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.

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.

New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal p H metry in extraesophageal gastroesophageal reflux disease

AIM:To determine the laryngeal H+K+-ATPase and pharyngeal p H in patients with laryngopharyngeal reflux(LPR)-symptoms as well as to assess the symptom scores during PPI therapy.METHODS:Endoscopy was performed to exclude neoplasia and to collect biopsies from the posterior cricoid area(immunohistochemistry and PCR analysis).Immunohistochemical staining was performed with monoclonal mouse antibodies against human H+K+-ATPase.Quantitative real-time RT-PCR for each of the H+K+-ATPase subunits was performed.The p H values were assessed in the aerosolized environment of the oropharynx(Dxp H Catheter) and compared to a subsequently applied combined p H/MII measurement.RESULTS:Twenty patients with LPR symptoms were included.In only one patient,the laryngeal H+K+-ATPase was verified by immunohistochemical staining.In another patient,real-time RT-PCR for each H+K+-ATPase subunit was positive.Fourteen out of twenty patients had pathological results in Dxp H,and 6/20 patients had pathological results in p H/MII.Four patients had pathological results in both functional tests.Nine out of twenty patients responded to PPIs.CONCLUSION:The laryngeal H+K+-ATPase can only be sporadically detected in patients with LPR symptoms and is unlikely to cause the LPR symptoms.Alternative hypotheses for the pathomechanism are needed.The role of pharyngeal p H-metry remains unclearand its use can only be recommended for patients in a research study setting.

Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on p H-monitoring and symptom-scale

AIM To compare the outcomes between laparoscopic Nissen fundoplication(LNF)and proton pump inhibitors(PPIs)therapy in patients with laryngopharyngeal reflux(LPR)and typeⅠhiatal hernia diagnosed by oropharyngeal p H-monitoring and symptom-scale assessment.METHODS From February 2014 to January 2015,70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment,oropharyngeal p H-monitoring,manometry,and gastrointestinal endoscopy were enrolled in this study.All of the patients met the inclusion criteria.All of the patients underwent LNF or PPIs administration,and completed a2-year follow-up.Patients’baseline characteristics and primary outcome measures,including comprehensive and single symptoms of LPR,PPIs independence,and satisfaction,and postoperative complications were assessed.The outcomes of LNF and PPIs therapy were analyzed and compared. RESULTS There were 31 patients in the LNF group and 39patients in the PPI group.Fifty-three patients(25 in the LNF group and 28 in the PPI group)completed reviews and follow-up.Oropharyngeal p H-monitoring parameters were all abnormal with high acid exposure,a large amount of reflux,and a high Ryan score,associated reflux symptom index(RSI)score.There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups(P<0.05),as well as typical symptoms of gastroesophageal reflux disease.Improvement in the RSI(P<0.005)and symptom scores of cough(P=0.032),mucus(P=0.011),and throat clearing(P=0.022)was significantly superior in the LNF group to that in the PPI group.After LNF and PPIs therapy,13 and 53 patients achieved independence from PPIs therapy(LNF:44.0%vs PPI:7.14%,P<0.001)during follow-up,respectively.Patients in the LNF group were more satisfied with their quality of life than those in the PPI group(LNF:62.49±28.68 vs PPI:44.36±32.77,P=0.004).Body mass index was significantly lower in the LNF group than in the PPI group(LNF:22.2±3.1kg/m^2 vs PPI:25.1±2.9 kg/m^2,P=0.001).CONCLUSION Diagnosis of LPR should be assessed with oropharyngeal p H-monitoring,manometry,and the symptom-scale.LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

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.

Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease:A definitive diagnostic test?

AIM: To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication(LF) for chronic laryngopharyngeal reflux symptoms.METHODS: Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional p H and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after surgery.RESULTS: Thirty four patients(20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour p H and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study(50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29%(5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive valueof 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable sideeffect profile. CONCLUSION: Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.

Laryngopharyngeal reflux in patients with reflux esophagitis

AIM: To assess the prevalence of laryngopharyngeal reflux (LPR) in patients with reflux esophagitis and dis-close factors contributing to the development of LPR. METHODS: A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled. They received laryngoscopy to grade the reflux find-ings for the diagnosis of LPR. We used validated ques-tionnaires to identify the presence of laryngopharyn-geal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR. RESULTS: The prevalence rate of LPR in studied sub-jects with reflux esophagitis was 23.9%. Age, hoarse- ness and hiatus hernia were factors significantly as-sociated with LPR. In 23 patients with a hiatus hernia, the group with LPR was found to have a lower trend of esophagitis grading. CONCLUSION: Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagi-tis. The importance of hiatus hernia deserves further study.

