Laryngopharyngeal reflux disease:Updated examination of mechanisms,pathophysiology,treatment,and association with gastroesophageal reflux disease

Laryngopharyngeal reflux disease(LPRD)is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus.LPRD commonly presents with symptoms such as hoarseness,cough,sore throat,a feeling of throat obstruction,excessive throat mucus.This complex condition is thought to involve both reflux and reflex mechanisms,but a clear understanding of its molecular mechanisms is still lacking.Currently,there is no standardized diagnosis or treatment protocol.Therapeutic strategies for LPRD mainly include lifestyle modifications,proton pump inhibitors and endoscopic surgery.This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms,pathophysiology and treatment of LPRD.We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.

Laryngopharyngeal reflux disease management for recurrent laryngeal contact granuloma:A case report

BACKGROUND Laryngeal contact granuloma(LCG)is difficult to treat and frequently associated with high persistence and recurrence,despite the availability of both surgical and pharmacological treatment options.An appropriate strategy is therefore needed to help patients with multiple recurrences of LCG to potentially avoid unnecessary surgery.CASE SUMMARY We describe the case of a 34-year-old male patient with recurrent LCG in which a good response was achieved through successful management of laryngopharyngeal reflux disease using a combination pharmacotherapeutic regimen consisting of anti-reflux therapy,pepsin secretion inhibition,bile acid neutralization,and lifestyle modifications.This patient underwent surgery to excise the granuloma,then relapsed,underwent a second surgery,which was followed by a second recurrence.The granuloma then disappeared after 9 mo of combined treatment with ilaprazole enteric-coated capsules(10 mg qd),mosapride tablets(5 mg tid)and compound digestive enzyme capsules(2 tablets).The drug regimen was discontinued after one year,and no recurrence of the lesion has been reported during the one-year follow-up period.CONCLUSION We report a combination of pharmacotherapeutics and lifestyle modifications for the management of laryngopharyngeal reflux disease to address recurring LCG.

Treatment of laryngopharyngeal reflux disease: A systematic review

BACKGROUNG For a long time,laryngopharyngeal reflux disease(LPRD)has been treated by proton pump inhibitors(PPIs)with an uncertain success rate.AIM To shed light the current therapeutic strategies used for LPRD in order to analysis the rationale in the LPRD treatment.METHODS Three authors conducted a PubMed search to identify papers published between January 1990 and February 2019 about the treatment of LPRD.Clinical prospective or retrospective studies had to explore the impact of medical treatment(s)on the clinical presentation of suspected or confirmed LPRD.The criteria for considering studies for the review were based on the population,intervention,comparison,and outcome framework.RESULTS The search identified 1355 relevant papers,of which 76 studies met the inclusion criteria,accounting for 6457 patients.A total of 64 studies consisted of empirical therapeutic trials and 12 were studies where authors formally identified LPRD with pH-monitoring or multichannel intraluminal impedance-pH monitoring(MII-pH).The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk.The most used PPIs were omeprazole,esomeprazole,rabeprazole,lansoprazole and pantoprazole with a success rate ranging from 18%to 87%.Other composite treatments have been prescribed including PPIs,alginate,prokinetics,and H2 Receptor antagonists.CONCLUSION Regarding the development of MII-pH and the identification of LPRD subtypes(acid,nonacid,mixed),future studies are needed to improve the LPRD treatment considering all subtypes of reflux.

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms(LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors(PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires(GERD impact scale,GIS;visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score(RFS) and reflux symptom index(RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH(MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis(ERD),pathological acid exposure time(AET) in the absence of esophageal erosions(NERD),and a positive correlation between symptoms and refluxes(hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52(14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m 2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms(heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia(38/41),linear indentation in the medial edge of the vocal fold(31/41),vocal fold nodules(6/41) and diffuse infraglottic oedema(25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy(P < 0.05);conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy(P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis showed an abnormal AET in 5/41 patients(2 ERD and 3 NERD);11/41 patients had a normal AET and a positive association between symptoms and refluxes(HE),and 25/41 patients had a normal AET and a negative association between symptoms and refluxes(no GERD patients).It is noteworthy that HE patients had a positive association with typical GERD-related symptoms.Gas refluxes were found more frequently in patients with globus(29.7 ± 3.6) and hoarseness(21.5 ± 7.4) than in patients with heartburn or regurgitation(7.8 ± 6.2).Gas refluxes were positively associated with extraesophageal symptoms(P < 0.05).Overall,no differences were found among the three groups of patients in terms of the frequency of laryngeal signs.The proximal reflux was abnormal in patients with ERD/NERD only.The differences observed by means of MII-pH analysis among the three subgroups of patients(ERD/NERD,HE,no GERD) were not demonstrated with the RSI and RFS.Moreover,only the number of gas refluxes was found to have a significant association with the RFS(P = 0.028 andP = 0.026,nominal and numerical correlation,respectively).CONCLUSION:MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR,most likely because of the low specificity of the laryngoscopic findings.

