ABSTRACT
La enfermedad por reflujo gastroesofágico puede generarsíntomas respiratorios. Éstos se desencadenan cuandoel contenido esofágico refluye a la vía aérea, generandouna microaspiracion; o a través de un reflejo vago-vagal. Los síntomas respiratorios pueden ser vagos ycoexistir con la enfermedad por reflujo, sin una verdaderarelación causa-efecto. Para tratar estos pacientes,es fundamental realizar un diagnóstico preciso que asocielas dos entidades. El algoritmo debe incluir estudiosque detecten reflujo gastroesofágico, microaspiración y,de corresponder, lesión laríngea. A continuación, se debeaplicar la terapéutica más efectiva. El tratamientomédico posee menor tasa de éxito si lo comparamos conla obtenida en pacientes con síntomas típicos. Esto puededeberse a que episodios de reflujo no-ácido son losgeneradores de síntomas, a la existencia de un dañoirreversible en la vía aérea o a dosis insuficientes demedicación para neutralizar el ácido. La fundoplicaturaes un tratamiento efectivo que frena todo tipo dereflujo patológico (ácido y no-ácido). Este artículo describela utilidad de los tests diagnósticos y menciona losresultados obtenidos con las diversas formas de tratamiento.Adicionalmente, comenta acerca de la potencialaplicación de la impedancia esófago-faringea enesta población.
Gastroesophageal reflux disease can cause respiratory symptoms. These symptoms are triggered by reflux events that reach the pharynx, causing microaspiration or through vagal reflex. Respiratory symptoms can be vague and coexist with gastroesophageal reflux disease, without a real link between the two entities. To effectively treat these patients, it is important tofind an association between the two diseases. Work up should include the diagnosis of reflux disease, the diagnosis of pharyngeal reflux events -microaspiration - and, if possible, of laryngeal injury. Once the diagnosis has been established, an effective therapy must be offered to the patient. In these patients, medical treatment is less effective when compared to the results in the population with typical symptoms. This may be due to the fact that non-acid reflux episodes are causing the respiratory symptoms or as a result of an irreversible damage generated in the airway. Antireflux surgery is an effective therapy that reduces both acid and non-acid reflux events. This article describes the different diagnostic tests as well as the results obtained with surgical treatment in this population. Additionally, it describes potential applications of esophageal and pharyngeal impedance monitoring in these patients.
Subject(s)
Humans , Proton Pumps/antagonists & inhibitors , Gastroesophageal Reflux/complications , Respiration Disorders/etiology , Hydrogen-Ion Concentration , Pharynx/physiopathology , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Acoustic Impedance Tests , Respiration Disorders/diagnosis , Respiration Disorders/therapyABSTRACT
BACKGROUND AND OBJECTIVES: Proton pump inhibitors (PPIs) can improve the symptoms of laryngopharyngeal reflux (LPR) if used for more than 8 weeks, but little information is available on the effects of short-term PPI therapy as an initial treatment for LPR. We aimed to evaluate the efficacy of 4-week short-term PPI medication as an initial treatment for LPR and to identify specific symptoms which can predict the outcome of treatment. SUBJECTS AND METHOD: Among the patients complaining of more than 3 typical LPR symptoms for over 3 months, 62 patients with LPR symptom scores over 8 points were enrolled for the study. The patients were randomly subjected either to the 4 weeks of prokinetics (n=31) or PPI (n=31) medication. Changes in subjective symptoms and objective findings were assessed at first visit and 4 weeks after the medication. RESULTS: Treatment with prokinetics or PPI resulted in more than 50% reduction of LPR symptom scores in 9.6% or 29% of the patients respectively and 25-50% reduction in 54.8% or 70.9% of them. Objective reflux findings didn't get improved in either group. Analyses of the obtained reflux symptom scores failed to predict the treatment outcome of PPI medication. CONCLUSION: Short-term PPI therapy is highly effective for the reduction of LPR symptoms in selected patients, which may validate the use of PPI as an initial treatment regimen for the patients with LPR. However, further studies are required to assess the long-term effects of 4-week PPI therapy as an initial treatment regimen.