Journal of Otolaryngology and Ophthalmology of Shandong University

Multidisciplinary research and advances in gastro-oesophageal reflux disease

WU Wei, WANG Lei, CHEN Sheng, LI Lianyong, WANG Gang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 1-14. doi:10.6040/j.issn.1673-3770.0.2024.396

Abstract ( 118 )

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Laryngopharyngeal reflux disease(LPRD)is a common disease with a high prevalence in the population. The concept of gastroesophageal airway reflux disease(GARD)is more beneficial for understanding and studying the pathogenesis of airway reflux disease. Both GARD and LPRD are the root diseases of many airway problems rather than a single throat disease. Due to its diverse clinical manifestations, there are still controversies regarding diagnostic criteria and treatment standards, which urgently require multidisciplinary cooperation. This article provides an overview of the injury mechanisms, diagnostic methods and treatment progress of this type of disease in recent years, with the aim of promoting interdisciplinary communication and collaboration.

Obstructive sleep apnea and laryngopharyngeal reflux

LIU Lianlian, LI Jinrang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 15-22. doi:10.6040/j.issn.1673-3770.0.2024.056

Abstract ( 73 )

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Up to 10% of patients may present to the otolaryngology, head and neck surgery clinic with laryngopharyngeal reflux(LPR), and nearly 1 billion adults around the world aged 30-69 years may suffer from obstructive sleep apnea(OSA), indicating that both diseases have affected the quality of life of many patients and increased their medical burden. OSA and LPR share many common factors such as obesity, age, alcohol consumption, etc. Clinical practice has shown that there is a high co-morbidity between the two, and the prevalence of LPR in OSA patients is several times higher than in the general population(5.0%-30.0% vs. 45.2%). Through in-depth analysis and study of a large body of scientific literature on the relationship between the two conditions, we have gained a deeper understanding of the relationship between the two conditions, the current status of treatment, and the mechanisms involved. We review the above three points with the aim of providing research directions for the study of the intrinsic relationship between OSA and LPR, and the basis for clinical diagnosis and treatment strategies.

Role of pharyngeal reflux in common respiratory diseases

ZHANG Li, ZHANG Mengru, Alimire Aierken, QIU Zhongmin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 23-29. doi:10.6040/j.issn.1673-3770.0.2023.489

Abstract ( 65 )

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Laryngopharyngeal reflux(LPR)is an extraesophageal manifestation of gastroesophageal reflux disease(GERD), involving multiple disciplines, with variable and nonspecific clinical presentations, and its exact pathogenesis remains unclear. The gastrointestinal tract(stomach, oesophagus, etc.)is adjacent to the respiratory tract, sharing a common foregut embryonic origin and vagal innervation. The two are closely linked by the oesophago-tracheobronchial or tracheobronchial-esophageal reflex and influence each other. LPR is a potential precipitating factor for upper and lower airway inflammation and is associated with several respiratory diseases(e.g. chronic cough, chronic rhinosinusitis, asthma, obstructive sleep apnoea-hypopnoea syndrome, chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis). In clinical practice, the management of patients with respiratory diseases associated with LPR should consider a combination of therapeutic approaches to provide individualized treatment plans for patients. This article provides an overview of the role of LPR in common respiratory diseases.

Diagnosis and treatment of gastroesophageal airway reflux disease: based on related consensus and guidelines from 2020 to 2024

HU Zhiwei, CHEN Dong, YANG Dong, WU Jimin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 30-38. doi:10.6040/j.issn.1673-3770.0.2024.075

Abstract ( 383 )

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In recent years, airway diseases caused by gastroesophageal reflux have become a clinical hotspot in disciplines such as gastroenterology, otolaryngology, respiratory and gastrointestinal surgery, and new clinical evidence has been obtained. Consensus and guidelines related to gastroesophageal airway reflux diseases have been frequently released in recent years. These consensus and guidelines represent the latest progress in clinical research and treatment of reflux related disease. This review interprets the main consensus and guidelines related to reflux in recent years, and outlines the pathogenesis, clinical manifestations, diagnosis, and treatment strategies of gastroesophageal airway reflux disease.

