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 

作者机构：Division of GastroenterologyTaichung Veterans General HospitalTaichung 402TaiwanChina Department of OtolaryngologyTaichung Veterans General HospitalTaichung 402TaiwanChina School of MedicineNational Yang Ming Chiao Tung UniversityTaipei 112TaiwanChina School of Speech Language Pathology and AudiologyChung Shan Medical UniversityTaichung 402TaiwanChina School of MedicineChung Shan Medical UniversityTaichung 402TaiwanChina Department of OtolaryngologyChung Shan Medical University HospitalTaichung 402TaiwanChina Department of Otorhinolaryngology-Head and Neck SurgeryChina Medical University HospitalTaichung 400TaiwanChina Division of Gastroenterology and HepatologyDepartment of Internal MedicineTungs’Taichung Metro Harbor HospitalTaichung 435TaiwanChina Division of GastroenterologyCenter for Functional Esophageal DisordersTaichung Veterans General HospitalTaichung 402TaiwanChina Department of Post-Baccalaureate MedicineCollege of MedicineNational Chung Hsing UniversityTaichung 402Taiwan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文）)

年 卷 期：2024年第30卷第48期

页      面：5162-5173页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Biostatistics Task Force at Taichung Veterans General Hospital National Science and Technology Council, NSTC Ministry of Science and Technology, Taiwan, MOST, (111-2314-B-005-004-MY2) Ministry of Science and Technology, Taiwan, MOST 

主　　题：Pharyngeal acid reflux episodes Laryngopharyngeal reflux Hypopharyngeal multichannel intraluminal impedance-pH 3-pH-sensor Proton pump inhibitors 

摘      要：BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping *** proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are *** monitoring techno-server *** hypothesized that PAR episodes alone might also predict PPI *** To investigate whether PAR episodes alone predict a positive response to PPI *** Patients suspected of having LPR were prospectively recruited from otolaryngologic clinics in three Taiwan residents tertiary *** 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 *** A total of 522 patients(mean age 52.3±12.8 years,54%male)were *** these,190(mean age 51.5±12.4 years,61%male)completed the treatment,and 89(47%)responded to PPI *** 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(-)*** analyses using the definition of≥1 PAR episode were less *** 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.