Reflux Laryngıtıs: Dıagnosıs and Treatment

Yıl 2019, Cilt: 11 Sayı: 2, 71 - 76, 29.03.2019

Opr. Dr. Seher Şirin

Öz

Abstract

Reflux disease is defined as retrograde movement of the gastric content that causesign and/or symptoms which affecting the quality of life. There is no reliable test defined as  ‘gold standard’ for a definitive diagnosis of this very prevalent disease. The mostreliable diagnostic method for reflux laryngitis is remission of symptoms and signs bylifestyle changes and anti-reflux treatment.Laryngeal mucosa, is more sensitive to acid than the esophagus. Thus a smaller amount and shorter exposure consists cell damage. Therefore reflux laryngitis therapy should be more aggressive and longer. Reflux laryngitis symptoms respond to treatment welland recovery occurs quickly. But  physical examination findings heals in long-term. Non-healing patients who have revealed pathological reflux with monitoring under treatment,high-dose or super high-dose PPI therapy provides better results. In  patients who developed severe complications or have to use continuous PPI, ifthey have revealed pathological reflux, laparoscopic anti-reflux surgery is a promisingmethod in selected patients.

Anahtar Kelimeler

Reflux, Reflux Laryngitis, Laryngopharyngeal reflux, anti-reflux surgery

Reflü Larenjit: Tanıve Tedavi

Öz

Öz

Gastrik içeriğin retrograd hareketi ile kişinin yaşam kalitesini etkileyen semptomve/veya bulgulara yol açması reflü hastalığı olarak tanımlanmaktadır. Çok yaygın görüldüğü kabul edilen bu hastalığın kesin tanısı için güvenilir altın standart bir test bulunmamaktadır. Reflü larenjitin en güvenilir tanı yöntemi,  değiştirilen yaşam şekli ve anti-reflü tedavi ile semptom ve bulgularda gerileme olmasıdır.  Larenks mukozası,aside özefagustan daha duyarlıdır. Dolayısıyla daha az miktarda ve daha kısa süreli maruziyet ile hücre hasarı oluşmaktadır. Bu nedenle reflü larenjit daha agresif ve dahauzun süreli tedavi edilmelidir. Reflü larenjit semptomları tedaviye çok iyi cevap verir ve çabuk düzelir. Ancak bulguların iyileşmesi zaman alır. Tedaviye cevap vermeyen hastalarda, tedavi altında yapılan monitorizasyon ile patolojik reflü ortaya konulmuşsa, yüksek doz veya süper yüksek doz proton pompa inhibitörü (PPİ) tedavisi yarar sağlar. Patolojik reflüsü ortaya konulmuş, devamlı PPİ kullanmak zorunda olan veyaciddi komplikasyon gelişmiş hastalarda laparoskopik anti-reflü cerrahi seçilmiş hastalarda gelecek vaat eden bir yöntemdir.

