Lechien Jérôme R
Department of Anatomy, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
J Voice. 2024 Nov 27. doi: 10.1016/j.jvoice.2024.11.014.
The laryngopharyngeal reflux disease (LPRD) treatment remains controversial due to the poor effectiveness of proton pump inhibitors (PPIs). In this paper, the author reviewed the current primary treatments used in clinical studies for managing LPRD and discussed the pharmacological, biological, and physiological properties of medication for providing clinical relevance for otolaryngological practice. A comprehensive review of the PubMed, Cochrane Library, and Scopus literature was conducted to document and analyze the medical treatments of LPRD in the largest case series published in the past 20 years. Fifty-five studies met the inclusion criteria, revealing that 67 different therapeutic regimens were used in the LPRD studies in the past 20 years with nine different therapeutic durations. PPIs have been used as a single therapy in 70.1% of cases. PPIs were combined with another drug in 23.9% of cases. Alginates and antacids were used as single therapy or in association with other drugs in 10.5% and 3.0% of cases, respectively. There was an important variability of molecules, doses, and regimens. There is an important gap between current therapeutic practice and the recent advancements in the pathophysiology of LPRD. The pharmacological and physiological findings of this review can reasonably support the notion that alternative gastroesophageal reflux disease therapies (alginate, antacids) could take a significant place in the treatment of primary or recalcitrant LPRD. Future studies are needed to confirm the stability of the LPRD profile at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH and the role of digestive enzymes in the development of upper aerodigestive tract mucosa inflammation and symptoms.
由于质子泵抑制剂（PPI）疗效不佳，喉咽反流病（LPRD）的治疗仍存在争议。在本文中，作者回顾了目前临床研究中用于管理LPRD的主要治疗方法，并讨论了药物的药理学、生物学和生理学特性，以为耳鼻喉科实践提供临床相关性。对PubMed、Cochrane图书馆和Scopus文献进行了全面综述，以记录和分析过去20年发表的最大病例系列中LPRD的医学治疗方法。55项研究符合纳入标准，显示过去20年LPRD研究中使用了67种不同的治疗方案，治疗持续时间有9种不同。70.1%的病例将PPI作为单一疗法使用。23.9%的病例将PPI与另一种药物联合使用。藻酸盐和抗酸剂分别在10.5%和3.0%的病例中作为单一疗法或与其他药物联合使用。分子、剂量和治疗方案存在重要差异。目前的治疗实践与LPRD病理生理学的最新进展之间存在重要差距。本综述的药理学和生理学研究结果可以合理支持以下观点，即替代胃食管反流病疗法（藻酸盐、抗酸剂）在原发性或顽固性LPRD的治疗中可能占据重要地位。未来需要进行研究，以确认下咽-食管多通道腔内阻抗-pH下LPRD特征的稳定性，以及消化酶在上呼吸道消化道黏膜炎症和症状发展中的作用。