Exploration of the relationship between laryngopharyngeal reflux and recurrent respiratory papilloma and its mechanism

ZHAO Jianing, CUI Yuanxin, WANG Dan, ZHAO Ming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 39-45. doi:10.6040/j.issn.1673-3770.0.2023.010

Abstract ( 56 )

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Laryngopharyngeal reflux(LPR)has a non-negligible role in the development of laryngeal tumors as an independent risk factor. Recurrent respiratory papillomatosis(RRP)is a disease with a very high recurrence rate, mostly in the larynx, which is benign but can be cancerous. The main treatment remains surgery, and the application of drugs, such as interferon and cidofovir, can be used as adjuvant therapy. Some studies have found that anti-reflux treatment also controls its development, and several studies have shown that LPR may be a risk factor for recurrent respiratory papillomatosis. We review the relevant literature at home and abroad that introduce the current research progress in LPR and RRP and discuss the possible relationship between LPR and RRP and the possible role of LPR in the occurrence, development, and malignant transformation of RRP to provide a theoretical basis for the next in-depth exploration of the specific mechanism and provide clinicians with new ideas for the diagnosis and treatment of RRP.

Research progress of biomarkers in laryngopharyngeal reflux disease

ZHANG Shan, CHEN Qiu, ZHOU Fangwei, MA Yifei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 46-54. doi:10.6040/j.issn.1673-3770.0.2024.122

Abstract ( 60 )

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Laryngopharyngeal reflux diease(LPRD)is a common disease in otolaryngology. Currently, the diagnostic criteria for LPRD are not uniform, and clinical manifestations combined with various auxiliary examinations are the main diagnostic methods. Patients with LPRD have different levels of certain substances compared to the normal population, which can cause damage to the pharyngeal mucosa through different mechanisms. There are many biomarkers associated with the onset of LPRD, and in addition to the most common reflux substance, gastric acid, more and more substances have received attention in recent years. These include pepsin, trypsin, neurogenic inflammatory factors, bile acids, tight junction proteins, carbonic anhydrase, mucin, MMP-7 and cell cadherin. Biomarkers have high specificity sensitivity and efficiency, which can reduce the use of diagnostic equipment such as laryngoscopy and pH impedance monitoring. Therefore, the establishment of an LPRD biomarker diagnostic system can help make LPRD diagnosis more convenient and accurate. Here is a summary of LPRD-related biomarkers and a review of their research progress in the diagnosis and treatment of LPRD.

Pepsin and laryngopharyngeal reflux disease: from pathogenic mechanisms to potential risk factors for pharyngeal and laryngeal squamous cell carcinoma

ZHOU Shitong, YANG Yanyan, YANG Yucheng, FANG Hongyan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 55-60. doi:10.6040/j.issn.1673-3770.0.2023.343

Abstract ( 76 )

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Laryngopharyngeal reflux disease(LPRD)is an inflammatory disease of the tissues of the upper aerodigestive tract caused by the direct or indirect action of reflux of gastroduodenal contents, with pepsin as the main causative agent. Numerous studies have shown a strong association between laryngeal reflux and squamous cell carcinoma of the pharynx and larynx. Nonetheless, the ongoing debate as to whether laryngeal reflux is a risk factor for laryngeal squamous cell carcinoma remains inconclusive. Pepsin, the main pathogenic factor of LPRD, has been shown to play a crucial role in the oncogenesis of squamous cell carcinoma of the pharynx and larynx. Possible mechanisms include damage to the epithelium of the pharyngeal and laryngeal mucosa, disruption of the epithelial defense barrier, induction of inflammation, and alterations in genes and miRNA. This article provides a comprehensive review of the role and mechanism of LPRD, with a special focus on pepsin, in terms of pathogenic mechanisms and potential risk factors for pharyngeal and laryngeal squamous cell carcinoma, with the aim of facilitating the explanation of oncogenesis and inspiring innovative therapeutic approaches in this disease.

Endoscopic treatment of laryngopharyngeal reflux disease

XI Xiaoyu, SUI Xinke, CHEN Sheng, LI Lianyong, ZHONG Changqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 61-65. doi:10.6040/j.issn.1673-3770.0.2024.260

Abstract ( 63 )

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Laryngopharyngeal reflux disease denotes the comprehensive manifestation of gastrointestinal contents refluxing to the region above the esophageal sphincter, eliciting a spectrum of symptoms and signs. Treatment has traditionally relied on proton pump inhibitors as the primary intervention, while laparoscopic fundoplication stands as the predominant surgical modality. With the continuous evolution of digestive endoscopy technology, a myriad of novel endoscopic techniques have emerged. These techniques confer advantages such as reduced hospitalization duration, marked alleviation in symptomatology, diminished incidence of complications, and favorable cost-effectiveness. Illustrative examples encompass endoscopic mucosal resection for anti-reflux, radiofrequency ablation, and transoral incisionless fundoplication. This manuscript offers a comprehensive exposition of such endoscopic modalities.

