Proton pompa inhibitörlerinin larengofarengeal reflü hastalarında larengeal irritasyon üzerine etkisi

Öz

Amaç: Larengofarengeal reflü (LFR) tanısı konmuş hastaların tedavi öncesi ve tedavi sonrası larengeal irritasyon bulguları, reflü semptom indeksi (RSİ) kullanılarak değerlendirildi.

Yöntem: 24 saatlik çift problu pH monitörizasyonu sonucuna göre LFR tanısı alan 30 hasta çalışmaya dahil edildi. RSİ sorgulaması hastalara tedavi öncesi ve tedavi sonrası uygulandı. Hastalar 3 aylık proton pompa inhibitörü tedavisi sonrası geniz akıntısı ve boğaz temizleme ihtiyacı açısından reflü semptom indeksi kullanılarak tekrar değerlendirildi.
Daha sonra geniz akıntısı ve boğaz temizleme ihtiyacı tedavi
öncesi ve tedavi sonrası karşılaştırıldı.

Bulgular: Geniz akıntısında tedavi sonrası RSİ değerinde istatistiksel olarak anlamlı azalma saptandı. Boğaz temizleme ihtiyacında tedavi sonrası RSİ değerinde istatistiksel olarak anlamlı azalma saptandı.

Sonuç: Uzun süreden beri devam eden geniz akıntısı ve boğaz temizleme flikayeti olan hastalarda, herhangi bir enfeksiyon odağı saptanamamışsa; hastalar LFR açısından laringoskopik bulgular olsun ya da olmasın 24 saatlik pH monitörizasyonu ile değerlendirilmelidir.

Anahtar sözcükler: Larengofaringeal reflü, pH monitörizasyonu.

Anahtar Kelimeler

• Larengofaringeal reflü, pH monitörizasyonu

Effects of a proton pump inhibitor on laryngeal irritation in patients with laryngopharyngeal reflux

Abstract

Objective: To evaluate laryngeal irritation before and after treatment using the reflux symptom index (RSI) in patients diagnosed with laryngopharyngeal reflux (LFR). Methods: A total of 30 patients who were diagnosed with LFR after 24 hours of dual-probe pH monitoring were included in the study. RSI was applied to the patients before and after treatment. In evaluating the patients’ symptoms, throat clearing need and post-nasal drainage, which are frequently observed in LFR, were evaluated post-treatment. The patients were followed for 3 months during proton pump inhibitor treatment. Data regarding the patients’ LFR symptoms were obtained after 3 months, and the responses to treatment based on reflux symptom scale scores, post-nasal drainage, and throat clearing need were evaluated and compared with those pre-treatment. Results: The decrease in the RSI for postnasal drainage value was statistically significant after treatment. The decrease in the throat clearing RSI value was statistically significant after treatment. Conclusion: In patients with persistent postnasal drainage and throat clearing need complaints, if no infection source is identified, the patients should be evaluated by 24-hour pH monitorization in terms of LFR, irrespective of the presence or absence of laryngoscopic findings. 

Keywords

• Laryngopharyngeal reflux,pH monitoring

References

1. Kahrilas PJ, Pandolfino JE. Gastroesophageal reflux disease and its complications, including Barrett’s metaplasia. In: Feldman M, Friedman LS, Sleisenger MH, editors. Sleisenger & Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, management. 7th ed. Philadelphia, PA: Saunders; 2002. p. 599–622.
2. Winkelstein A. Peptic esophagitis: a new entity. JAMA 1935;104: 906–9.
3. Napierkowski J, Wong KH. Extraesophageal manifestations of GERD. Am J Med Sci 2003;326:285–99.
4. Weaver EM. Sociation between gastroesophageal reflux and sinusitis, otitis media, and laryngeal malignancy: a systematic review of evidence. Am J Med 2003;115 Suppl 3A:81S-89S.
5. Geterud A, Bove M, Ruth M. Hypopharyngeal acid exposure: an independent risk factor for laryngeal cancer? Laryngoscope 2003;1213:2201–5.
6. Fontana GA, Pistolesi M. Cough 3: chronic cough and gastroe- sophageal reflux. Thorax 2003;58:1092–5.
7. Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274–7.
8. Friedman M, Hamilton C, Samuelson CG, et al. The value of routine pH monitoring in the diagnosis and treatment of laryn- gopharyngeal reflux. Otolaryngol Head Neck Surg 2012;146:952–8.

9. Fusconi M, De Virgilio A, Conte M, et al. The importance of the number of reflux episodes in the diagnosis of laryngopharyngeal reflux disease. Otolaryngol Head Neck Surg 2013;148:261–6.
10. Smit CF, Tan J, Devriese PP, Mathus-Vliegen LM, Brandsen M, Schouwenburg PF. Ambulatory pH measurements at the upper esophageal sphincter. Laryngoscope 1998;108:299–302.
11. Zeleník K, Matoušek P, Urban O, Schwarz P, Stárek I, Komínek P. Globus pharyngeus and extraesophageal reflux: simultaneous pH <4.0 and pH <5.0 analysis. Laryngoscope 2010;120:2160– 4.
12. Koufman JA, Aviv JE, Casiano RR, et al. Laryngopharyngeal reflux: position statement on the Committee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127:32–35.
13. Copper MP, Smit CF, Stanojcic LD, et al. High incidence of laryngopharyngeal reflux in patients with head and neck cancer. Laryngoscope 2000;110:1007–11.
14. Yorulmaz İ. Laryngopharyngeal reflux. [Article in Turkish] KBB Forum 2002;1:22–34. Available from: http://www.kbb-forum.net/ journal/pdf/pdf_KBB_3.pdf
15. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
16. NC-ND3.0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
17. tion in any medium, provided the original work is properly cited.
18. Please cite this article as: Külekçi M, Budun R, Avinçsal MÖ, Dizdar D, Ulusoy S, Develioğlu ÖN, Topak M. Effects of a proton pump inhibitor on
19. laryngeal irritation in patients with laryngopharyngeal reflux. ENT Updates 2015;5(2):58–62.