Rikkunshito improves globus sensation in patients with proton-pump inhibitor-refractory laryngopharyngeal reflux

AIM: To investigate the effect of rikkunshito on laryngopharyngeal reflux(LPR) symptoms and gastric emptying in patients with proton-pump inhibitor(PPI)refractory LPR.METHODS: In total,22 patients with LPR were enrolled.Following a 2-wk treatment with PPI monotherapy,PPI-refractory LPR patients were randomly divided into two treatment groups(rikkunshito alone or rikkunshito plus the PPI,lansoprazole).LPR symptoms were assessed using a visual analog scale(VAS) score,gastrointestinal symptoms were assessed using the gastrointestinal symptom rating scale(GSRS),and gastric emptying was assessed using the radio-opaque marker method prior to and 4 wk following treatments.RESULTS: The 4-wk treatment with rikkunshito alone and with rikkunshito plus the PPI significantly decreased the globus sensation VAS scores.The VAS score for sore throat was significantly decreased following treatment with rikkunshito plus PPI but not by rik kunshito alone.Neither treatment significantly changed the GSRS scores.Rikkunshito improved delayed gastric emptying.We found a significant positive correlation between improvements in globus sensation and in gastric emptying(r2= 0.4582,P < 0.05).CONCLUSION: Rikkunshito improved globus sensation in patients with PPI-refractory LPR,in part,because of stimulation of gastric emptying.Thus,rikkunshito is an effective treatment for PPI-refractory LPR.

A combined treatment for patients with dry eye and associated laryngopharyngeal reflux:a real-life approach

AIM:To evaluate the efficacy and tolerability of administering a combined therapy in patients with dry eye syndrome(DES)and associated laryngopharyngeal reflux(LPR).METHODS:The study was retrospective,open,observational,and conducted in a real-life setting.Patients had pathological symptom assessment in dry eye(SANDE)and reflux symptom index(RSI)at baseline.Patients were re-assessed after 1mo and at the end of treatment.The treatment consisted of a three-month course based on the combined therapy:Gastroftal eye drops,one drop three times a day,and Gastroftal tablets,two tablets after lunch and two tablets after dinner.Tear break-up-time(TBUT)test,Schirmer test,RSI,and SANDE questionnaire were evaluated.RESULTS:The study included 253 patients.The mean age was 58±11.19y.TBUT test score and Schirmer’s test significantly increased(both P<0.001)after 1mo and at the end of treatment.The RSI score and SANDE scores significantly decreased(both P<0.001)after 1mo and at the end of treatment.CONCLUSION:The current,retrospective,and open study shows that combined therapy using Gastroftal eye drops and tablets could represent a valuable option in managing patients with DES associated with LPR.

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.

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.

Software improvement for evaluation of laryngopharyngeal pH testing(Restech)——a comparison between Data View 3 and 4

