眠障碍（匹兹堡睡眠质量指数[PSQI]）、食管胃十二指肠镜检查、动态阻抗-pH监测以及高分辨率阻抗测压。还招募了健康无症状个体以比较心理发病率和睡眠障碍情况。
分析了97例成年患者和48名健康志愿者。与健康志愿者相比，患者的心理困扰患病率（52.6%对2.1%，<0.001）和睡眠障碍患病率（82.5%对37.5%，<0.001）明显更高。RSI与BSRS-5评分之间以及RSI与PSQI评分之间存在显著相关性（分别为r = 0.26，P = 0.010和r = 0.29，P = 0.004）。58例患者同时有胃食管反流病症状。与仅患有喉部症状的患者相比，他们有更明显的睡眠障碍（89.7%对71.8%，<0.001），但反流情况和食管动力相似。
PPI难治性喉部症状大多与心理合并症和睡眠障碍有关。认识到这些社会心理合并症可能有助于优化对这些患者的管理。
