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1.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(10): 754-759, 2019 Oct 07.
Artigo em Chinês | MEDLINE | ID: mdl-31606988

RESUMO

Objective: To explore the correlation between sleep and laryngopharyngeal reflux disease by epidemiological approaches. Methods: From May 1, 2017 to April 30, 2018, data of age, gender, height, weight, smoking, alcohol consumption, constipation and high fat diet in patients in Otorhinolaryngology specialist clinic, the Eighth Medical Center, General Hospital of the Chinese PLA were retrospectively analyzed. Reflux Symptom Index (RSI), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS)were filled. According to RSI scores, patients were divided into case group and control group. The differences of the above indicators between the two groups were compared by Stata 12.0 software, and the risk factors of LPRD were analyzed by multivariate Logistic regression. Results: A total of 908 patients were enrolled, including 166 in the case group and 742 in the control group. There was no significant difference in BMI, smoking, drinking, constipation and high fat diet between the two groups (all P>0.05). The PSQI, anxiety and depression score of the case group were higher than those of the control group. The anxiety and depression scores of the patients with sleep disorders in the case group were significantly higher than those of the normal sleepers (all P<0.05). RSI of the patients with sleep disorders was higher than that of the patients with normal sleep(9.5[4.0,16.0]vs. 5.0[1.0,10.0], Z=-6.07, P<0.001). Multivariate analysis showed that sleep disorder was the risk factors of LPRD (OR=2.59, 95%CI 1.75-3.84). Conclusions: Sleep disorder is related to the occurrence of LPRD. The association between LPRD and sleep disturbances is bidirectional. Sleep disorder may also be related to the anxiety and depression in LPRD patients. Handling sleep disorder timely may benefit LPRD patients.


Assuntos
Refluxo Laringofaríngeo/complicações , Transtornos do Sono-Vigília/etiologia , Adulto , Ansiedade/complicações , Ansiedade/epidemiologia , China/epidemiologia , Depressão/complicações , Depressão/epidemiologia , Humanos , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/psicologia , Estudos Retrospectivos , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia
2.
Ear Nose Throat J ; 98(6): 346-350, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31018689

RESUMO

The aim of this study is to investigate the effect of gastric Helicobacter pylori colonization on nasal functions. The study enrolled patients (n = 100) who underwent endoscopy for gastroesophageal reflux disease. Patients with laryngopharyngeal reflux (LPR) were identified by Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Patients were divided into 2 groups: LPR (+) (n = 64) H pylori (+), RSI > 13, RFS > 7; LPR (-) (n = 36) H pylori (+), RSI < 13, RFS < 7. Visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), peak nasal inspiratory flowmeter (PNIF), mucociliary clearance (MCC), and olfactory tests were used to evaluate the nasal functions. The average VAS for nasal obstruction, PNIF, and MCC did not differ significantly between the LPR (+) and LPR (-) groups (P > .05). However, the average olfactory test scores were lower in the LPR (+) patients than the LPR (-) patients (P < .05). Also, the SNOT-22 scores were significantly higher in LPR (+) patients than in LPR (-) (P < .01). Nasal functions and symptom scores were also evaluated according to the H pylori grading. The PNIF, MCC, SNOT-22, and olfactory test results deteriorated as the gastric mucosal H pylori colonization increased (P < .05). In conclusion, nasal functions differed between LPR disease and GERD only, while the density of H pylori colonization in the gastric mucosa had an effect on nasal function.


Assuntos
Infecções por Helicobacter/epidemiologia , Refluxo Laringofaríngeo/epidemiologia , Obstrução Nasal/epidemiologia , Adulto , Idoso , Feminino , Helicobacter pylori , Humanos , Masculino , Pessoa de Meia-Idade , Depuração Mucociliar , Doenças Nasais/epidemiologia , Olfato , Escala Visual Analógica , Adulto Jovem
3.
Expert Rev Gastroenterol Hepatol ; 13(3): 213-227, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30791766