Gastroesophageal reflux disease and the airway-essentials for the surgeon

Gastroesophageal reflux disease(GERD) has many protean manifestations.Some of the most vexing have to do with the airway.GERD affects the tracheobronchial tree directly,leading to aspiration pneumonia and asthma,or exacerbating existing pulmonary disease,such as asthma or chronic obstructive pulmonary disease.In addition to the respiratory manifestation of GERD,there are unique pharyngeal and laryngeal manifestations.These include voice hoarseness,throat-clearing,chronic cough,globus,and "post-nasal drip".Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion.Despite proton pump inhibitor therapy being the mainstay of treatment,with anti-reflux surgery being reserved for intractable cases,there is no definitive evidence of the superiority of either.

平阳霉素局部注射治疗咽喉部血管瘤22例

目的探讨平阳霉素在显微支撑喉镜下局部注射治疗咽喉部血管瘤的效果。方法咽喉部血管瘤患者44例,随机分为治疗组和对照组各22例。对照组显微支撑喉镜下血管瘤体内注射博来霉素5 mg,治疗组显微支撑喉镜下血管瘤体内注射平阳霉素,一次4~8 mg,注射1次,未愈者,间歇15 d重复注射,一般不超过3次。比较两组的疗效及不良反应。结果治疗组和对照组总有效率分别为95.4%,59.1%（P〈0.05）,两组均未发生严重不良反应。结论平阳霉素局部注射治疗咽喉部血管瘤,疗效好,不良反应少。

CT在喉与喉咽肿瘤诊断中的应用

目的 探讨CT扫描在喉与喉咽癌诊断中的应用价值。方法 收集 81例由CT诊断、经手术病理证实的喉与喉咽癌患者 ,其中喉癌 73例 ,喉咽癌 8例。患者取颈过伸位 ,扫描基线平行于真声带 ,层厚 3～ 5mm (必要时 1～ 2mm) ,扫描范围包括整个喉咽和颈部各组淋巴结。增强扫描应用 65 %安其格纳芬或 3 0 0mg优维显 80～ 10 0ml。结果 喉癌的主要CT表现为会厌喉面、杓会皱壁及假声带增厚 ,或有不规则肿物突向前庭 ;声带局限性增厚隆起 ,声带固定。喉咽癌见梨状窝占位性病灶 ,环 椎间距 >2 .0cm。本组 70 %的病例伴有颈部淋巴结肿大 ,为转移灶。结论 CT扫描能够较准确作出喉癌和喉咽癌的诊断 ,以及颈部淋巴结转移灶 ,为临床治疗提供可靠依据。

喉咽反流疾病的诊断和治疗

目前，对喉咽反流疾病（laryngopharyngeal reflux，LPR）的诊断及治疗尚未形成一致，治疗效果并不令人满意。2004年9月以来本人共诊治LPR患者52例，取得了一定效果，现报道如下。