Expression analysis of pepsin in vocal cord leukoplakia tissues

NIU Yanyan, GU Wei, JIN Xiaofeng, HUO Hong, YANG Dahai, CUI Tingting, WANG Jian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 66-70. doi:10.6040/j.issn.1673-3770.0.2024.073

Abstract ( 42 )

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Objective To investigate the expression of pepsin in different pathological types of vocal cord leukoplakia tissues and to explore the relationship between vocal cord leukoplakia and laryngopharyngeal reflux(LPR), providing evidence for the prevention and treatment of vocal cord leukoplakia. Methods Clinical data of 71 patients with vocal cord leukoplakia were retrospectively analyzed. Immunohistochemical staining was used to analyze the expression of pepsin in vocal cord leukoplakia tissues. Multivariate analysis was performed to clarify the relationship between laryngopharyngeal reflux and vocal cord leukoplakia. Results Among the 71 patients, there were 63 males and 8 females. The age ranged from 40 to 75 years with a mean age of 58.6±8.6 years. The proportions of positive pepsin staining in the low-grade dysplasia group and the high-grade dysplasia group of vocal cord leukoplakia were 23.4%(11/47)and 75%(18/24), respectively, with statistical significance. After adjustment for possible risk factors such as age, gender, smoking and alcohol consumption, positive pepsin expression also increased the risk of high-grade dysplasia with an odds ratio of 9.64(95%CI:2.96-31.38). Conclusion Pepsin, as a biomarker of LPR, is an independent risk factor for high-grade dysplasia of vocal cord leukoplakia. LPR may be one of the potential risk factors for high-grade dysplasia of vocal cord leukoplakia.

Correlations between vocal cord hyperplastic lesions, vocal cord leukoplakia, chronic laryngopharyngitis, and laryngopharyngeal reflux

WANG Lei, WANG Gang, SUN Zhezhe, LIU Hongdan, HAN Haolun, LI Baowei, ZHANG Xiaoli, WU Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 71-77. doi:10.6040/j.issn.1673-3770.0.2023.028

Abstract ( 56 )

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Objective The purpose of this study was to explore the correlations between vocal cord hyperplastic lesions, vocal cord leukoplakia, chronic laryngopharyngitis, and laryngopharyngeal reflux(LPR). Methods A retrospective analysis of 153 patients with benign vocal cord hyperplastic lesions(including 92 cases of vocal cord polyps, 24 cases of vocal cord cyst, and 37 cases of Reinke’s edema), 53 patients with vocal cord leukoplakia, and 106 patients with chronic laryngopharyngitis was performed. Reflux symptom index(RSI), reflux finding score(RFS), and oropharyngeal pH monitoring results were analyzed. The positive rate of LPR and the reflux-related indexes of each group were compared. Multi-factor logistic regression analysis was performed and included age, sex, smoking, and drinking habits. Results The prevalence of LPR in the vocal cord lesion group(benign vocal cord hyperplastic lesions and leukoplakia)was significantly higher than in the laryngopharyngitis group, according to the RSI, RFS, Ryan score, W score, and other parameters of oropharyngeal pH monitoring(P<0.05). The leukoplakia group had the lowest positive rate of RSI, but the reflux-related parameters of pH monitoring were significantly higher than those in other groups(P<0.05). The positive rate and W score in the vocal cord cyst group were second to those in the leukoplakia group. Multivariate analysis showed that LPR was an independent risk factor for leukoplakia, except for old age, male, and smoking. LPR was also a risk factor for vocal cord cysts when W score was considered as the standard. Conclusions LPR is associated with a variety of laryngeal diseases. Vocal cord hyperplastic lesions and leukoplakia are related to LPR more closely than laryngopharyngitis disease, especially leukoplakia. Further studies to validate the relationship between vocal cord cysts and LPR are necessary.