Anahtar Kelimeler

Reflü, Reflü Larenjit, Larengofarengeal reflü, Antireflü cerrahi

Kaynakça

• Kaynaklar 1.Mungan Z. Prevalence and demographic determinants of gas-troesophageal reflux disease (GERD) in the Turkish generalpopulation: A population-based cross-sectional study Turk JGastroenterol 2012; 23(4):323-332. 2.Koufman JA. The otolaryngologic manifestations of gastroesop-hageal reflux disease (GERD): a clinical investigation of 225 pa-tients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the deve-lopment of laryngeal injury. Laryngoscope 1991; 101(53):1-78. 3.Hopkins C, Yousaf U, Pedersen M. Acid reflux treatment forhoarseness. The Cochrane Library 2006. 4.El-Serag HB. Time trends of gastroesophageal reflux disease: asystematic review. Clin Gastroenterol Hepatol 2007; 5:17–26. 5.Altman KW, Stephen RM, Lyttle CS, Weiss KB. Changing im-pact of gastroesophageal reflux in medical and otolaryngo-logy practice. Laryngoscope 2005; 115(7):1145-53. 6.Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R. The Mon-treal definition and classification of gastroesophageal refluxdisease: a global evidence-based consensus. Am J Gastroen-terol 2006; 101(8):1900-20. 7.De Bortoli N, Nacci A, Savarino E, Martinucci I, Bellini M,Fattori B et al. How many cases of laryngopharyngeal ref-lux suspected by laryngoscopy are gastroesophageal reflux di-sease-related? World J Gastroenterol 2012; 18(32):4363-70. 8.Johnson N, Bulmer D, Gill GA, Panetti M, Ross PE, PearsonJP et al. Cell biology of laryngeal epithelial defenses in he-alth and disease: further studies. Ann Otol Rhinol Laryngol2003; 112(6):481-91. 9.Little FB, Koufman JA, Kohut RI, Marshall RB. Effect of gas-tric acid on the pathogenesis of subglottic stenosis. Ann OtolRhinol Laryngol 1985; 94:516-9. 10.Belafsky PC, Postma GN, Koufman JA. Validity and reliabilityof the reflux symptom index (RSI). J Voice 2002; 16(2):274-7. 11.Belafsky PC, Postma GN, Koufman JA. The validity and re-liability of the reflux finding score (RFS). Laryngoscope 2001;111(8):1313-7. 12.Powell J, Cocks HC. Mucosal changes in laryngopharynge-al reflux-prevalence, sensitivity, specificity and assessment.Laryngoscope 2013; 123(4):985-91. 13.Hickson C, Simpson CB, Falcon R. Laryngeal pseudosulcusas a predictor of laryngopharyngeal reflux. Laryngoscope 2001;111:1742-5. 14.Jette ME, Gaumnitz EA, Birchall MA, Welham NV, ThibeaultSL. Correlation between reflux and multichannel intralumi-nal impedance pH monitoring in untreated volunteers Laryn-goscope 2014; 124(10):2345–51. 15.Miller FA, Dovale J, Gunther T: Utilization of inlying pH probe forevaluation of acid-peptic diathesis. Arch Surg 1964; 89:199-203. 16.Wiener JG, Koufman, JA, Wu W. The pharyngoesophageal dual am-bulatory pH probe for evaluation of atypical manifestations of gas-troesophageal reflux (GER). Gastroenterology 1987; 92:1694-9. 17.Harrell S, Evans B, Goudy S, Winstead W, Lentsch E, Koop-man J et al. Design and implementation of an ambulatory pHmonitoring protocol in patients with suspected laryngopharyn-geal reflux. Laryngoscope 2005;115(1):89-92. 18.Merati AL, Ulualp SO, Lim HJ , Toohill RJ. Meta-analysis of upperprobe measurements in normal subjects and patients with laryngop-haryngeal reflux. Ann Otol Rhinol Laryngol 2005;114(3):177-82. 19.Carroll TL, Fedore LW, Aldahlawi MM. pH Impedance andhigh-resolution manometry in laryngopharyngeal reflux disea-se high-dose proton pump inhibitor failures. Laryngoscope2012;122(11):2473-81. 20.Vailati C, Mazzoleni G, Bondi S, Bussi M, Testoni PA et al.Oropharyngeal pH monitoring for laryngopharyngeal reflux:is it a reliable test before therapy ? J Voice 2013;27(1):84-9. 