BACKGROUND When gastroesophageal reflux contents reach above the upper esophageal sphincter,patients may,in addition to typical reflux symptoms,present with atypical,extraesophageal symptoms related to laryngopharyngeal reflux(LPR).Surgical treatment of LPR has shown to lead to 70%symptom improvement,however no gold standard for the diagnosis of LPR exists.In 2007,the Restech Dx-pH was released as a valid method to measure acid exposure above the upper esophageal sphincter.Recently,a new software update was introduced for analysis of measured pH data and calculation of composite scores.The effect of the changes applied to the new software version have not yet been analyzed.AIM To compare results generated by Data View 3 to the most recently released Data View 4.METHODS All patients with gastroesophageal reflux disease symptoms were seen in a specialized surgical outpatient clinic for gastrointestinal function testing.Retrospective chart review was performed of all patients presenting with suspected gastroesophageal reflux disease and extraesophageal reflux symptoms,who underwent laryngopharyngeal pH monitoring using the Restech Dx-pH system(Respiratory Technology Corp.,Houston,TX,United States)and simultaneous esophageal pH monitoring.Data View 3 and Data View 4 were used to evaluate Restech studies obtained.Diary entries such as mealtimes,supine and upright periods,and symptoms were entered manually to ensure accuracy and precise conversion of data between both software versions.Paired t test was performed for statistical analysis of results.RESULTS A total of 174 patients(63.8%female)met inclusion criteria,all suffering from extraesophageal reflux symptoms as well as typical gastroesophageal reflux disease symptoms.Mean RYAN score upright was 48.77 in Data View 3 compared to 22.17 in Data View 4,showing a significant difference(~aP=0.0001).Similar results were shown for supine period(mean RYAN Score Data View 35.29 vs 1.42 in Data View 4,~cP=0.0001).For upright periods 80 patients showed a decrease of value of the RYAN score with a mean of-58.9(mean 51.1%decrease).For supine position 25 patients showed a decrease of value of the RYAN score with a mean of-15.13[range(-153.44)–(-0.01)],which equals a mean decrease of value of 44.5%.Ten patients showed no oropharyngeal acid exposure in Data View 3,but mild/moderate(n=7)or severe(n=3)acid exposure in Data View 4.Correlation with positive esophageal pH measurement was improved in all 10 patients.CONCLUSION Results of both software versions cannot be compared to each other.However,our data suggests that Data View 4 may be an improvement of the Restech pH measurement in the evaluation of LPR.

Gastrointestinal function testing model using a new laryngopharyngeal pH probe(Restech)in patients after Ivor-Lewis esophagectomy

BACKGROUND There is no established correlation between 24-h esophageal pH-metry(Eso-pH)and the new laryngopharyngeal pH-monitoring system(Restech)as only small case series exist.Eso-pH was not designed to detect laryngopharyngeal reflux(LPR)and Restech may detect LPR better.We have previously published a dataset using the two techniques in a large patient collective with gastroesophageal reflux disease.Anatomically,patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists.AIM To use a human reflux model to examine our previously published correlation in these patients.METHODS Patients after Ivor Lewis esophagectomy underwent our routine follow-up program with surveillance endoscopies,computed tomography scans and further exams following surgery.Only patients with a complete check-up program and reflux symptoms were offered inclusion into this prospective study and evaluated using Restech and simultaneous Eso-pH.Subsequently,the relationship between the two techniques was evaluated RESULTS A total of 43 patients from May 2016-November 2018 were included.All patients presented with mainly typical reflux symptoms such as heartburn(74%),regurgitation(84%),chest pain(58%),and dysphagia(47%).Extraesophageal symptoms such as cough,hoarseness,asthma symptoms,and globus sensation were also present.Esophageal 24-hour pH-metry was abnormal in 88%of patients with a mean DeMeester Score of 229.45[range 26.4-319.5].Restech evaluation was abnormal in 61%of cases in this highly selective patient cohort.All patients with abnormal supine LPR were also abnormal for supine esophageal reflux measured by conventional Eso-pH.CONCLUSION Patients following esophagectomy and reconstruction with gastric interposition can ideally serve as a human reflux model.Interestingly,laryngopharyngeal reflux phases occur mainly in the upright position.In this human volume-reflux model,results of simultaneous esophageal and laryngopharyngeal(Restech)pHmetry showed 100%correlation as being explicable by one of our reflux scenarios.

Characteristic pathological findings and effects of ecabet sodium in rat reflux esophagitis

AIM： To explore the pathological findings in the entire esophagus in rats with reflux esophagitis, and the effects of ecabet sodium （ES）. METHODS： A rat model of chronic acid reflux esophagitis was used. In the treatment group, ES was administered after surgery （n = 16）. No drug was administered postoperatively to the esophagitis group （n = 9）. Shamoperated rats were used as a control group （n = 5）. Rats were sacrificed on day 7 after the operation. The epithelial thickness and leukocyte infiltration were examined in the upper, middle and lower areas of the esophagus. The survival rate, incidence of esophageal ulcer, and mean surface area and number of esophageal ulcers were determined in the esophagitis and ES groups. Esophageal histology was assessed in all three groups. RESULTS： Leukocyte infiltration in the esophagitis group was 26.3 ± 22.0 in the middle esophagus and 8.2 ± 4.9 in the upper esophagus, which was significantly greater than that in the controls （1.3 ± 1.1 and 1.4 ±1.0, respectively） （P 〈 0.05）. The thickness of the epithelium in the esophagitis group was 210.8 ± 47.7 μm in the lower esophagus and 204.2 ± 60.1 μm in the middle esophagus, which was significantly greater than that in the controls （26.0 ± 5.5 and 21.0 ± 6.5 μm, respectively） （P 〈 0.05）. The mean number of ulcers per animal in the ES group in the entire esophagus was 5.4 =1= 2.5, which was significantly less than that in the esophagitis group （9.0 ± 3.5） （P 〈 0.05）. The epithelial thickness in the ES group was 97.5 ± 32.2 μm in the lower esophagus, which was decreased compared with that in the esophagitis group （210.8 ± 47.7 μm） （P 〈 0.05）. CONCLUSION： Mucosal inflammation extended to the upper esophagus close to the hypopharynx. Our study suggested that ES may have a useful defensive role in reflux esophagitis.