Study of the association between salivary microbiota and reflux symptoms in patients with laryngopharyngeal reflux

CUI Xiaohuan, YIN Longlong, ZHANG Yanping, JIANG Xingwang, LI Lina

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 78-84. doi:10.6040/j.issn.1673-3770.0.2024.111

Abstract ( 52 )

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Objective To investigate the correlation between salivary microbiota and symptoms in laryngopharyngeal reflux(LPR)patients. Methods Patients with a reflux symptom index(RSI)score>13 and an apparent response after 8 weeks of proton pump inhibitor medication were enrolled as the LPR group in the Department of Otorhinolaryngology Head and Neck Surgery, the Eighth Medical Center, Chinese PLA General Hospital from February 2022 to November 2022. Another 34 matched healthy volunteers were enrolled as the control group. Their saliva samples were collected, and salivary microbiota was detected and analysed by 16S rRNA gene sequencing. The correlation between differential bacteria in LEfSe analysis and RSI scores was investigated. SPSS 25.0 software was used for statistical analysis. Results LEfSe difference analysis showed that Lactobacillus_murinus, Lactobacillaceae, Lactobacillus, Prevotellaceae, Prevotella, Bacteroidales, Bacteroidia, Bacteroidetes and other 30 species were enriched in the LPR group. Firmicutes, Bacilli, Pseudomonas and other 28 species were enriched in the control group. The correlation analysis demonstrated that the relative abundance of Bacteroidetes, Bacteroidetes, Bacteroidetes, Prevotellaceae and Prevotella were positively correlated with the symptom score of gastric burning sensation, chest pain, dyspepsia or stomachache, and the relative abundance of Prevotella was significantly correlated with the above symptoms(P<0.05). The relative abundance of Prevotella_oralis was positively correlated with the symptom score of difficulty to swallow food, liquids, and tablets(P<0.05). The relative abundance of Lactobacillaceae and Lactobacillu was negatively related to the total score of RSI. Conclusion The salivary dysbiosis might be related to the reflux symptoms of LPR patients and modify the imbalance of ecology in saliva might help to alleviate the symptoms.

Changes in endoscopic and pathological indices of the lower oesophageal mucosa in patients with simple pharyngeal reflux

LI Dou, SUI Xinke, YANG Xiaoman, GUO Hongyuan, WANG Min, ZHONG Changqing, LI Lianyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 85-90. doi:10.6040/j.issn.1673-3770.0.2024.197

Abstract ( 44 )

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Objective To investigate the changes in endoscopic and pathological indices of the lower oesophageal mucosa in patients with simple oesophageal reflux. Methods The data of patients with simple LPR and healthy controls were retrospectively analysed and observed using cytotronic endoscopy to compare the number, morphology and dilated intercellular spaces(DIS)width, cell number, cell nucleus size and cell morphology of the intrapapillary capillary loops(IPCLs)in the mucosal epithelium of the lower esophagus between the two groups, and biopsies were taken from 4 quadrants of the lower esophagus 2cm above the dentate line of the two groups using HE staining. width, cell number, nucleus size and cell morphology, and biopsies were taken from 4 quadrants 2 cm above the dentate line in the lower esophagus of the two groups, and HE staining was used to compare the two groups in terms of pathology of dilatation of intrapapillary capillaries, congestion and prolongation of papillae; hyperplasia of cells in the basal layer; infiltration of eosinophils and neutrophils; widening of the intervals between mucosal epithelium; and balloon-like expansion of epithelial cells. swelling, and statistically analysed the differences between the above groups. Results There were no significant differences in age, sex, body mass index(BMI)and disease progression between the two groups(P>0.05). There were significant differences between the two groups in the number of increased IPCLs, the width of the DIS, the number of increased cells and the size of the nucleus, as well as in the three pathological indicators of intrapillary telangiectasia, congestion, papillary elongation, eosinophilic and neutrophil infiltration and widening of the mucosal epithelial space(P<0.05). Conclusion In patients with simple pharyngopharyngeal reflux there were early endoscopic and pathological microscopic changes in the lower oesophageal mucosa.

