合并咽喉症状胃食管反流病患者的临床特征分析

Clinical Characteristics of Gastroesophageal Reflux Disease Patients With Laryngopharyngeal Symptoms

背景:胃食管反流病(GERD)的咽喉症状包括声音嘶哑、咽喉异物感、慢性咳嗽、吞咽困难等,其发生机制和反流特征可能与单纯食管内症状的GERD患者存在差异。目的:探讨合并咽喉症状GERD患者的临床特征。方法:59例于2019年1月—2021年12月在南京医科大学第一附属医院门诊就诊,胃食管反流病问卷(GerdQ)评分≥8分并经24 h食管阻抗-pH监测明确存在异常反流者纳入研究,单纯食管内症状组29例,合并咽喉症状组30例。收集患者一般资料以及胃镜检查、24 h食管阻抗-pH监测、食管测压、质子泵抑制剂(PPI)疗效等信息,进行两组间比较。结果:单纯食管内症状组GERD患者的食管炎比例显著高于合并咽喉症状组(P<0.05),下食管括约肌(LES)上方7~3 cm处平均夜间基线阻抗值显著降低(P均<0.05)。与单纯食管内症状组相比,合并咽喉症状组弱酸反流次数显著增多,平均酸清除时间更长,LES松弛率更高,LES以上11~7 cm蠕动速度更慢,PPI疗效更差(P均<0.05)。烧心症状严重程度与总酸暴露时间百分比、DeMeester评分呈显著正相关(P均<0.05),咽喉异物感严重程度与弱酸反流次数、平均酸清除时间呈显著正相关(P均<0.05)。结论:合并咽喉症状的GERD患者食管黏膜损伤较轻,咽喉症状更可能与食管体部运动障碍所致的酸清除能力下降有关,治疗上可能需要进一步加强抑酸治疗。

The laryngopharyngeal symptoms of gastroesophageal reflux disease(GERD)include hoarseness,foreign body sensation,chronic cough,dysphagia,etc.Its pathogenic mechanisms and reflux characteristics may be different from those of GERD patients simply with typical esophageal symptoms.Aims:To explore the clinical characteristics of GERD patients complicated with laryngopharyngeal symptoms.Methods:Fifty‑nine patients having a gastroesophageal reflux disease questionnaire(GerdQ)score≥8 and abnormal reflux identified by 24 h esophageal impedance‑pH monitoring were selected from the outpatients at the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2021.Twenty‑nine cases simply with typical esophageal symptoms were allocated into typical symptom group,and 30 cases complicated with laryngopharyngeal symptoms were allocated into laryngopharyngeal reflux(LPR)group.The general information,results of gastroscopy,24 h esophageal impedance‑pH monitoring and esophageal manometry,as well as the efficacy of proton pump inhibitor(PPI)were collected and compared between the two groups.Results:The proportion of esophagitis in GERD patients in typical symptom group was significantly increased than that in LPR group(P<0.05),while the values of mean nocturnal baseline impedance at 7‑3 cm above lower esophageal sphincter(LES)were significantly lower(all P<0.05).Compared with typical symptom group,increased frequency of weak acid reflux,prolonged mean acid clearance time,higher LES relaxation rate,lower velocity of peristaltic waves at 11‑7 cm above LES,and poor efficacy of PPI treatment were observed in LPR group(all P<0.05).The severity of heartburn was positively correlated with the percentage of total acid exposure time and DeMeester score(all P<0.05);while the severity of foreign body sensation was positively correlated with the frequency of weak acid reflux and mean time of acid clearance(all P<0.05).Conclusions:The esophageal mucosal injury was mild in GERD patients complicated with laryngopharyngeal symptoms.Laryngopharyngeal symptoms are more likely to be associated with the decreased acid clearance capacity due to esophageal body dysmotility.Strengthened acid suppression therapy should be recommended.