Evidence of Extraesophageal Reflux in Idiopathic Subglottic Stenosis
Evidence of Extraesophageal Reflux in Idiopathic Subglottic Stenosis
复制标题
DOI：
10.1002/lary.21776
复制
发表时间：
2011-06-01
期刊：
影响因子：
2.6
通讯作者：
Johnston, Nikki
中科院分区：
文献类型：
--
作者：
Blumin, Joel H.;Johnston, Nikki
目的/假设：特发性声门下狭窄（iSGS）是一种主要发生于女性的疾病，根据定义，其病因不明。胶原血管疾病、局部创伤、食管外反流（EER）和激素变化均被假定为iSGS的潜在病因。据推测，iSGS是一种反流介导的疾病，EER的证据存在于受影响的patients.Study设计：病例对照study.Methods：iSGS患者被确定为前瞻性超过2.5年的时间（2007-2010）。在他们的内镜治疗中，评价声门下瘢痕和环状软骨后区的活检是否存在胃蛋白酶，胃蛋白酶是暴露于胃反流的指标。对照组患者在接受与反流无关的疾病手术治疗时进行了类似的活检。图表的患者和对照组进行了审查的反流，pH值测定，和实验室检测胶原血管diseases.Results的临床史：22例iSGS进行了治疗。所有患者均为女性。无患者血清学胶原血管疾病阳性。13例（59%）iSGS患者的喉部或气管中存在胃蛋白酶。对照组患者的组织中没有检测到胃蛋白酶（P = 0.041）。在10例（45%）患者中进行了双探头24小时pH值研究。这些研究是积极的EER在7例患者，但这并没有统计学相关的胃蛋白酶在其组织中的存在（P = 1.0）。结论：iSGS是一种疾病几乎完全是女性。EER与iSGS的发展有关。在iSGS患者的声门下瘢痕和喉部可检测到胃蛋白酶。标准pH测定法可能不足以预测iSGS患者的EER程度。
Objectives/Hypothesis: Idiopathic subglottic stenosis (iSGS) is a disease predominantly of females that, by definition, has no known etiology. Collagen-vascular disease, localized trauma, extraesophageal reflux (EER), and hormonal alterations have all been postulated as potential etiologies of iSGS. It is hypothesized that iSGS is a reflux mediated disease and that evidence of EER exists in affected patients.Study Design: Case-control study.Methods: Patients with iSGS were identified prospectively over a 2.5-year period (2007-2010). During their endoscopic management, biopsies of the subglottic scar and postcricoid area were evaluated for the presence of pepsin, an indicator of exposure to gastric refluxate. Control patients had similar biopsies while undergoing operative management for disease unrelated to reflux. Charts of both patients and controls were reviewed for clinical history of reflux, pH-metry, and laboratory testing for collagen-vascular disease.Results: Twenty-two patients with iSGS were treated. All patients were female. No patient had serology positive for collagen-vascular disease. Thirteen (59%) patients with iSGS had pepsin present in their larynx or trachea. Control patients did not have detectable pepsin in their tissue (P = .041). Dual probe 24-hour pH studies were performed in 10 (45%) patients. These studies were positive for EER in seven patients but this did not statistically correlate to the presence of pepsin in their tissue (P = 1.0).Conclusions: iSGS is a disease almost exclusively of women. EER is implicated in the development of iSGS. Pepsin is detectable in the subglottic scar and larynges of patients with iSGS. Standard pH-metry may be inadequate in predicting degree of EER in patients with iSGS.