RESUMO

INTRODUCTION: Systemic sclerosis (SSc) is a multisystem connective tissue disease, characterized by chronic inflammation and vascular changes that result in esophageal smooth muscle atrophy and fibrosis. Subsequent progressive loss of peristalsis in the distal esophagus and loss of lower esophageal sphincter function lead to problems with the protective barrier and exposure of sensitive tissues to the gastroduodenal contents, a disorder called reflux disease. Areas covered: Depending on the range, nature and symptoms of the disease, the term 'reflux disease' may refer to gastroesophageal reflux, laryngopharyngeal reflux, microaspiration into the airways and silent reflux. Despite the links between these visceral complications, this connection remains controversial. This is due to a lack of complete understanding, the asymptomatic nature of the disease and the limited diagnostic accuracy of tests, which can delay diagnosis. Such delays are problematic, given that the early detection of GERD in SSc patients, the timing of assessment, the treatment of the organs involved are critical aspects of patient prognosis and disease outcome. Expert commentary: This review summarizes the most recent knowledge about the pathophysiology, diagnosis and prospective treatment of GERD in SSc patients and highlights how innovative technologies applied through an integrative, interdisciplinary approach may soon lead to effective treatment strategies.


Assuntos
Esôfago/fisiopatologia , Refluxo Gastroesofágico , Refluxo Laringofaríngeo , Aspiração Respiratória , Sistema Respiratório/fisiopatologia , Escleroderma Sistêmico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/terapia , Humanos , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/fisiopatologia , Refluxo Laringofaríngeo/terapia , Laringe/fisiopatologia , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/epidemiologia , Aspiração Respiratória/fisiopatologia , Fatores de Risco , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologia , Escleroderma Sistêmico/fisiopatologia , Escleroderma Sistêmico/terapia , Resultado do Tratamento
4.
PLoS One ; 14(2): e0212704, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30811470

RESUMO

BACKGROUND: High-quality chest compressions are imperative for Cardio-Pulmonary-Resuscitation (CPR). International CPR guidelines advocate, that chest compressions should not be interrupted for ventilation once a patient's trachea is intubated or a supraglottic-airway-device positioned. Supraglottic-airway-devices offer limited protection against pulmonary aspiration. Simultaneous chest compressions and positive pressure ventilation both increase intrathoracic pressure and potentially enhances the risk of pulmonary aspiration. The hypothesis was, that regurgitation and pulmonary aspiration is more common during continuous versus interrupted chest compressions in human cadavers ventilated with a laryngeal tube airway. METHODS: Twenty suitable cadavers were included, and were positioned supine, the stomach was emptied, 500 ml of methylene-blue-solution instilled and laryngeal tube inserted. Cadavers were randomly assigned to: 1) continuous chest compressions; or, 2) interrupted chest compressions for ventilation breaths. After 14 minutes of the initial designated CPR strategy, pulmonary aspiration was assessed with a flexible bronchoscope. The methylene-blue-solution was replaced by 500 ml barium-sulfate radiopaque suspension. 14 minutes of CPR with the second designated ventilation strategy was performed. Pulmonary aspiration was then assessed with a conventional chest X-ray. RESULTS: Two cadavers were excluded for technical reasons, leaving 18 cadavers for statistical analysis. Pulmonary aspiration was observed in 9 (50%) cadavers with continuous chest compressions, and 7 (39%) with interrupted chest compressions (P = 0.75). CONCLUSION: Our pilot study indicate, that incidence of pulmonary aspiration is generally high in patients undergoing CPR when a laryngeal tube is used for ventilation. Our study was not powered to identify potentially important differences in regurgitation or aspiration between ongoing vs. interrupted chest compression. Our results nonetheless suggest that interrupted chest compressions might better protect against pulmonary aspiration when a laryngeal tube is used for ventilation.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/terapia , Refluxo Laringofaríngeo/epidemiologia , Respiração com Pressão Positiva/efeitos adversos , Aspiração Respiratória de Conteúdos Gástricos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Estudos Cross-Over , Feminino , Humanos , Incidência , Máscaras Laríngeas/efeitos adversos , Refluxo Laringofaríngeo/etiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração com Pressão Positiva/instrumentação , Distribuição Aleatória , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Aspiração Respiratória de Conteúdos Gástricos/etiologia
5.
Laryngoscope ; 129(5): 1244-1249, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30443914