Laryngopharengeal Reflux in Gastroesophageal Reflux Disease: Does “Silent Laryngopharengeal Reflux” Really Exist?

Background: Gastroesophageal reflux disease (GERD) is a disorder resulting from the reversed flow of gastroduodenal contents into the esophagus, and producing different symptoms, while laryngopharyngeal reflux (LPR) is a disorder resulting from the reversed flow of gastric contents into the hypopharynx. The aim of this work is to evaluate LPR in cases of GERD. Methods: The present study was performed on fifty GERD patients diagnosed by gastroscope. LPR was assessed by reflux symptoms score (RSI) and reflux finding score (RFS). Accordingly, patients are classified into: Group I = 25 patients with manifest LPR, and Group II = 25 control patients without LPR symptoms. Results: GERD accounts for 17.4% of attendants of gastroscope unit, where manifest LPR accounts for 29.1% of GERD cases recording mean RSI and RFS 16.48 and 8.44 respectively. Silent LPR accounts for 8% recording mean RFS 7. Conclusion: There is a significant direct proportional relationship between severity of GERD and the RSI and RFS (p = 0.015 and 0.005 respectively).

腹针导气法联合奥美拉唑治疗咽喉反流性疾病的疗效观察及对焦虑抑郁状态的影响

目的观察腹针导气法联合奥美拉唑治疗肝胃不和型咽喉反流性疾病的临床疗效及对患者焦虑抑郁状态的影响。方法选取90例肝胃不和型咽喉反流性疾病患者作为研究对象,分为观察组和对照组,每组45例。两组均予以口服奥美拉唑肠溶胶囊治疗,观察组另予腹针导气法治疗。比较两组临床疗效,观察两组治疗前后反流症状指数(reflux symptom index,RSI)评分、反流体征评分(reflux finding score,RFS)和医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评分的变化,比较两组不良反应发生情况。结果观察组总有效率高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组RSI和RFS各单项评分及HADS评分均较治疗前降低(P<0.05),且观察组上述各项评分均低于对照组(P<0.05)。两组均未见明显不良反应事件。结论腹针导气法联合奥美拉唑治疗肝胃不和型咽喉反流性疾病的疗效优于单一奥美拉唑治疗,可促进患者症状与体征恢复,改善焦虑抑郁情绪。

奥美拉唑在分泌性中耳炎合并咽喉反流患者中的治疗价值

目的:探讨奥美拉唑在分泌性中耳炎(SOM)合并咽喉反流(LPR)患者中的治疗价值。方法:选取单侧或双侧SOM合并LPR患者82例,根据治疗方案不同将患者分为治疗组(35例)和对照组(47例)。所有患者均给予鼓膜穿刺术、配合使用鼻部激素、口服黏液促排剂和抗组胺药物1个月。治疗组同时给予患者抗反流宣教及足疗程奥美拉唑抗反流干预。随访3个月,比较两组患者治疗前后气骨导差、七项咽鼓管功能障碍症状评分量表(ETDQ-7)评分及临床疗效。结果:两组治疗后第1~3个月气骨导差较治疗前降低(均P<0.05)。治疗组治疗后第1~3个月气骨导差低于对照组(均P<0.05)。两组患者治疗后第1~3个月ETDQ-7评分较治疗前降低(均P<0.05)。治疗组治疗后第1~3个月ETDQ-7评分较对照组降低(均P<0.05)。治疗后第2、3个月,治疗组总有效率高于对照组(均P<0.05)。结论:对于SOM合并LPR患者,奥美拉唑能改善咽鼓管功能,提高听力水平及SOM治疗效果。

