Update on laryngopharyngeal reflux disease.

IF 2.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Miguel A Algara, Walter W Chan
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引用次数: 0

Abstract

Purpose of review: Chronic laryngopharyngeal symptoms (LPS) are increasingly prevalent presentations to gastroenterologists' offices, and clinicians often make a presumptive diagnosis of laryngopharyngeal reflux disease (LPRD) based on LPS symptoms or laryngoscopic findings alone. Such presumptive diagnoses of LPRD often are incorrect, and establishing the correct diagnosis poses significant challenges for clinicians. This review addresses the timely need for advances in evaluating and managing LPS/LPRD, given their diagnostic complexity and the healthcare burden of ineffective empiric treatments.

Recent findings: Recent evidence emphasizes the diverse etiologies of LPS including LPRD, oropharyngeal or other airway pathologies, allergic conditions, and cognitive-affective processes or altered brain-larynx interaction. The diagnostic approach should be individualized and multimodal, including upfront reflux testing over empiric acid suppression trials for possible LPRD, given the poor correlation between LPS and objective evidence of reflux. Predictive models and risk stratification tools such as the COuGH RefluX score show promise to help guide testing and therapeutic strategies. Reflux testing modalities include wireless pH monitoring and impedance-based testing (traditional impedance-pH or combined hypopharyngeal-esophageal reflux monitoring). Biochemical testing for salivary pepsin may also offer adjunctive value. Management should include antireflux strategies for those with objectively-proven LPRD, alongside treatments targeting nonreflux mechanisms of LPS, such as voice therapy, neuromodulation, and behavioral therapy.

Summary: An individualized, multidisciplinary approach is essential in managing LPS/LPRD. Objective reflux testing improves diagnostic accuracy, avoids unnecessary therapies, and enables tailored treatment. Future research should further refine diagnostic thresholds, validate risk stratification tools, and explore novel therapeutic targets to optimize outcomes.

喉咽反流病最新进展。
综述的目的:慢性喉部症状(LPS)越来越普遍地出现在胃肠科医生的办公室,临床医生经常根据LPS症状或喉镜检查结果单独推定喉咽反流病(LPRD)。这种对LPRD的推定诊断往往是不正确的,建立正确的诊断对临床医生构成了重大挑战。鉴于LPS/LPRD的诊断复杂性和无效经验性治疗的医疗负担,本综述讨论了在评估和管理LPS/LPRD方面取得进展的及时需求。最近的发现:最近的证据强调了LPS的多种病因,包括LPRD、口咽或其他气道病变、过敏性疾病、认知-情感过程或脑-喉相互作用的改变。鉴于LPS与反流的客观证据之间的相关性较差,诊断方法应该是个体化和多模式的,包括对可能的LPRD进行前期反流检测而不是经验酸抑制试验。预测模型和风险分层工具,如咳嗽反流评分,有望帮助指导测试和治疗策略。反流检测方式包括无线pH监测和基于阻抗的检测(传统的阻抗-pH或联合下咽-食管反流监测)。唾液胃蛋白酶的生化检测也可提供辅助价值。治疗应包括客观证实的LPRD患者的抗反流策略,以及针对LPS非反流机制的治疗,如语音治疗、神经调节和行为治疗。总结:个体化、多学科的方法是治疗LPS/LPRD的关键。客观的反流检测提高了诊断的准确性,避免了不必要的治疗,并使治疗成为可能。未来的研究应进一步完善诊断阈值,验证风险分层工具,并探索新的治疗靶点以优化结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Opinion in Gastroenterology
Current Opinion in Gastroenterology 医学-胃肠肝病学
CiteScore
5.30
自引率
0.00%
发文量
137
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Gastroenterology features hand-picked review articles from our team of expert editors. With twelve disciplines published across the year – including gastrointestinal infections, nutrition and inflammatory bowel disease – every issue also contains annotated references detailing the merits of the most important papers.
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