RESUMO

OBJECTIVES/HYPOTHESIS: To assess if there is a significant difference in the prevalence and severity of chronic cough symptoms in obstructive sleep apnea (OSA) patients versus non-OSA patients and examine this relationship in regard to laryngopharyngeal reflux (LPR) symptoms. STUDY DESIGN: Prospective cohort study. METHODS: Patients referred to Northwestern Medicine Sleep Lab for home sleep testing were enrolled. Patients filled out the Leicester Cough Questionnaire (LCQ) and Reflux Symptom Index (RSI) before completing sleep testing. Home sleep testing results were reviewed, and patients were separated into non-OSA and OSA groups by standard Apnea-Hypopnea Index (AHI) criteria. Demographic characteristics and questionnaire scores of the two groups were compared. The relationship between OSA severity, as determined by AHI, and LCQ and RSI scores was assessed. RESULTS: Of the 52 patients enrolled, 33 patients met criteria for OSA and 19 patients did not. Comparing patients without OSA versus those with OSA, there was a significant difference in mean LCQ score (129.9 vs. 120.0, respectively; P = .02), implying worse cough symptoms among OSA patients, and mean RSI score (3.2 vs. 11.2, respectively; P = .0013), implying worse upper-airway reflux symptoms among OSA patients. There was a significant correlation between LCQ score and AHI (r = -0.39, P = .0061) and between RSI score and AHI (r = 0.37, P = .0078). CONCLUSIONS: OSA patients demonstrate worse chronic cough and LPR-related quality of life versus non-OSA patients. Furthermore, the severity of these quality-of-life measures was correlated with the severity of the AHI. Chronic cough and particularly the pharyngeal LPR symptoms may be associated with the presence and severity of OSA. LEVEL OF EVIDENCE: 2 . Laryngoscope, 129:1244-1249, 2019.


Assuntos
Tosse/epidemiologia , Tosse/etiologia , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/etiologia , Apneia Obstrutiva do Sono/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença
6.
Curr Opin Otolaryngol Head Neck Surg ; 26(6): 392-402, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30234664

RESUMO

PURPOSE OF REVIEW: To review the recent literature on presentation, diagnosis and treatment of laryngopharyngeal reflux. RECENT FINDINGS: Patients with laryngopharyngeal reflux have a higher risk for gastroesophageal reflux and respiratory-related diseases. Many symptoms and findings are underestimated, contributing to the inconclusive results of many therapeutic trials. Additionally, little significance is given to nonacid and mixed refluxates, although a significant prevalence. The association between symptoms, signs, impedance-pH studies and pepsin detection could be the most accurate way for a clear diagnosis. 'Reflux profiling' is also important for the administration of a personalized treatment based on diet, proton pump inhibitors, alginate, magaldrate and other second-line drugs. There are only a handful of studies focusing on the addition of alginate or magaldrate to the treatment of laryngopharyngeal reflux, although their contribution has extensively been demonstrated. SUMMARY: Diagnosis remains controversial despite improvement in impedance and availability of pepsin detection in daily practice. With recent studies exhibiting a significant prevalence of nonacid or mixed refluxes, the addition of alginate or magaldrate to proton pump inhibitors should be considered. Future studies are needed to assess these new therapeutic schemes in moderate and severe laryngopharyngeal reflux.


Assuntos
Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/terapia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/epidemiologia
7.
Am J Otolaryngol ; 39(6): 776-780, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30224217

RESUMO

PURPOSE: Laryngopharyngeal reflux (LPR) is a frequent condition in Obstructive Sleep Apnoea (OSA) patients and different studies have been published in the last years about this topic. A review of the published literature regarding LPR in OSA patients has been reported. A meta-analysis to evaluate the incidence of LPR in OSA patients and correlate LPR positivity with OSA patients' characteristics has been performed. METHODS: A comprehensive review of the English language literature about LPR in OSA patients was performed using the most important electronic databases (PubMed, EMBASE, the Cochrane Library etc.). A total of 10 papers studying LPR in OSA were assessed and considered eligible for the meta-analysis. RESULTS: The data analysis regarding 870 identified OSA patients showed that 394 patients were LPR +, while 476 were LPR-. The meta-analysis showed no statistical difference regarding the AHI value between LPR + patients and LPR- patients (p = 0,3). Mean BMI was more higher in LPR + patients than in the patients without LPR, showing a significant statistical difference (p = 0.001). CONCLUSION: Current international literature demonstrates a high incidence of LPR (45.2%) in OSA patients. The severity of AHI in OSA patients would not seem to correlate with the presence of laryngopharyngeal reflux. The OSA patients with LPR showed a higher BMI compared with LPR- patients.