Influence of body positions on laryngopharyngeal reflux disease

SUN Zhezhe, WANG Gang, WANG Lei, LI Baowei, HAN Haolun, LIU Hongdan, ZHANG Xiaoli, WU Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 91-95. doi:10.6040/j.issn.1673-3770.0.2024.098

Abstract ( 48 )

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Objective To explore the characteristics of different postural reflux patterns in laryngopharyngeal reflux disease. Methods In a retrospective study, we reviewed the clinical data of 987 patients with symptoms of LPRD from May 2016 to May 2023. According to the upright and supine Ryan index, patients with positive Ryan index were divided into upright-positive, supine-positive and double-positive groups, and the RSI, RFS and various reflux parameters of each group were compared. Statistical analysis was performed with SPSS 24.0. Results Among the 987 subjects, 288 cases were positive for Ryan index, of which 176 cases(61.1%)were upright positive, 47 cases(16.3%)were supine positive, and 65 cases(22.6%)were double positive. There was no statistically significant difference in gender and age among the groups, and there was no significant difference in RSI score and positive rate among the groups(P=0.29, P=0.345). The scores for the excess throat mucus or postnasal drip were higher in upright-positive group than in the supine-positive group(P=0.008). There was no significant difference in RFS scores and sub-items among the groups, but the positive rate of RFS in the double-positive group was higher than that in the supine-positive and upright-positive groups(P=0.009). Comparison of pH monitoring parameters showed that the percentage of reflux time, the number of refluxes, and the longest reflux time were significantly higher in the double-positive group than in the other two groups(P<0.001). The percentage of reflux time and the longest reflux time in the upright group were significantly shorter than those in the supine group(P<0.001), but there was no significant difference in the total number of refluxes between the two groups(P=0.357). Conclusion The upright reflux pattern is predominant in the LPRD patiens. Upright relux events are characterised by air-containing reflux and short duration. Upright reflux was less damaging to the mucosa, but could cause more serious subjective symptoms.

Study of the laryngeal reflux symptom index and analysis of influencing factors in pregnant women

WEI Xin, XING Dongsheng, ZHAI Zhenwei, YAN Aihui, LIU Zhenyu, CAO Hongwei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 96-102. doi:10.6040/j.issn.1673-3770.0.2024.046

Abstract ( 49 )

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Objective To explore the throat reflux in women in the course of pregnancy and analyze the influencing factors. Methods The medical records of pregnant women from January 2020 to October 2023 were prospectively collected, and the number of reflux symptoms, age, height, and corresponding gestational weight, body mass index, uterine length, and abdominal circumference were recorded for statistical analysis. Results This study included 150 valid respondents and 1350 valid questionnaires from 150 groups, including 381 questionnaires with RSI>13 points. From 22 to 46 years old, Mean(29.66±4.971)years; 153 to 175 cm, Mean(163.0±5.005)cm; Body mass of 43 to 86 kg when enrollment, Mean(58.83±8.924)kg, BMI(16.18-29.76), average(22.12±2.908), from(35⁺⁴)weeks to(41⁺⁶)weeks at delivery, Body mass 55 to 124 kg, mean(76.19±12.52)kg, BMI(20.70 to 42.41), Average(28.63±4.380). As the gestational age increases, Gradually increase increased body mass, BMI, RSI. RSI positive rate in early pregnancy was 19.33%, second trimester 33.33%, Late pregnancy trimester 66.67%, The difference was statistically significant(P<0.05). Univariate analysis of the influence of RSI, RSI, 13 by gestational age, age, height, BMI and abdominal circumference, where the gestational week comparison difference was statistically significant(P<0.05). The other factors were not significant(P>0.05). Univariate analysis of the effects of gestational age, age, height, BMI, uterine length, and abdominal circumference on RSI>13 in the middle and late trimester. Among them, gestational age, BMI, uterine length and abdominal circumference were significantly different(P<0.05), There was no significant difference between age and height(P>0.05).In multivariate Logistic regression analysis, four factors including gestational age, BMI, uterine length, and abdominal circumference showed that BMI and abdominal circumference on RSI>13(P<0.05), an independent risk factor for RSI>13, ROC for AUC=0.922, 27.265, ROC for abdominal circumference and RSI>13, AUC=0.896, 88.5, were statistically significant(P<0.001). Conclusion With the increase of BMI and abdominal circumference during pregnancy, the proportion of RSI>13 increased,BMI and abdominal circumference can be used as important indicators for obstetricians to assess whether pregnant women are at risk of LPRD.