咽喉反流对CO2激光喉显微手术后喉功能及创面愈合影响及对策初探

目的探讨咽喉反流对CO_2激光喉显微手术后喉功能康复与创面愈合的影响及其对策。方法回顾性分析2010年1月至2014年7月我院支撑喉镜下CO_2激光喉显微手术患者63例,根据RSI、RFS量表得分确定患者是否存在咽喉反流;术后对部分咽喉反流患者进行质子泵抑制剂治疗。患者随访3月,应用嗓音障碍指数量表对患者进行嗓音评估。结果咽喉反流组的术后声带肉芽肿发生率高于无咽喉反流组(P<0.05)。无咽喉反流且未行质子泵抑制剂干预患者术后肉芽肿发生率为57.1%,咽喉反流阴性但行PPI干预治疗患者术后肉芽肿发生率为16.7%,组间差异具有统计学意义(P<0.05);咽喉反流阳性而未行质子泵抑制剂干预患者术后肉芽肿发生率为61.1%,咽喉反流阳性并行PPI干预患者术后肉芽肿发生率为27.8%,组间差异具有统计学意义(P<0.05)。无论咽喉反流阴性或阳性,给予或不给予PPI干预治疗,其术后嗓音障碍指数评分指数分布差异均有统计学意义(P<0.05)。结论咽喉反流对CO_2激光喉显微手术后的喉功能康复及创面愈合有一定影响,应用PPI干预治疗能有效减少术后声带肉芽肿等并发症的发生,促进喉功能及创面恢复。

支撑喉镜下喉部巨大血管瘤注射治疗1例

喉部血管瘤较为少见,尤其是引起呼吸困难的巨大血管瘤更为少见。2013年10月笔者收治1例喉部巨大血管瘤患者,在支撑喉镜下给予平阳霉素局部注射治疗成功治愈,现报道如下。 1病例资料 患者,女,57岁,因间断性咽喉部疼痛、咳嗽1年,伴有呼吸不畅并在轻微运动后即出现呼吸困难1个月就诊,无咯血,但有明显的咽喉部异物感和进食哽噎感,在当地医院按照咽炎治疗无效,且有渐进性呼吸困难加重转来我院。喉镜检查发现声门上方紫红色巨大血管瘤及会厌谷和环后同性质肿瘤（图1A）,喉部CT证实肿瘤的存在。

胃食管反流病相关咽喉疾病的中西医治疗进展

胃食管反流病(GERD)是消化系统的常见疾病,咽喉不适是GERD的主要食管外表现之一。随着GERD发病率在我国逐渐上升,GERD相关咽喉疾病的发病机制和诊治方法逐渐成为研究热点,受到了消化科和耳鼻喉科医师的重视。随着临床研究的深入,人们对GERD相关咽喉疾病的病因、发病机制、诊断方法的认识已逐渐完善,但治疗方面西医以质子泵抑制剂抑制酸分泌为主要手段,中医药基于中医传统理论,通过辨证论治进行对因、对症的综合治疗,已逐渐显现出优势。

低温等离子消融联合平阳霉素及生理盐水治疗咽喉部巨大血管瘤的临床效果

目的探讨低温等离子消融联合平阳霉素及生理盐水治疗咽喉部巨大血管瘤的临床效果。方法回顾性分析2013年4月至2022年1月在郑州大学第一附属医院咽喉头颈外科就诊的78例咽喉部巨大血管瘤患者的临床资料,其中接受平阳霉素注射配合低温等离子消融治疗的为对照组,接受低温等离子消融联合平阳霉素及生理盐水注射治疗的为观察组,每组39例。统计分析两组患者咽喉部血管瘤的治疗效果,并观察治疗后的不良反应发生情况。结果随访1 a,观察组的治疗有效率为100.00%,对照组的治疗有效率89.74%,差异有统计学意义(P<0.05),观察组手术时间、切口愈合时间短于对照组,术中出血量少于对照组(P<0.05)。治疗期间两组肺部CT、肝肾功能、凝血功能均无明显异常,观察组的不良反应发生率为5.13%,对照组不良反应发生率为20.51%,差异有统计学意义(P<0.05)。结论低温等离子联合平阳霉素及生理盐水局部注射治疗咽喉部血管瘤的效果确切,能够减少手术次数,安全性高。

