{"title":"质子泵抑制-无反应性喉部症状与心理合并症和睡眠障碍有关:一项测压和阻抗- ph监测研究","authors":"Wen-Hsuan Tseng, Wei-Chung Hsu, Tsung-Lin Yang, Tzu-Yu Hsiao, Jia-Feng Wu, Hui-Chuan Lee, Hsiu-Po Wang, Ming-Shiang Wu, Ping-Huei Tseng","doi":"10.5056/jnm22099","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/aims: </strong>Laryngeal symptoms are largely treated with empiric proton pump inhibitor (PPI) therapy if no apparent pathology shown on ear, nose, and throat evaluation and reflux-related etiologies are suspected. However, treatment response remains unsatisfactory. This study aimed to investigate the clinical and physiological characteristics of patients with PPI-refractory laryngeal symptoms.</p><p><strong>Methods: </strong>Patients with persistent laryngeal symptoms despite PPI treatment for ≥ 8 weeks were recruited. A multidisciplinary evaluation comprising validated questionnaires for laryngeal symptoms (reflux symptom index [RSI]), gastroesophageal reflux disease symptoms, psychological comorbidity (5-item brief symptom rating scale [BSRS-5]) and sleep disturbance (Pittsburgh sleep quality index [PSQI]), esophagogastroduodenoscopy, ambulatory impedance-pH monitoring, and high-resolution impedance manometry were performed. Healthy asymptomatic individuals were also recruited for comparison of psychological morbidity and sleep disturbances.</p><p><strong>Results: </strong>Ninety-seven adult patients and 48 healthy volunteers were analyzed. The patients had markedly higher prevalence of psychological distress (52.6% vs 2.1%, <i>P</i> < 0.001) and sleep disturbance (82.5% vs 37.5%, <i>P</i> < 0.001) than the healthy volunteers. There were significant correlations between RSI and BSRS-5 scores, and between RSI and PSQI scores (<i>r</i> = 0.26, <i>P</i> = 0.010, and <i>r</i> = 0.29, <i>P</i> = 0.004, respectively). Fifty-eight patients had concurrent gastroesophageal reflux disease symptoms. They had more prominent sleep disturbances (89.7% vs 71.8%, <i>P</i> < 0.001) than those with laryngeal symptoms alone but similar reflux profiles and esophageal motility.</p><p><strong>Conclusions: </strong>PPI-refractory laryngeal symptoms are mostly associated with psychological comorbidities and sleep disturbances. Recognition of these psychosocial comorbidities may help optimize management in these patients.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/be/jnm-29-3-314.PMC10334203.pdf","citationCount":"1","resultStr":"{\"title\":\"Proton Pump Inhibitor-unresponsive Laryngeal Symptoms Are Associated With Psychological Comorbidities and Sleep Disturbance: A Manometry and Impedance-pH Monitoring Study\",\"authors\":\"Wen-Hsuan Tseng, Wei-Chung Hsu, Tsung-Lin Yang, Tzu-Yu Hsiao, Jia-Feng Wu, Hui-Chuan Lee, Hsiu-Po Wang, Ming-Shiang Wu, Ping-Huei Tseng\",\"doi\":\"10.5056/jnm22099\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background/aims: </strong>Laryngeal symptoms are largely treated with empiric proton pump inhibitor (PPI) therapy if no apparent pathology shown on ear, nose, and throat evaluation and reflux-related etiologies are suspected. However, treatment response remains unsatisfactory. This study aimed to investigate the clinical and physiological characteristics of patients with PPI-refractory laryngeal symptoms.</p><p><strong>Methods: </strong>Patients with persistent laryngeal symptoms despite PPI treatment for ≥ 8 weeks were recruited. A multidisciplinary evaluation comprising validated questionnaires for laryngeal symptoms (reflux symptom index [RSI]), gastroesophageal reflux disease symptoms, psychological comorbidity (5-item brief symptom rating scale [BSRS-5]) and sleep disturbance (Pittsburgh sleep quality index [PSQI]), esophagogastroduodenoscopy, ambulatory impedance-pH monitoring, and high-resolution impedance manometry were performed. Healthy asymptomatic individuals were also recruited for comparison of psychological morbidity and sleep disturbances.