Gastroesophageal reflux disease and laryngopharyngeal reflux disease in 25 elderly patients with pneumonia

LI Fengjiang, WEI Jie, LIU Hongdan, ZHANG Li, ZHAO Weichao, WU Nana, WANG Lei, WU Wei, WANG Ruijuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 103-107. doi:10.6040/j.issn.1673-3770.0.2024.062

Abstract ( 46 )

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Objective To investigate the clinical characteristics of gastroesophageal reflux disease(GERD)and laryngopharyngeal reflux disease(LPRD)in elderly patients with pneumonia. Methods The study was conducted on elderly patients with pneumonia hospitalized in the respiratory department at the Ninth Medical Center of Chinese PLA General Hospital from January 2022 to December 2023. These patients completed 24-hour Dx-pH monitoring and had complete hospital records. The study involved analyzing the clinical characteristics in patients with gastroesophageal and laryngopharyngeal reflux were analyzed. Results Of the 23 patients who underwent pharyngeal pH monitoring, 10 had a Ryan index score >6.79 in the supine position, one patient had a Ryan index score >9.41 in the upright position, and 16 had a W index greater than 0. Among the 20 patients who underwent 24-hour esophageal Dx-pH monitoring, 3 had a DeMeester score ≥14.72, and 4 had an acid exposure time(AET)≥4.0%. In the laryngopharyngeal reflux group, pneumonia was observed in the right upper lobe in 7 patients(63.6%), compared to 4 patients(33.3%)in the non- laryngopharyngeal reflux group. CURB-65 scores were 2.45±0.82 for patients with laryngopharyngeal reflux and 2.08±0.79 for those without laryngopharyngeal reflux. Among patients with laryngopharyngeal reflex, 4(36.4%)died within 28 days, while only one(8.3%)patient without laryngopharyngeal reflux died during the same period. Conclusions Elderly patients with pneumonia are susceptible to GERD and LPRD. Among patients with laryngopharyngeal reflux, inflammation in the upper lobe of the right lung and the lower lobe of the left lung is high, and the mortality rate in this group is significantly increased.

Analysis of reflux types in patients with laryngeal reflux associated with Helicobacter pylori infection

LIU Xiaohong, ZHANG Qingqing, GUO Ruixin, QIANG Yin, SHI Yao, YANG Haonan, CAO Nan, JIA Wei, XIE Meng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 108-114. doi:10.6040/j.issn.1673-3770.0.2024.059

Abstract ( 42 )

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Objective To investigate the reflux types of Laryngopharyngeal reflux(LPR)patients with Helicobacter pylori(HP)infection. Methods According to ¹⁴C breath test and 24-hour impedance pH monitoring(24 h MII-pH), all LPR patients were divided into HP(+)LPR patients(the experimental group)and HP(-)LPR patients(the control group). Both experimental and control patients underwent electronic laryngoscopy and completed reflux symptom index(RSI)and reflux finding score(RFS). The RSI and RFS scores, the number of total reflux, acid reflux and non-acid reflux and the reflux types were analyzed and compared to explore the difference between the experimental group and the control group. Results Combined with the results of 24 h MII-pH monitoring and ¹⁴C breath test, 54 patients were LPR(+), including 14 cases HP(+)(the experimental group)and 40 cases HP(-)(the control group), and the infection rate of HP was 25.93%(14/54). In the experimental group and the control group, there were no significant differences in the total score of the RSI(P=0.424>0.05)and RFS(P=0.382>0.05)scale and the incidence of symptoms and signs(P>0.05), and there were also no significant differences in the total number of reflux(P=0.470>0.05), acid reflux(P=0.207>0.05)and non-acid reflux(P=0.921>0.05)between them(P>0.05). In the experimental group, the proportion of non-acid reflux was significantly higher than that of acid reflux(57.14% vs. 14.29%,P⁺_Non-acid=0.046),while the ratio between mixed reflux and non-acid reflux and the ratio between mixed reflux and acid reflux were both no significant different(P>0.05).In the control group the proportions of mixed reflux and non-acid reflux were significantly higher than those of acid reflux(45.00% vs. 15.00%,P^-_Mix=0.003;40.00% vs. 15.00%,P^-_Non-acid=0.012), but there was no significant difference between mixed reflux and non-acid reflux ratio(P=0.651). Conclusion Compared with the HP(-)LPR patients, the main reflux type of HP(+)LPR patients was non-acid reflux, and the symptoms and signs of cough, subglottic edema and thick endolaryngeal mucus were more obvious.

