Comprehensive analysis of acidic pharyngeal reflux before and after proton pump inhibitor treatment in patients with suspected laryngopharyngeal reflux.
Comprehensive analysis of acidic pharyngeal reflux before and after proton pump inhibitor treatment in patients with suspected laryngopharyngeal reflux.
复制标题
质子泵抑制剂治疗前后对可疑喉咽反流的患者进行酸性咽部反流的全面分析。
DOI：
10.1097/meg.0000000000001584
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发表时间：
2020-02
影响因子：
2.1
通讯作者：
Kollarik, Marian
中科院分区：
文献类型：
--
作者：
Duricek, Martin;Banovcin, Peter, Jr.;Halickova, Tatiana;Hyrdel, Rudolf;Kollarik, Marian
关键词：
咽部pH监测在咽部反流（LPR）症状患者中的有效性一直受到质疑。一个问题是不确定咽pH监测是否捕捉到导致症状的LPR方面。我们的目的是通过对疑似LPR患者在质子泵抑制剂（PPIs）治疗前后的酸性咽反流进行全面分析，以更深入地了解这一问题。我们同时使用咽和远端食管24小时pH/阻抗监测来确定咽反流的胃食管起源，并通过评估咽反流酸度的整个范围（pH < 6, pH < 5.5, pH < 5.0, pH < 4.5和pH < 4.0）采用无偏方法进行分析。PPI治疗显著（约50%）改善了LPR引起的症状。相比之下，PPI没有减少咽反流发作的次数或咽酸暴露在任何pH水平的持续时间。在被认为对PPI有良好反应的患者亚组中也是如此（症状改善约75%）。此外，反应良好的患者并不比对PPI反应较差的患者有更多的酸性咽反流。PPI治疗并没有减少咽部酸性反流，尽管大大改善了LPR引起的症状。这可能是因为咽pH监测不能定量地捕捉到LPR引起症状的各个方面，或者是因为酸也通过LPR以外的机制引起症状。我们的研究结果反对在疑似LPR患者中使用咽pH监测。
The usefulness of pharyngeal pH monitoring in patients with symptoms attributed to laryngopharyngeal reflux (LPR) has been questioned. One problem is the uncertainty whether the pharyngeal pH monitoring captures the aspects of LPR which are responsible for symptoms. We aimed to gain more insight into this problem by performing a comprehensive analysis of acidic pharyngeal reflux before and after the treatment with proton pump inhibitors (PPIs) in patients with suspected LPR. We used simultaneous pharyngeal and distal esophageal 24-hour pH/impedance monitoring to establish the gastroesophageal origin of pharyngeal reflux, and an unbiased approach to analysis by evaluating a whole range of pharyngeal reflux acidity (pH < 6, pH < 5.5, pH < 5.0, pH < 4.5 and pH < 4.0). PPI treatment substantially (by ~50%) improved the symptoms attributed to LPR. In contrast, PPI did not reduce the number of pharyngeal reflux episodes or duration of pharyngeal acid exposure at any pH level. This was also true in a subgroup of patients considered to be good responders to PPI (symptoms improvement by ~75%). Furthermore, good responders did not have more acidic pharyngeal reflux than the patients who were less responsive to PPI. PPI treatment did not reduce acidic pharyngeal reflux despite substantially improving the symptoms attributed to LPR. This may be because pharyngeal pH monitoring does not quantitatively capture the aspects of LPR responsible for symptoms or because acid causes the symptoms also by mechanisms other than LPR. Our results argue against the utility of pharyngeal pH monitoring in patients with suspected LPR.