</p><p><strong>Results: </strong>Ninety-seven adult patients and 48 healthy volunteers were analyzed. The patients had markedly higher prevalence of psychological distress (52.6% vs 2.1%, <i>P</i> < 0.001) and sleep disturbance (82.5% vs 37.5%, <i>P</i> < 0.001) than the healthy volunteers. There were significant correlations between RSI and BSRS-5 scores, and between RSI and PSQI scores (<i>r</i> = 0.26, <i>P</i> = 0.010, and <i>r</i> = 0.29, <i>P</i> = 0.004, respectively). Fifty-eight patients had concurrent gastroesophageal reflux disease symptoms. They had more prominent sleep disturbances (89.7% vs 71.8%, <i>P</i> < 0.001) than those with laryngeal symptoms alone but similar reflux profiles and esophageal motility.</p><p><strong>Conclusions: </strong>PPI-refractory laryngeal symptoms are mostly associated with psychological comorbidities and sleep disturbances. 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引用次数: 1
摘要
背景/目的:如果在耳、鼻和咽喉评估中没有明显的病理表现，并且怀疑与反流相关的病因，则喉部症状主要采用经验性质子泵抑制剂(PPI)治疗。然而，治疗效果仍不理想。本研究旨在探讨ppi难治性喉部症状患者的临床和生理特征。方法:招募PPI治疗≥8周后喉部症状仍持续的患者。多学科评估包括对喉症状(反流症状指数[RSI])、胃食管反流病症状、心理合并症(5项简短症状评定量表[bsr -5])和睡眠障碍(匹兹堡睡眠质量指数[PSQI])、食管胃十二指肠镜检查、动态阻抗- ph监测和高分辨率阻抗测压进行有效问卷调查。健康的无症状个体也被招募来比较心理发病率和睡眠障碍。结果:对97例成人患者和48例健康志愿者进行了分析。患者的心理困扰患病率(52.6%比2.1%，P < 0.001)和睡眠障碍患病率(82.5%比37.5%，P < 0.001)明显高于健康志愿者。RSI与bsr -5评分、PSQI评分之间存在显著相关性(r = 0.26, P = 0.010; r = 0.29, P = 0.004)。58例患者并发胃食管反流病症状。他们有更明显的睡眠障碍(89.7% vs 71.8%， P < 0.001)，比那些只有喉部症状但有相似反流特征和食管运动的人。结论:ppi难治性喉部症状多与心理合并症和睡眠障碍有关。认识到这些社会心理合并症可能有助于优化对这些患者的管理。
Proton Pump Inhibitor-unresponsive Laryngeal Symptoms Are Associated With Psychological Comorbidities and Sleep Disturbance: A Manometry and Impedance-pH Monitoring Study
Background/aims: Laryngeal symptoms are largely treated with empiric proton pump inhibitor (PPI) therapy if no apparent pathology shown on ear, nose, and throat evaluation and reflux-related etiologies are suspected. However, treatment response remains unsatisfactory. This study aimed to investigate the clinical and physiological characteristics of patients with PPI-refractory laryngeal symptoms.
Methods: Patients with persistent laryngeal symptoms despite PPI treatment for ≥ 8 weeks were recruited. A multidisciplinary evaluation comprising validated questionnaires for laryngeal symptoms (reflux symptom index [RSI]), gastroesophageal reflux disease symptoms, psychological comorbidity (5-item brief symptom rating scale [BSRS-5]) and sleep disturbance (Pittsburgh sleep quality index [PSQI]), esophagogastroduodenoscopy, ambulatory impedance-pH monitoring, and high-resolution impedance manometry were performed. Healthy asymptomatic individuals were also recruited for comparison of psychological morbidity and sleep disturbances.
Results: Ninety-seven adult patients and 48 healthy volunteers were analyzed. The patients had markedly higher prevalence of psychological distress (52.6% vs 2.1%, P < 0.001) and sleep disturbance (82.5% vs 37.5%, P < 0.001) than the healthy volunteers. There were significant correlations between RSI and BSRS-5 scores, and between RSI and PSQI scores (r = 0.26, P = 0.010, and r = 0.29, P = 0.004, respectively). Fifty-eight patients had concurrent gastroesophageal reflux disease symptoms. They had more prominent sleep disturbances (89.7% vs 71.8%, P < 0.001) than those with laryngeal symptoms alone but similar reflux profiles and esophageal motility.
Conclusions: PPI-refractory laryngeal symptoms are mostly associated with psychological comorbidities and sleep disturbances. Recognition of these psychosocial comorbidities may help optimize management in these patients.
期刊介绍：
Journal of Neurogastroenterology and Motility (J Neurogastroenterol Motil) is a joint official journal of the Korean Society of Neurogastroenterology and Motility, the Thai Neurogastroenterology and Motility Society, the Japanese Society of Neurogastroenterology and Motility, the Indian Motility and Functional Disease Association, the Chinese Society of Gastrointestinal Motility, the South East Asia Gastro-Neuro Motility Association, the Taiwan Neurogastroenterology and Motility Society and the Asian Neurogastroenterology and Motility Association, launched in January 2010 after the title change from the Korean Journal of Neurogastroenterology and Motility, published from 1994 to 2009.
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