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Link between pharyngeal acid reflux episodes and the effectiveness of proton pump inhibitor therapy

World Journal of Gastroenterology 2024年第48期30卷 5162-5173页

作者： Yen-Yang Chen Chen-Chi Wang Chun-Yi Chuang Yung-An Tsou Yen-Chun Peng Chi-Sen Chang Han-Chung Lien Division of Gastroenterology Taichung Veterans General HospitalTaichung 402TaiwanChina Department of Otolaryngology Taichung Veterans General HospitalTaichung 402TaiwanChina School of Medicine National Yang Ming Chiao Tung UniversityTaipei 112TaiwanChina School of Speech Language Pathology and Audiology Chung Shan Medical UniversityTaichung 402TaiwanChina School of Medicine Chung Shan Medical UniversityTaichung 402TaiwanChina Department of Otolaryngology Chung Shan Medical University HospitalTaichung 402TaiwanChina Department of Otorhinolaryngology-Head and Neck Surgery China Medical University HospitalTaichung 400TaiwanChina Division of Gastroenterology and Hepatology Department of Internal MedicineTungs’Taichung Metro Harbor HospitalTaichung 435TaiwanChina Division of Gastroenterology Center for Functional Esophageal DisordersTaichung Veterans General HospitalTaichung 402TaiwanChina Department of Post-Baccalaureate Medicine College of MedicineNational Chung Hsing UniversityTaichung 402Taiwan

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.

关键词： pharyngeal acid reflux episodes Laryngopharyngeal reflux Hypopharyngeal multichannel intraluminal impedance-pH 3-pH-sensor Proton pump inhibitors

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