康复新液治疗后段喉炎的单盲随机对照临床研究

目的研究康复新液对以反流和发音损伤为主要病因的后段喉炎的治疗作用。方法采用康复新液局部含服加口服,为期4个月;以奥美拉唑(20mg,2次/d)和生理盐水治疗为对照组;采用反流症状指数(RSI)、反流体征评分(RFS)、嗓音相关生活质量评估(V-RQOL)为评价指标。分别在治疗前、治疗后2个月和4个月进行评估。研究采用前瞻性、随机、单盲、对照方式。各组病例均为12例。结果在主观性的RSI和V-RQOL中,治疗2个月和4个月时,在康复新和奥美拉唑组均显著好转;生理盐水组中,RSI项目显著改善;V-RQOL项目有所好转,但未达显著性。在由医生单盲评分的RFS中,在2个月与4个月时,只有奥美拉唑组在4个月时达显著性(P=0.001);康复新液组在4个月时接近达到显著性(P=0.066)。其它各组项均未达显著性。在3种药物对比中,2个月时,各评估项目差异无有统计学意义。在4个月时,在RSI项目中,康复新液和奥美拉唑组显著优于生理盐水组(P=0.013)。RFS和V-RQOL则未达显著性(P=0.068,RFS;0.760,V-RQOL)。结论康复新液对由反流和发音损伤引起的后段喉炎有治疗效果。如果与质子泵抑制剂,生活习惯矫正结合应可达更佳效果。

CT在喉及喉咽癌诊断中的应用——12例CT与喉造影对比研究

本文总结了12例喉及喉咽癌的CT表现,并与喉造影所见作了比较。结果表明:早、中期肿瘤,喉造影能较清楚地显示病变范围,CT检查意义不大,对于晚期肿瘤,喉造影显示肿瘤喉内病变较理想,但CT有助于了解肿瘤深部浸润情况,补充喉造影所见,为临床治疗方案的拟定提供参考。

支撑喉镜下平阳霉素注射加电刀凝切综合治疗咽喉血管瘤

目的观察支撑喉镜下应用平阳霉素注射加电刀切除综合治疗下咽及喉部血管瘤的临床疗效。方法选择下咽及喉部血管瘤患者27例。患者经喉插管全身麻醉后,支撑喉镜下显露血管瘤,瘤体内局部注射平阳霉素(8 mg,用5 m L生理盐水注射液稀释),然后应用息肉钳式电刀沿瘤体根底部完整切除瘤体或采用钳夹瘤体电凝的方法完整凝固瘤体。记录术中和术后出血情况,术后进流食2周。分别于术后1个月、3个月、1年、2年、3年复查纤维喉镜判定疗效。结果瘤体在注射5 m L平阳霉素后由粉红色或紫红色变为粉白色。当钳夹瘤体能够显露根蒂部时,应用息肉钳式电刀沿根底部可完整切除瘤体,术中几乎无血;当无法显露根蒂或根蒂较大时,采用钳夹瘤体电凝的方法可完整凝固瘤体。所有患者术后均无呼吸困难和创面出血。1个月后复查纤维喉镜显示创面为粉红色正常黏膜修复。术后1年随访全部病例均未见复发;术后2年随访,1例患者咽侧壁黏膜再现片状紫色隆起,再次行上述疗法完整切除瘤体;术后3年随访未见复发。结论下咽及喉部血管瘤经支撑喉镜下局部注射平阳霉素后应用电刀切除的手术方法可一次性切除病变,手术创伤小,恢复快。该治疗方案疗效肯定,易于普及。

富马酸伏诺拉生片联合兰索拉唑治疗胃食管反流性咽喉病的临床效果

目的探究富马酸伏诺拉生片联合兰索拉唑治疗胃食管反流性咽喉病的临床效果。方法选取江苏省苏州市第九人民医院2020年1月至2021年11月收治的82例胃食管反流性咽喉病患者作为研究对象,以电脑随机数字表法将其分为研究组和对照组,各41例。对照组予以兰索拉唑治疗,研究组予以富马酸伏诺拉生片联合兰索拉唑治疗。两组均于给药28 d后评估临床疗效、咽喉反流症状及胃肠激素、血清炎症因子水平,并记录两组不良反应发生情况。结果研究组临床疗效优于对照组(P<0.05)。治疗后,两组反流性疾病问卷(RDQ)评分、胃肠道影响量表(GIS)评分及肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、血管活性肠肽水平均低于治疗前,促胃液素水平高于治疗前(P<0.05)。治疗后,研究组RDQ、GIS评分及TNF-α、IL-1β、血管活性肠肽水平均低于对照组,促胃液素水平高于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论富马酸伏诺拉生片联合兰索拉唑治疗胃食管反流性咽喉病患者,临床疗效优越且安全性良好,值得推广。

