Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: A controlled study
Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: A controlled study
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DOI：
10.1016/j.cgh.2006.01.011
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发表时间：
2006-04-01
影响因子：
12.6
通讯作者：
Vaezi, MF
中科院分区：
文献类型：
--
作者：
Swoger, J;Ponsky, J;Vaezi, MF
背景与目的：尽管进行了积极的质子泵抑制剂治疗，但喉部症状持续存在的患者，仍然与胃食管反流病（GERD）有关。手术胃底折叠术作为这些患者的确定性治疗的作用尚不确定。方法：在这项前瞻性同步对照研究中，72 名疑似 GERD 相关喉部症状的患者接受了积极的抑酸治疗。四个月的症状无反应（改善< 50%）且持续喉部炎症且食管酸暴露正常的患者接受腹腔镜尼森胃底折叠术。主要结局是术后一年症状改善/缓解。结果：72 名患者中有 25 名 (35%) 在 4 个月的抑酸治疗后仍然没有反应。 10 名患者 (40%) 接受了胃底折叠术（中位年龄 54 岁；男性 4 名），15 名患者 (60%) 继续接受药物治疗（中位年龄 52 岁；男性 4 名）。最常见的喉部症状是喉咙痛、声音嘶哑和咳嗽。胃底折叠术后所有患者在 3 个月和 12 个月时的 pH 研究均正常（中位 pH 时间百分比 < 4，分别为 0.0% 和 0.3%）。手术组中有 10 名患者 (10%) 报告 1 年时喉部症状有所改善，而对照组有 15 名患者中有 1 名 (6.7%) (P = 1.0)。手术组 10 名患者中另外 2 名 (20%) 患者中另外 2 名 (20%) 患者的症状得到了 GERD 以外原因的治疗，非手术组 15 名患者中 10 名 (66%) 患者的症状得到了改善。结论：对于对积极的质子泵抑制剂治疗无反应的患者，胃底折叠术不能可靠地改善喉部症状。低流量或间歇性反流是持续性喉部症状的原因的争论需要用对其他潜在非 GERD 原因的评估和治疗来取代。
Background & Aims: In patients with persistent laryngeal symptoms despite aggressive proton pump inhibitor therapy, gastroesophageal reflux disease (GERD) continues to be implicated. The role of surgical fundoplication as the definitive therapy for these patients is uncertain. Methods: In this prospective concurrent controlled study, 72 patients with suspected GERD-related laryngeal symptoms received aggressive acid-suppressive therapy. Four-month symptomatic nonresponders (< 50% improvement) with continued laryngeal inflammation and normalized esophageal acid exposure were offered laparoscopic Nissen fundoplication. The primary outcome was symptom improvement/resolution at I year after surgery. Results: Twenty-five of 72 (35%) patients remained unresponsive after 4 months of acid-suppressive therapy. Ten patients (40%) underwent surgical fundoplication (median age, 54 y; men, 4) and 15 patients (60%) continued medical therapy (median age, 52; men, 4). The most common laryngeal symptoms were sore throat, hoarseness, and cough. pH studies at 3 and 12 months were normal in all patients after fundoplication (median % time pH < 4, .0% and .3%; respectively). One of 10 (10%) patients in the surgery group reported improvement of laryngeal symptoms at 1 year compared with 1 of 15 in the control group (6.7%) (P = 1.0). Treatment of causes other than GERD improved symptoms in an additional 2 of 10 (20%) patients in the surgical group, and 10 of 15 (66%) patients in the nonsurgical cohort. Conclusions: Surgical fundoplication does not improve laryngeal symptoms reliably in patients unresponsive to aggressive proton pump inhibitor therapy. The argument of low volume or intermittent reflux as the cause of persistent laryngeal symptoms needs to be replaced with evaluation and therapy for other potential non-GERD causes.