管腔内pH监测在反流性疾病中的应用

doi:10.6040/j.issn.1673-3770.0.2019.036

摘要/Abstract

摘要： 反流性疾病包括为食管反流病(GERD)和咽喉反流性疾病(LPRD),两者虽在发病机制及表现上有所不同,但均指胃内容物向上反流导致的疾病。GERD尤其是LPRD/胃食管气道反流性疾病其临床症状缺乏特异性,且体征往往不完全与疾病严重程度相符,临床实践中做出正确诊断并不容易。pH监测可以客观直接监测食管或咽喉部酸碱度变化,克服了通过主观症状诊断的非特异性,其在反流性疾病诊断中的意义不言而喻,论文对管腔内pH监测的发展历程和其特点进行综述。

关键词: 管腔, pH检测, 胃食管反流, 咽喉反流

Abstract: Reflux diseases such as gastroesophageal reflux disease(GERD)and laryngopharyngeal reflux disease(LPRD)are caused by upward reflux of gastric contents, but differ in pathogenesis and manifestations. The clinical symptoms of GERD, especially LPRD, are non-specific; therefore, it is difficult to correctly diagnose these diseases in clinical practice. However, pH changes in the esophagus or throat can be objectively and directly monitored to circumvent diagnoses based on the non-specific subjective symptoms, and therefore can be used in the diagnosis of reflux diseases. Here, we review the developmental processes and characteristics of intraluminal pH monitoring.

Key words: Lumen, pH monitoring, Gastroesophageal reflux, Laryngopharyngeal reflux

中图分类号:

R766

孙喆喆,吴玮,王刚. 管腔内pH监测在反流性疾病中的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 90-94.

SUN Zhezhe, WU Wwei, WANG Gang. Utility of intraluminal pH monitoring in reflux diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 90-94.

