Pompeu Clara Mota Randal, Sales Thiago Meneses Araújo Leite, Nicolau Lucas Antonio Duarte, de Souza Matos Anna Caroline Rodrigues, Borsaro Aline Almeida Figueiredo, Coutinho Tanila Aguiar Andrade, Nogueira Larissa Freire Alves, Távora Fábio Rocha Fernandes, Souza Miguel Ângelo Nobre E, Siffrim Daniel, de Souza Marcellus Henrique Loiola Ponte
Federal University of Ceará, Fortaleza, Brazil.
Federal University of Delta do Parnaíba, Parnaíba, Brazil.
Eur Arch Otorhinolaryngol. 2025 Apr;282(4):2159-2164. doi: 10.1007/s00405-025-09214-1. Epub 2025 Feb 1.
To evaluate whether impairment of integrity of laryngeal and hypopharyngeal mucosa in laryngopharyngeal reflux (LPR) could be related to response to proton pump inhibitors (PPIs).
Chronic hoarseness with Reflux Finding Score (RFS) > = 7 was evaluated using the Reflux Disease Questionnaire (RDQ) and Reflux Symptoms Index (RSI). Upper endoscopy was performed and samples of the laryngeal posterior commissure were collected to evaluate ex vivo laryngeal mucosal integrity by transepithelial resistance (TER) using Ussing chamber. In vivo, hypopharyngeal integrity was measured using intraluminal impedance. Clinical responders scored < 13 and had a drop of at least 50% in the initial RSI after 8 weeks of pantoprazole.
Eighteen patients completed the protocol, Esophagitis was detected in 28% of the patients, and one patient presented acid exposure above 6%. After treatment, 66.67% responded to PPI. Laryngeal basal TER and TER drops after the weakly acidid challenge showed no difference between PPI responders and non-responders. Hypopharyngeal basal impedance was similar between the groups. After acid exposure test, there was a lower impedance in non-responders.
In laryngopharyngeal reflux, hypopharyngeal mucosal integrity was lower in PPI non-responders. These preliminary results suggest that the weaker laryngopharyngeal mucosa in refractory LPR may require new therapies aimed at improving barrier function.
N/A.
评估喉咽反流（LPR）中喉和下咽黏膜完整性受损是否与质子泵抑制剂（PPI）的反应有关。
使用反流疾病问卷（RDQ）和反流症状指数（RSI）评估反流发现评分（RFS）≥7的慢性声音嘶哑。进行上消化道内镜检查，并采集喉后联合的样本，使用Ussing chamber通过跨上皮电阻（TER）评估离体喉黏膜完整性。在体内，使用腔内阻抗测量下咽完整性。临床反应者评分＜13，且在泮托拉唑治疗8周后初始RSI下降至少50%。
18名患者完成了方案，28%的患者检测到食管炎，1名患者的酸暴露高于6%。治疗后，66.67%的患者对PPI有反应。PPI反应者和无反应者之间，喉基底TER和弱酸刺激后的TER下降无差异。两组之间下咽基底阻抗相似。酸暴露试验后，无反应者的阻抗较低。
在喉咽反流中，PPI无反应者的下咽黏膜完整性较低。这些初步结果表明，难治性LPR中较弱的喉咽黏膜可能需要旨在改善屏障功能的新疗法。
无。
