《喉咽症状与喉咽反流病圣地亚哥共识》
The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease.
作者信息
Yadlapati Rena, Weissbrod Philip, Walsh Erin, Carroll Thomas L, Chan Walter W, Gartner-Schmidt Jackie, Guadagnoli Livia, Jette Marie, Myers Jennifer C, O'Rourke Ashli, Sweis Rami, Wu Justin, Barkmeier-Kraemer Julie M, Cates Daniel, Chen Chien-Lin, Coss-Adame Enrique, Dion Gregory, Francis David, Kaneko Mami, Lechien Jerome R, Misono Stephanie, Rameau Anais, Roman Sabine, Vertigan Anne, Xiao Yinglian, Zerbib Frank, Greytak Madeline, Pandolfino John E, Gyawali C Prakash
机构信息
Center for Esophageal Diseases, University of California San Diego, La Jolla, California, USA.
Department of Otolaryngology, University of California San Diego, La Jolla, California, USA.
出版信息
Am J Gastroenterol. 2025 Apr 8. doi: 10.14309/ajg.0000000000003482.
INTRODUCTION
The term laryngopharyngeal reflux (LPR) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. The aim of this initiative was to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.
METHODS
A 28-member international interdisciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations.
RESULTS
The term laryngopharyngeal symptoms (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. Laryngopharyngeal reflux disease (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for nonreflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive antireflux management. The two recommended ambulatory reflux monitoring modalities, 24-hour pH-impedance and 96-hour wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators.
DISCUSSION
The San Diego Consensus represents the formal modern-day interdisciplinary care paradigm to evaluate and manage LPS and LPRD.
引言
尽管缺乏客观的反流证据，但喉咽反流（LPR）一词仍经常用于描述气消化道症状。本倡议的目的是制定一种由耳鼻喉科和胃肠病学科支持的LPR现代护理模式。
方法
一个由28名成员组成的国际跨学科工作组在以下领域制定了实用声明：定义/术语、初始诊断评估、反流监测、治疗试验、行为因素与治疗以及风险分层。文献综述指导声明的制定，并在虚拟/面对面会议上进行展示。每项声明均按照兰德适宜性方法进行两轮或更多轮投票；达成≥80%一致适宜性的声明被纳入推荐意见。
结果
喉咽症状（LPS）一词适用于可能由反流引起的气消化道症状，包括咳嗽、声音改变、清嗓、咽喉部痰液过多和咽痛。喉咽反流病（LPRD）指有LPS且有反流客观证据的患者。重要的是，LPS的存在并不等同于LPRD。喉镜检查在评估非反流性喉咽病变方面有价值，但仅喉镜检查结果不能诊断LPRD。LPS患者应分为有或无并发食管反流症状两类。当存在食管反流症状时，生活方式改变和抑酸±藻酸盐的经验性试验是合适的，但当症状持续、LPS孤立存在或管理需要升级至包括侵入性抗反流治疗时，LPRD诊断需要进行上消化道内镜检查和动态反流监测。推荐的两种动态反流监测方式，即24小时pH-阻抗监测和96小时无线pH监测，在评估LPS方面并非相互排斥，各有不同作用。喉高反应性和过度警觉通常在LPS和LPRD表现中都起作用，并且对喉部重新校准治疗和神经调节剂有反应。
讨论
圣地亚哥共识代表了评估和管理LPS及LPRD的正式现代跨学科护理模式。
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