参考文献

[1] Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon consensus[J]. Gut, 2018, 67(7): 1351-1362. doi:10.1136/gutjnl-2017-314722.
[2] Cherry J, Margulies SI. Contact ulcer of the larynx[J]. Laryngoscope, 1968, 78(11): 1937-1940. doi:10.1288/00005537-196811000-00007.
[3] Wiener GJ, Koufman JA, Wu WC, et al. Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring[J]. Am J Gastroenterol, 1989, 84(12): 1503-1508. PMID: 2596451.
[4] Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease(GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury[J]. Laryngoscope, 1991, 101(4 Pt 2 Suppl 53): 1-78. doi: 10.1002/lary.1991.101.s53.1.
[5] Koufman JA, Aviv JE, Casiano RR, et al. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American academy of otolaryngology-head and neck surgery[J]. Otolaryngol Head Neck Surg, 2002, 127(1): 32-35. doi:10.1067/mhn.2002.125760.
[6] Hunt R, Armstrong D, Katelaris P, et al. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease[J]. J Clin Gastroenterol, 2017, 51(6): 467-478. doi:10.1097/MCG.0000000000000854.
[7] 吴玮, 王刚, 徐小杭, 等. 胃食管气道反流性疾病提出的依据及意义[J]. 中国医学文摘(耳鼻咽喉科学), 2018, 33(1): 14-17. doi:10.19617/j.issn1001-1307.2018.01.014. WU Wei, WANG Gang, XU Xiaohang, et al. Evidence and significance of gastroesophago-airway reflux disease[J]. Chin Med Dig Otorhinolaryngol, 2018, 33(1): 14-17. doi:10.19617/j.issn1001-1307.2018.01.014.
[8] Spencer J. Prolonged pH recording in the study of gastro-oesophageal reflux[J]. Br J Surg, 1969, 56(12): 912-914. doi:10.1002/bjs.1800561211.
[9] Taghavi SA, Ghasedi M, Saberi-Firoozi M, et al. Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole[J]. Gut, 2005, 54(8): 1067-1071. doi:10.1136/gut.2004.054981.
[10] Vaezi MF, Sifrim D. Assessing old and new diagnostic tests for gastroesophageal reflux disease[J]. Gastroenterology, 2018, 154(2): 289-301. doi:10.1053/j.gastro.2017.07.040.
[11] 陈旻湖, 侯晓华, 肖英莲, 等. 2014年中国胃食管反流病专家共识意见[J]. 胃肠病学, 2015, 20(3): 155-168. doi: 10.3760/cma.j.issn.0254-1432.2014.10.001.
[12] Sidhwa F, Moore A, Alligood E, et al. Diagnosis and treatment of the extraesophageal manifestations of gastroesophageal reflux disease[J]. Ann Surg, 2017, 265(1): 63-67. doi:10.1097/SLA.0000000000001907.
[13] Ulualp SO, Roland PS, Toohill RJ, et al. Prevalence of gastroesophagopharyngeal acid reflux events: an evidence-based systematic review[J]. Am J Otolaryngol, 2005, 26(4): 239-244. doi: 10.1016/j.amjoto.2005.01.005.
[14] Johnson PE, Koufman JA, Nowak LJ, et al. Ambulatory 24-hour double-probe pH monitoring: the importance of manometry[J]. Laryngoscope, 2001, 111(11 Pt 1): 1970-1975. doi:10.1097/00005537-200111000-00019.
[15] Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M, et al. Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants[J]. J Pediatr Gastroenterol Nutr, 1989, 9(1): 34-39. doi: 10.1203/00006450-198909000-00033.
[16] Vincent DA Jr, Garrett JD, Radionoff SL, et al. The proximal probe in esophageal pH monitoring: development of a normative database[J]. J Voice, 2000, 14(2): 247-254. doi: 10.1016/S0892-1997(00)80033-8.
[17] Adhami T, Goldblum JR, Richter JE, et al. The role of gastric and duodenal agents in laryngeal injury: an experimental canine model[J]. Am J Gastroenterol, 2004, 99(11): 2098-2106. doi:10.1111/j.1572-0241.2004.40170.x.
[18] Reichel O, Issing WJ. Impact of different pH thresholds for 24-hour dual probe pH monitoring in patients with suspected laryngopharyngeal reflux[J]. J Laryngol Otol, 2008, 122(5): 485-489. doi:10.1017/S0022215107008 390.
[19] Mazzoleni G, Vailati C, Lisma DG, et al. Correlation between oropharyngeal pH-monitoring and esophageal pH-impedance monitoring in patients with suspected GERD-related extra-esophageal symptoms[J]. Neurogastroenterol Motil, 2014, 26(11): 1557-1564. doi:10.1111/nmo.12422.
[20] Ayazi S, Lipham JC, Hagen JA, et al. A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold[J]. J Gastrointest Surg, 2009, 13(8): 1422-1429. doi:10.1007/s11605-009-0915-6.
[21] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 咽喉反流性疾病诊断与治疗专家共识(2015年)[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(5): 324-326. doi:10.3760/cma.j.issn.1673-0860.2016.05.002 Subspecialty Group Of Laryngopharyngology, Editori, Subspecialty Group Of Laryngopharyngology, Society. Experts consensus on diagnosis and treatment of laryngopharyngeal reflux disease(2015)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(5): 324-326. doi:10.3760/cma.j.issn.1673-0860.2016.05.002.
[22] Ayazi S, Hagen JA, Zehetner J, et al. The value of high-resolution manometry in the assessment of the resting characteristics of the lower esophageal sphincter[J]. J Gastrointest Surg, 2009, 13(12): 2113-2120. doi:10.1007/s11605-009-1042-0.
[23] Worrell SG, DeMeester SR, Greene CL, et al. Pharyngeal pH monitoring better predicts a successful outcome for extraesophageal reflux symptoms after antireflux surgery[J]. Surg Endosc, 2013, 27(11): 4113-4118. doi:10.1007/s00464-013-3076-3.
[24] 王刚, 吴玮, 王磊, 等. Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 48-52. doi:10.6040/j.issn.1673-3770.0.2017.507. WANG Gang, WU Wei, WANG Lei, et al. Correlation analysis between Ryan index and reflux symptom index and reflux finding score, in the diagnosis of laryngopharyngeal reflux diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(4): 48-52. doi:10.6040/j.issn.1673-3770.0.2017.507.
[25] Kowalik K, Krzeski A. The role of pepsin in the laryngopharyngeal reflux[J]. Pol Otolaryngol, 2017, 71(6): 7-13. doi:10.5604/01.3001.0010.7194.
[26] MacKay RS, Jacobson B. Endoradiosonde[J]. Nature, 1957, 179(4572): 1239-1240. doi:10.1038/1791239a0.
[27] Friedman M, Schalch P, Vidyasagar R, et al. Wireless upper esophageal monitoring for laryngopharyngeal reflux(LPR)[J]. Otolaryngol Head Neck Surg, 2007, 137(3): 471-476. doi:10.1016/j.otohns.2007.04.014.
[28] Capovilla G, Salvador R, Spadotto L, et al. Long-term wireless pH monitoring of the distal esophagus: prolonging the test beyond 48 hours is unnecessary and May be misleading[J]. Dis Esophagus, 2017, 30(10): 1-8. doi:10.1093/dote/dox069.
[29] Rao NM, Campbell DI, Rao P. Two years experience of using the Bravo wireless oesophageal pH monitoring system at a single UK tertiary centre[J]. Acta Paediatr, 2017, 106(2): 312-315. doi:10.1111/apa.13667.

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