Assuntos
Refluxo Laringofaríngeo/epidemiologia , Apneia Obstrutiva do Sono/complicações , Humanos
8.
Artigo em Chinês | MEDLINE | ID: mdl-30121996

RESUMO

Objective: To observe the incidence and to determine the significance of laryngopharyngeal reflux (LPR) in laryngeal cancer and vocal leukoplakia. Methods: The patients who had been diagnosed as laryngeal cancer or vocal leukoplakia between January 2014 and June 2017 were included in this study. All of them received 24-hour multichannel intraluminal impedance-pH monitoring. The prevalence of LPR and numerous parameters from the 24-hour pH monitoring in laryngeal cancer patient and vocal leukoplakia patient groups were analyzed. The chi-square test was used for counting data, t test and Mann-Whitney U were used for measuring data. Results: In the 91 laryngeal cancer patients, the prevalence of pathologic LPR was 28.6%(26/91), the median number[P(25), P(75), P(95)]of acid reflux events was 0[0, 3, 5], time of acid exposure was 0[0, 14, 234]s, number of weakly acidic reflux events was 3[0, 6, 11]. In the 54 vocal leukoplakia patients, the prevalence of pathologic LPR was 29.6%(16/54), the number of acid reflux events was 0[0, 3, 4], time of acid exposure was 0[0, 13, 118]s, number of weakly acidic reflux events was 1.5[0, 5, 9]. The incidence of LPR did not vary in the laryngeal cancer patient and vocal leukoplakia patient groups, but were both higher than healthy Chinese volunteers according to a report in the other literature. Furthermore, all the three patients with no history of tobacco or alcohol existed acid or weakly acidic reflux episodes. Conclusions: Laryngopharyngeal reflux might play a role as an etiologic factor in laryngeal cancer and vocal leukoplakia.


Assuntos
Neoplasias Laríngeas/etiologia , Refluxo Laringofaríngeo/complicações , Leucoplasia/etiologia , Prega Vocal/patologia , Distribuição de Qui-Quadrado , Refluxo Gastroesofágico , Humanos , Incidência , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Neoplasias Laríngeas/epidemiologia , Refluxo Laringofaríngeo/epidemiologia , Leucoplasia/epidemiologia , Prevalência , Estatísticas não Paramétricas
9.
Am J Otolaryngol ; 39(5): 493-496, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29880317

RESUMO

OBJECTIVE: To summarize the characteristics of laryngopharyngeal reflux (LPR) in patients with chronic otitis media. METHODS: This was a prospective study in which 31 patients with chronic otitis media were enrolled. General patient information, reflux symptom index (RSI), reflux finding scores (RFSs), and Ryan scores were summarized. RESULTS: Most (29/31, 93.5%) patients had a negative RSI (RSI ≤ 13). The most common symptoms of these patients were throat clearing (22/31, 71.0%), symptoms of the stomach and esophagus (19/31, 61.3%), and excess throat mucus or postnasal drip (14/31, 45.2%). In contrast to the RSI, most patients (22/31, 71.0%) had a positive RFS (RFS > 7). Among all of the signs found under the transnasal fiber-optic laryngoscope, erythema was the most frequent symptom (31/31, 100.0%), followed by vocal cord edema (27/31, 87.1%), and posterior commissure hypertrophy (27/31, 87.1%). Most cases (24/31, 77.4%) had a positive Ryan score, and most positive scores were upright scores. CONCLUSIONS: Most patients with chronic otitis media had LPR simultaneously. The LPR in these patients manifested mainly by a positive RFS under a laryngoscope and not by symptoms of the larynx and pharynx. This suggests that LPR may be an important factor in the pathogenesis of COM and anti-reflux treatment may play a significant role in the management of chronic otitis media.