Association of gastroesophageal reflux disease and laryngeal cancer

Objective:Studies examining the association of reflux disease with the risk of developing laryngeal cancer have both proven and disproven the null hypothesis.Methods:This retrospective caseecontrol study examines the association of reflux in two populations exposed to similar risk factors,including tobacco,to the extent that end-organ malignant transformation has occurred.After IRB approval was obtained,a search of our hospital’s cancer center’s database was performed from 2000 to 2013.A retrospective chart review was then performed and the prevalence of gastroesophageal reflux disease among patients with laryngeal cancer(n Z 290)was determined.It was then compared to the prevalence of gastroesophageal reflux disease among patients presenting with lung cancer(n Z 2440)during the same time period.A multivariate logistic regression was performed to determine the association of reflux with laryngeal cancer.Results:Taking into consideration tobacco use,there was a strong association between male gender and occurrence of laryngeal cancer as opposed to lung cancer(OR Z 3.30;95%CI 2.53e4.36,P<0.001).There was a modest association between reflux and laryngeal cancer(OR Z 1.65;95%CI 1.19e2.25,P Z 0.003).However,there was no association between reflux and the propensity for carcinoma in specific laryngeal subsites(P Z 0.47).Conclusions:In this study examining a heterogeneous population with end-organ malignancy there was a modest association between reflux and laryngeal cancer.Further research is necessary to determine the biologic relevance of this finding.

57例下咽癌综合治疗分析

目的评价下咽癌不同治疗方法的疗效。方法回顾性分析2 0 0 2年9月～2 0 0 8年1 2月平煤医疗集团总医院耳鼻咽喉头颈外科住院治疗的5 7例下咽癌患者,其中术前放疗加手术者1 7例,手术加术后放疗者2 7例,单纯放疗者1 3例。4 4例手术患者中,按手术方式分为梨状窝手术7例,下咽后壁手术6例,单纯环后手术3例,下咽侧壁手术6例,下咽并喉部分切除8例(梨状窝并杓会厌襞切除术2例,梨状窝并半喉切除术6例),喉全切1 4例。结果术前放疗加手术者5年生存率4 3.1%,术后加放疗者4 5.7%,单纯放射治疗者2 0.3%。结论术前或术后加放疗的疗效无明显差异,手术加放射治疗疗效优于单纯放射治疗。

质子泵抑制剂在疑似咽喉反流性疾病中的应用

目的探讨质子泵抑制剂(protonpump inhibitors,PPI)试验性治疗在疑似咽喉反流性疾病(laryngopharyngeal reflux diease,LPRD)中的应用价值。方法选取根据反流症状指数量表(The reflux symptom index,RSI)和反流检查计分量表(The reflux finding score,RFS)均为阳性的130例我院门诊患者。随机分为质子泵抑制剂奥美拉唑治疗组和咽喉炎药物治疗组,分别治疗2周后再次追踪RSI和RFS评估。结果 2周治疗后PPI治疗组38例RSI评分下降,29例RFS评分下降,RFS评分无下降的仍有11例RSI下降,治疗前后RSI和RFS评分差异经检验具有统计学意义(P<0.01)。咽喉炎药物治疗组17例RSI评分下降,12例RFS评分下降,治疗前后RSI和RFS评分差异经检验无统计学意义(P>0.05)。结论临床疑似咽喉反流性疾病可予短期质子泵抑制剂试验性治疗,其敏感性和特异性好,值得临床广泛应用。

低温等离子消融术联合平阳霉素注射法治疗咽喉血管瘤的效果及对患者免疫功能的影响

目的:探究用低温等离子消融术联合平阳霉素注射法治疗咽喉血管瘤的效果及对患者免疫功能的影响。方法:随机选取北京市石景山医院2016年1月至2019年12月期间收治的45例咽喉血管瘤患者为研究对象。将其随机分为参照组(n=23)和研究组(n=22)。为参照组患者采用平阳霉素注射法进行治疗,为研究组患者采用平阳霉素注射法+低温等离子消融术进行治疗,然后对比两组患者的临床疗效及各项免疫功能指标。结果:研究组患者治疗的总有效率(95.45%)高于参照组患者治疗的总有效率(73.91%),差异有统计学意义(P<0.05)。治疗后,研究组患者血清免疫球蛋白G、免疫球蛋白A、免疫球蛋白M的水平均高于参照组患者,差异有统计学意义(P<0.05)。结论:用低温等离子消融术联合平阳霉素注射法治疗咽喉血管瘤的效果显著,能有效地改善患者的免疫功能,促进其康复。