睡眠剥夺大鼠脑肠肽改变在大鼠咽喉反流中的作用

目的研究睡眠剥夺大鼠血清中脑肠肽改变在大鼠咽喉反流发病中的作用。方法选取40只健康成年雄性SD大鼠,分为实验组和对照组,对照组正常睡眠,实验组分为三组,每组10只,用改良多平台水环境法剥夺8 h的白天睡眠,分别持续1、2、3个月,用ELISA法检测各组外周血中胃泌素(MTL)和生长抑素(SS)浓度,放射免疫法检测外周血中胃动素(GAS)浓度,比较各组结果。结果睡眠剥夺2月组GAS浓度明显低于对照组,睡眠剥夺3月组GAS浓度明显高于1月组和2月组(P<0.05)。三个实验组与对照组之间比较MTL浓度差异均无统计学意义(P>0.05),睡眠剥夺2月组MTL浓度明显高于3月组(P<0.01)。各实验组与对照组之间、三个实验组之间SS浓度均无统计学差异。结论睡眠剥夺可能通过影响GAS和MTL的分泌与大鼠咽喉反流的发生相关。

改变生活及饮食方式在咽喉反流性疾病治疗中的作用研究

目的探讨改变生活及饮食方式在咽喉反流性疾病(LPRD)治疗中的疗效。方法选取2022年1月~2023年6月于福建医科大学附属第二医院门诊治疗的92例LRPD患者作为研究对象,分为对照组46例和治疗组46例。对照组采用常规的抑酸及促胃动力治疗,治疗组在对照组治疗基础上,给予生活及饮食方式指导。比较治疗后8周、12周两组的反流症状指数(RSI)量表、反流体征评分(RFS)量表各项指标变化及临床疗效。结果RSI总分治疗后8周与治疗前比较,对照组和治疗组均较治疗前有改善(P<0.05);RSI总分治疗后12周与治疗后8周比较,对照组和治疗组均较治疗前有改善(P<0.05)。RFS总分治疗后8周与治疗前比较,对照组和治疗组均较治疗前有改善(P<0.05);RFS总分治疗后12周与治疗后8周比较,对照组和治疗组均较治疗前有改善(P<0.05)。治疗8周后,对照组总有效率(60.9%)与治疗组总有效率(71.7%)比较,两组比较差异无统计学意义(χ^(2)=1.335,P=0.513)。治疗12周后,对照组总有效率(73.9%)与治疗组总有效率(91.3%)比较,两组比较差异有统计学意义(χ^(2)=6.226,P=0.044)。结论生活及饮食方式改变应成为LRPD治疗的重要一部分,通过调整不良生活饮食方式,可以明显减轻患者症状,获得更好的临床疗效。

伴咽喉反流性疾病的声带突肉芽肿的影响因素及治疗效果分析

目的:探讨与伴咽喉反流性疾病的声带突肉芽肿相关的危险因素以及抗酸治疗的效果分析。方法:回顾性分析就诊于耳鼻喉门诊的咽喉反流性疾病患者,分为伴有声带突肉芽肿组和不伴有声带突肉芽肿组,对患者的性别、BMI等基本信息和吸烟、饮酒、睡前进食、慢性咳嗽以及用声过度等病史进行单因素和多因素分析。所有患者均接受艾司奥美拉唑镁肠溶片口服治疗2~3个月,保守治疗无效的患者接受显微镜激光手术治疗,术后辅以口服药物治疗至少8周,随诊8~12周。结果:收集120例咽喉反流性疾病患者,性别、BMI、吸烟及饮酒与伴咽喉反流性疾病的声带突肉芽肿具有显著的相关性(P<0.05),其中,男性、BMI>25kg/m^(2)、吸烟、饮酒、喝饮料是咽喉反流性疾病的危险因素。抗胃酸反流治疗对于大部分伴咽喉反流疾病的声带突肉芽肿患者疗效较好,治愈率为93.10%,对于2例抗酸治疗效果欠佳的患者选择显微镜激光手术治疗,术后辅以抗酸治疗仍取得了较好疗效。结论:性别、BMI、吸烟、饮酒以及喝饮料是伴咽喉反流性疾病的声带突肉芽肿重要影响因素。抗酸治疗可作为伴咽喉反流疾病的声带突肉芽肿的首选治疗方案。