Link between pharyngeal acid reflux episodes and the effectiveness of proton pump inhibitor therapy  

作　　者：Yen-Yang Chen Chen-Chi Wang Chun-Yi Chuang Yung-An Tsou Yen-Chun Peng Chi-Sen Chang Han-Chung Lien 

机构地区：[1]Division of Gastroenterology,Taichung Veterans General Hospital,Taichung 402,Taiwan,China [2]Department of Otolaryngology,Taichung Veterans General Hospital,Taichung 402,Taiwan,China [3]School of Medicine,National Yang Ming Chiao Tung University,Taipei 112,Taiwan,China [4]School of Speech Language Pathology and Audiology,Chung Shan Medical University,Taichung 402,Taiwan,China [5]School of Medicine,Chung Shan Medical University,Taichung 402,Taiwan,China [6]Department of Otolaryngology,Chung Shan Medical University Hospital,Taichung 402,Taiwan,China [7]Department of Otorhinolaryngology-Head and Neck Surgery,China Medical University Hospital,Taichung 400,Taiwan,China [8]Division of Gastroenterology and Hepatology,Department of Internal Medicine,Tungs’Taichung Metro Harbor Hospital,Taichung 435,Taiwan,China [9]Division of Gastroenterology,Center for Functional Esophageal Disorders,Taichung Veterans General Hospital,Taichung 402,Taiwan,China [10]Department of Post-Baccalaureate Medicine,College of Medicine,National Chung Hsing University,Taichung 402,Taiwan

出　　处：《World Journal of Gastroenterology》2024年第48期5162-5173,共12页世界胃肠病学杂志（英文）

摘　　要：BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping symptoms.While proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are unclear.Reflux monitoring techno-server reliability.We hypothesized that PAR episodes alone might also predict PPI responsiveness.AIM To investigate whether PAR episodes alone predict a positive response to PPI therapy.METHODS Patients suspected of having LPR were prospectively recruited from otolaryngologic clinics in three Taiwan residents tertiary centers.They underwent a 24-hour esophagopharyngeal pH test using either 3-pH-sensor or hypopha-ryngeal MII-pH catheters while off medication,followed by a 12-week esomeprazole course(40 mg twice daily).Participants were categorized into four groups based on pH results:PAR alone,EAR alone,both pH(+),and both pH(-).The primary outcome was a≥50%reduction in primary laryngeal symptoms,with observers blinded to group assignments.RESULTS A total of 522 patients(mean age 52.3±12.8 years,54%male)were recruited.Of these,190(mean age 51.5±12.4 years,61%male)completed the treatment,and 89(47%)responded to PPI therapy.Response rates were highest in the PAR alone group(73%,n=11),followed by EAR alone(59%,n=68),both pH(+)(56%,n=18),and both pH(-)(33%,n=93).Multivariate analysis adjusting for age,sex,body mass index,and endoscopic esophagitis showed that participants with PAR alone,EAR alone,and both pH(+)were 7.4-fold(P=0.008),4.2-fold(P=0.0002),and 3.4-fold(P=0.03)more likely to respond to PPI therapy,respectively,compared to the both pH(-)group.Secondary analyses using the definition of≥1 PAR episode were less robust.CONCLUSION In the absence of proven hypopharyngeal predictors,this post-hoc analysis found that baseline≥2 PAR episodes alone are linked to PPI responsiveness,suggesting the importance of hypopharyngeal reflux monitoring.

关 键 词：Pharyngeal acid reflux episodes Laryngopharyngeal reflux Hypopharyngeal multichannel intraluminal impedance-pH 3-pH-sensor Proton pump inhibitors 

分 类 号：R45[医药卫生—治疗学]