Impact of acid reflux event thresholds on the diagnosis and management of oesophageal reflux disease

DU Chen, YAN Yan, WANG Li, LU Peiquan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 115-119. doi:10.6040/j.issn.1673-3770.0.2024.057

Abstract ( 47 )

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Objective To compare the similarities and differences of 24-hour multichannel intraluminal impedance pH monitoring(24 h MII-pH)with empiric proton pump inhibitor(PPI)therapy in the diagnosis of laryngopharyngeal reflux disease(LPRD), and to analyze the benefits of empiric PPI therapy in patients with negative 24 h MII-pH monitoring. Methods A total of 70 patients suspected of having LPRD, who attended the otolaryngology department of our hospital from January 2017 to December 2019, were selected. Reflux symptom index(RSI)and reflux finding score(RFS)were evaluated. 24-hour MII-pH monitoring and empiric PPI treatment for 8 weeks were performed. The diagnostic results of pH<4 and pH<5 as the pathological threshold defining acid reflux events in 24h MII-pH monitoring was statistically analyzed, and the consistency with empiric PPI therapy was calculated separately. The PPI treatment effect of negative patients with pH <4 but positive with pH <5 was observed. Results Of the 70 patients, 41 responded to empirical PPI treatment. When pH <4 was used as the pathological threshold, 35 patients were positive, the diagnostic results were moderate(κ=0.429)with empiric PPI therapy, and the diagnostic sensitivity was 68.3%. When pH <5 was used as the pathological threshold, 47 patients were positive, the diagnostic results were moderate(κ=0.514)with empiric PPI therapy, the diagnostic sensitivity was 87.8%. A total of 12 patients were negative at pH<4 but positive at pH<5. Among these 12 patients, a total of 8(36-28)patients were effectively treated with empiric PPI treatment, and the treatment response rate was 66.7%. Conclusion The diagnosis of empiric PPI therapy was well consistent with the diagnosis of empiric PPI therapy when pH <5 was used as the pathological threshold. In patients with a negative pH <4 threshold but a positive pH <5 threshold, there are still patients responded to empiric PPI therapy. Suggests that an appropriate increase in the pH threshold could increase the likelihood of benefiting from empiric PPI therapy in patients with negative 24-hour MII-pH monitoring.

Analysis of the two-year clinical effectiveness of anti-reflux mucosectomy in 74 patients with laryngopharyngeal reflux

ZHANG Bin, CHEN Sheng, LI Bing, XI Xiaoyu, ZHONG Changqing, GAO Xiaopei, LI Lianyong, SUI Xinke

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 120-125. doi:10.6040/j.issn.1673-3770.0.2024.185

Abstract ( 45 )

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Objective To evaluate the two-year clinical efficacy of endoscopic anti-reflux mucosectomy(ARMS)in the treatment of laryngopharyngeal reflux disease(LPRD). Methods A retrospective analysis was performed on 221 patients who underwent ARMS and had available follow-up data. All patients were diagnosed with LPRD by oropharyngeal pH monitoring. Comparisons were made between pre-operative and two-year post-operative Reflux Symptom Index(RSI)scores and 24-hour Dx-pH monitoring results to assess the efficacy of ARMS in the treatment of LPRD. Patients were also grouped by gastroesophageal valve(GEFV)grade to investigate the influence of GEFV on ARMS efficacy. Results 74 out of 221 patients were included in the study. RSI scores decreased significantly compared to preoperative values(P=0.005), with the most notable improvements observed in hoarseness/voice disorders, persistent throat clearing, difficulty swallowing food, liquids or pills, heartburn, chest pain and stomach pain(P=0.013, 0.04, 0.043, 0.02). According to the Dx-pH monitoring, the upright Ryan score decreased significantly compared to preoperative values(P<0.001). Patients with GEFV grades Ⅰ and Ⅱ showed a significant improvement in Ryan scores in the upright position postoperatively(P<0.05), while no significant changes were observed in Ryan scores in the supine position(P>0.05). In patients with GEFV grades Ⅲ and Ⅳ, no significant changes were observed in either the upright or supine Ryan scores postoperatively(P>0.05). Conclusion ARMS can effectively improve symptoms of LPRD and GEFV grading is valuable in predicting prognosis. Patients with GEFV grades Ⅰ and Ⅱ show significant symptom improvement, whereas patients with GEFV grades Ⅲ and Ⅳ show limited surgical benefit.

