Wo J M, Grist W J, Gussack G, Delgaudio J M, Waring J P
Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Am J Gastroenterol. 1997 Dec;92(12):2160-5.
The optimal management of patients suspected with gastroesophageal reflux-related posterior laryngitis is unclear. History, physical examination, and ambulatory pH monitoring all have significant limitations in identifying patients who will respond to antireflux therapy.
To evaluate the merit of empiric omeprazole therapy in patients with posterior laryngitis.
Twenty-two patients (11 men/11 women, median age 58 yr) with newly diagnosed posterior laryngitis were enrolled. All had persistent laryngeal symptoms for at least 1 month. An empiric trial of omeprazole at 40 mg q.h.s. was given for 8 wk. Four laryngeal symptoms (hoarseness, throat burning/pain, throat clearing, and cough) and four esophageal symptoms (heartburn, regurgitation, dysphagia, and odynophagia) were scored from 0 to 3. Symptom scores were obtained before, 4 wk after, and 8 wk after the start of omeprazole. Patients were classified as responders if they were symptom free or satisfied with results. Omeprazole was stopped in the responders to look for relapse. Ambulatory pH monitoring was performed in patients who did not respond.
One patient discontinued omeprazole and withdrew from the study. In the remaining 21 patients, the total laryngeal and esophageal symptom scores significantly improved after empiric omeprazole. Fourteen patients (67%) were classified as responders. Eight patients (38%) had a relapse when omeprazole was stopped. Six patients (29%), interestingly, did not relapse and did not require long-term antireflux therapy. Seven patients (33%) were classified as nonresponders. Ambulatory pH monitoring was abnormal in four of the five patients who agreed to have this test. Increasing the dose of omeprazole to 40 mg b.i.d. provided no additional benefit in the nonresponders.
Empiric omeprazole therapy is a reasonable, initial approach to patients with suspected gastroesophageal reflux-related posterior laryngitis. A significant number of patients do well with a short course of antireflux therapy. Additionally, a third of the patients may not completely respond to intensive medical therapy despite the fact that reflux is documented.
疑似胃食管反流相关的喉后部炎患者的最佳管理尚不明确。病史、体格检查和动态pH监测在识别对抗反流治疗有反应的患者方面均有显著局限性。
评估经验性使用奥美拉唑治疗喉后部炎患者的价值。
纳入22例新诊断为喉后部炎的患者（11例男性/11例女性，中位年龄58岁）。所有患者持续存在喉部症状至少1个月。给予经验性试验，每晚口服40毫克奥美拉唑，持续8周。对四种喉部症状（声音嘶哑、咽喉灼痛/疼痛、清嗓、咳嗽）和四种食管症状（烧心、反流、吞咽困难、吞咽痛）进行0至3分的评分。在开始使用奥美拉唑之前、之后4周和8周获得症状评分。如果患者无症状或对结果满意，则分类为有反应者。对有反应者停用奥美拉唑以观察复发情况。对无反应的患者进行动态pH监测。
1例患者停用奥美拉唑并退出研究。在其余21例患者中，经验性使用奥美拉唑后，喉部和食管症状总评分显著改善。14例患者（67%）被分类为有反应者。8例患者（38%）在停用奥美拉唑后复发。有趣的是，6例患者（29%）未复发且不需要长期抗反流治疗。7例患者（33%）被分类为无反应者。同意进行此项检查的5例患者中有4例动态pH监测异常。将奥美拉唑剂量增加至每日两次40毫克对无反应者没有额外益处。
经验性使用奥美拉唑治疗是疑似胃食管反流相关喉后部炎患者的一种合理的初始方法。相当一部分患者短期抗反流治疗效果良好。此外，尽管记录到反流，但仍有三分之一的患者可能对强化药物治疗不完全反应。