21.Worrell SG, DeMeester SR, Greene CL, Oh DS, Hagen JA.Pharyngeal pH monitoring better predicts a successful out-come for extraesophageal reflux symptoms after antireflux sur-gery. Surg Endosc 2013; 27(11):4113-8. 22.El-Serag HB, Lee P, Buchner A. Lansoprazole treatment of pa-tients with chronic idiopathic laryngitis: a placebo-control-led trial. Am J Gastroenterol 2001; 96:979–83. 23.Asaoka D, Nagahara A, Matsumoto K, Hojo M, Watanabe S.Current perspectives on reflux laryngitis. Clin J Gastroente-rol 2014; 7(6):471-5. 24.Gooi Z, Ishman SL, Bock JM, Blumin JH, Akst LM. ChangingPatterns in Reflux Care: 10-Year Comparison of ABEAMembers. Ann Otol Rhinol Laryngol 2015. doi:10.1177/0003489415592407. 25.Koufman JA. Low-acid diet for recalcitrant laryngopharyn-geal reflux: therapeutic benefits and their implications. AnnOtol Rhinol Laryngol 2011; 120(5):281-287. 26.Miner P Jr, Katz PO, Chen Y, Sostek M. Reanalysis of intra-gastric pH results based on updated correction factors for Slim-line and Zinetics 24 single-use pH catheters. Am J Gastroen-terol 2006; 101(2):404-405. 27.Lee JS, Lee YC, Kim SW, Kwon KH, Eun YG. Changes in thequality of life of patients with laryngopharyngeal reflux aftertreatment. J Voice 2014; 28(4):487-91. 28.Portnoy JE, Gregory ND, Cerulli CE, Hawkshaw MJ, LurieD, Katz PO et al. Efficacy of super high dose proton pump in-hibitor administration in refractory laryngopharyngeal reflux:a pilot study. J Voice 2014; 28(3):369-77. 29.Zentilin P, Dulbecco P, Savarino E, Parodi A, Liritano E, Bilar-di C et al. An evaluation of the antireflux properties of sodium al-ginate by means of combined multichannel intraluminal impedan-ce and pH-metry. Aliment Pharmacol Ther 2005; 21:29-34. 30.Viazis N, Keyoglou A, Kanellopoulos AK, Karamanolis G, Vlac-hogiannakos J, Triantafyllou K et al. Selective serotonin re-uptake inhibitors for the treatment of hypersensitive esopha-gus: a randomized, double-blind, placebo-controlled study. AmJ Gastroenterol 2012; 107(11):1662-7. 31.Guo H, Ma H, Wang J. Proton Pump Inhibitor Therapy for the tre-atment of Laryngopharyngeal Reflux: A meta-analysis of Rando-mized Controlled Trials. J Clin Gastroenterol 2015; 25906028. 32.Carlson MA, Frantzides CT. Complications and results of pri-mary minimally invasive antireflux procedures: a review of10,735 reported cases. J Am Coll Surg 2001;193(4):428-39. 33.Weber B, Portnoy JE, Catellanos A, Hawkshaw MJ, Lurie D,Katz PO, Sataloff RT. Efficacy of anti-reflux surgery on ref-ractory laryngopharyngeal reflux disease in professional voi-ce users: a pilot study. J Voice 2014; 28(4):492-500. 34.Sahin M, Vardar R, Ersin S, Kirazlı T, Ogut MF, Akyıldız NS,Bor S. The effect of antireflux surgery on laryngeal symptoms,findins and voice parameters. Eur Arch Otorhinolaryngol. 2015; 272(11):3375-83. 35.Tjon JA, Pe M, Soscia J, Mahant S. Efficacy and safety of protonpump inhibitors in the management of pediatric gastroesophage-al reflux disease. Pharmacotherapy 2013; 33(9):956-71. 36.Malfertheiner SF, Malfertheiner MV, Kropf S, Costa SD, Malferthei-ner P. A prospective longitudinal cohort study: evolution of GERDsymptoms during the course of pregnancy. BMC Gastroenterol 2012;12: 131. 37.Madanick RD. Proton pump inhibitor side effects and drug interac-tions: much ado about nothing? Cleve Clin J Med 2011; 78: 39-49. 38.Tantry US, Kereiakes DJ, Gurbel PA. Clopidogrel and protonpump inhibitors: influence of pharmacological interactions onclinical outcomes and mechanistic explanations. JACC Car-diovasc Interv 2011; 4: 365-80).