A case of infantile hypopharyngeal gastric mucosal ectasia causing pharyngeal reflux symptoms and review of the literature

YAO Tingting, ZHANG Delun, LI Lan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 126-130. doi:10.6040/j.issn.1673-3770.0.2024.110

Abstract ( 43 )

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Objective To explore the diagnosis and treatment options for pharyngeal reflux symptoms caused by gastric mucosal ectasia in the hypopharynx. Methods The medical records of a 4-month-old boy were reviewed. The child was admitted to the hospital with "laryngeal tinnitus with episodic dyspnea". The diagnosis of laryngopharyngeal reflux was made on the basis of the child's medical history, laryngoscopic findings, and the RSI scale score. Two spherical masses at the junction of the larynx and the esophageal inlet were examined by electron laryngoscopy and surgically removed. Pathology suggested that the masses were an ectopic gastric mucosa. Results At follow-up examinations at 3 months, 1 year and 3 years after surgery, the children's respiratory and swallowing functions improved significantly and there was no recurrence of the masses. Conclusion Ectopic gastric mucosa in the hypopharynx is rarely reported. In the process of diagnosing pharyngeal reflux in children, if mucosal lesions or masses are found in the pharynx, the possibility of gastric mucosal ectasia should be alerted. Surgical resection of the mass is the mainstay of treatment, and proton pump inhibitors can be used to control reflux symptoms during treatment.

A case of otitis media associated with pharyngeal reflux with literature review

ZHOU Ying, WANG Gang, WANG Lei, ZHANG Xiaoli, HAN Haolun, LI Baowei, SUN Zhezhe, WU Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 131-135. doi:10.6040/j.issn.1673-3770.0.2024.052

Abstract ( 62 )

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Objective To investigate the clinical characteristics, diagnosis and treatment of reflux-associated otitis media. Methods A case of reflux-associated otitis media was reviewed. The patient presented to our hospital with cough and left ear fullness. Laryngopharyngeal reflux was suggested by scale evaluation, pH monitoring, and pepsin was detected in tympanic puncture fluid. The patient was treated with acid inhibition, gastric motility improvement, antiallergics, airway stabilisation, nasal hormone spray, evacuation and atomised inhalation. Results Three months later, the patient's symptoms had disappeared and the test results were normal. The relevant national and international literature was searched to analyse the causes of the disease and the effect of laryngopharyngeal reflux on the airway. Conclusion Laryngopharyngeal reflux may be involved in the pathogenesis of recurrent secretory otitis media, sinusitis and chronic lung disease.

Meta-analysis of the clinical efficacy and safety of proton pump inhibitors versus gastric mucosal protective agents in the treatment of laryngopharyngeal reflux disease

MI Xueqin, LI Songzhe, DENG Yingjie, LI Shengyang, XIAO Dingqi, FAN Lei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(6): 136-142. doi:10.6040/j.issn.1673-3770.0.2024.491

Abstract ( 44 )

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Objective To analyse the clinical effectiveness and safety of proton pump inhibitors(PPIs)and gastric mucosal protectors in the treatment of laryngopharygeal reflux disease(LPRD)by Meta-analysis. Methods The CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane library, Web of Science databases on PPIs, gastric mucosal protectors and LPRD were retrieved up to September 2024. Two reviewers screened the literature, extracted data and performed meta-analysis of studies that met the quality criteria using R4.3.1 software. Results Six randomised controlled trials(RCT)were included, and the results of the meta-analysis showed that the response rate of LPRD with PPIs was better than that of gastric mucosal protectors ［RR=1.19(95%CI:1.10-1.29, P<0.000 1)］; the incidence of adverse reactions of PPI treatment in LPRD was not significantly different from that of gastric mucosal protectors ［RR=0.51(95%CI:0.18-1.41, P=0.19)］; the differences were statistically significant. Conclusion In short-term treatment with an LPRD course of no more than 4 weeks, PPIs significantly improved clinical efficacy compared with gastric mucosal protectors, but the incidence of adverse effects was not significantly different from that of gastric mucosal protectors.

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