RESUMO
UNLABELLED: The aim of the study was the quantitative and qualitative assessment of the pathological reflux episodes present in laryngological diseases in relation to GERD. These findings allowed for outlining the relationship between the reported subjective ailments and the disturbances of function and acidic refluxes diagnosed in pH-metric measurements. The study included 40 patients (23 women, 17 men) with clinical laryngological symptoms of GERD (aged 19-63 years, median 42.2): chronic persistent cough, laryngitis, pharyngitis, ulceration of vocal cords, hacking. The patients underwent laryngological check-up (direct laryngoscopy), gastroscopy, 24-hour pH-metry and manometry of the oesophagus. The analysis of the subjective symptoms reported by the patients was done according to the DeMeester's and Likert's scale. The 24-hour abdominal pH-metry was carried out with the use of microDigitrappr MARK III (Synecpol) pH-meter and antymon probe with the reference epidermal electrode. The manometric analysis of the pressure in lower oesophagal sphincter (LES) and the antral function was done with the use of Köenisberg probe integrated with microDigitrapper. RESULTS: In 80% of the patients we observed the presence of pathological acid refluxes and so called high pharyngeal refluxes (the total number of reflux episodes--91 +/- 8.2, the number of reflux episodes lasting longer than 5 minutes--19.6 +/- 4.6, "fraction time" the percentage of pH < 4.0-7.1 +/- 2.9). In this group of patients chronic laryngitis was observed in 50% of cases, chronic hacking--in 31%, persistent pain in the pharynx--in 28.1%, strong cough--in 59.4%. In 18.7% of the patients with the pathological recurrent reflux of gastro-intestinal content to the oesophagus we observed inflammatory changes of various extent in gastroscopy. We found a strong causal relationship between cough and hacking and the pathological GERD (time interval 5 min, Wiener's indicator SI > or = 75%). CONCLUSIONS: 1. The achieved results confirm the significant role of pathological GERDS in the pathogenesis of many laryngological symptoms. 2. On the basis of the achieved data it seems purposeful that the diagnosis should be much more detailed with the use of 24-hour gastroesophageal pH-metry in the patients with persistent laryngological (mainly cough and hacking) symptoms, especially in case of the patients in whom the reported symptoms are not relieved after routine laryngological treatment. 3. Our findings create the possibility for the modification of the so far diagnostic and therapeutical procedures in this group of patients and the relief of the reported subjective ailments.