Assuntos
Refluxo Laringofaríngeo/tratamento farmacológico , Refluxo Laringofaríngeo/epidemiologia , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/cirurgia , Adulto , Doença Crônica , Estudos de Coortes , Comorbidade , Monitoramento do pH Esofágico/métodos , Feminino , Seguimentos , Humanos , Refluxo Laringofaríngeo/diagnóstico , Masculino , Mastoidectomia/métodos , Pessoa de Meia-Idade , Otite Média com Derrame/diagnóstico , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Timpanoplastia/métodos
10.
Pediatr Crit Care Med ; 19(6): 528-537, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29863636

RESUMO

OBJECTIVES: Cricoid pressure is often used to prevent regurgitation during induction and mask ventilation prior to high-risk tracheal intubation in critically ill children. Clinical data in children showing benefit are limited. Our objective was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in PICU. DESIGN: A retrospective cohort study of a multicenter pediatric airway quality improvement registry. SETTINGS: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). PATIENTS: Children (< 18 yr) with initial tracheal intubation using direct laryngoscopy in PICUs between July 2010 and December 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable logistic regression analysis was used to evaluate the association between cricoid pressure use and the occurrence of regurgitation while adjusting for underlying differences in patient and clinical care factors. Of 7,825 events, cricoid pressure was used in 1,819 (23%). Regurgitation was reported in 106 of 7,825 (1.4%) and clinical aspiration in 51 of 7,825 (0.7%). Regurgitation was reported in 35 of 1,819 (1.9%) with cricoid pressure, and 71 of 6,006 (1.2%) without cricoid pressure (unadjusted odds ratio, 1.64; 95% CI, 1.09-2.47; p = 0.018). On multivariable analysis, cricoid pressure was not associated with the occurrence of regurgitation after adjusting for patient, practice, and known regurgitation risk factors (adjusted odds ratio, 1.57; 95% CI, 0.99-2.47; p = 0.054). A sensitivity analysis in propensity score-matched cohorts showed cricoid pressure was associated with a higher regurgitation rate (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; p = 0.036). CONCLUSIONS: Cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders. Further studies are needed to determine whether cricoid pressure for specific indication with proper maneuver would be effective in reducing regurgitation events.


Assuntos
Cartilagem Cricoide/fisiopatologia , Estado Terminal/terapia , Intubação Intratraqueal/efeitos adversos , Refluxo Laringofaríngeo/epidemiologia , Canadá , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/métodos , Japão , Refluxo Laringofaríngeo/etiologia , Refluxo Laringofaríngeo/prevenção & controle , Laringoscopia/efeitos adversos , Masculino , Nova Zelândia , Pressão , Pontuação de Propensão , Melhoria de Qualidade , Sistema de Registros , Estudos Retrospectivos , Singapura , Estados Unidos
11.
PLoS One ; 13(5): e0196848, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29723303

RESUMO

BACKGROUND: We aimed to clarify the factors associated with the presentation of erosive esophagitis (EE) symptoms in subjects undergoing health checkups. METHODS: We utilized baseline data from 7,552 subjects who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The subjects were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Based on the heartburn and/or acid regurgitation frequency, the EE subjects were stratified into the following three groups: (1) at least one day a week (symptomatic EE [sEE]), (2) less than one day a week (mild symptomatic EE [msEE]), and (3) never (asymptomatic EE [aEE]). Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were defined according to the Rome III criteria. RESULTS: Of the 1,262 (16.7%) subjects (male 83.8%, mean age 52.6 years) with EE, the proportions of sEE, msEE and aEE were 15.0%, 37.2% and 47.9%, respectively. The sEE group showed significant associations with overlapping EPS (OR: 58.4, 95% CI: 25.2-160.0), overlapping PDS (OR: 9.96, 95% CI: 3.91-26.8), severe hiatal hernia (OR: 2.43, 95% CI: 1.43-4.05), experiencing high levels of stress (OR: 2.20, 95% CI: 1.43-3.40), atrophic gastritis (OR: 1.57, 95% CI: 1.03-2.36) and Los Angeles (LA) grade B or worse (OR: 1.72, 95% CI: 1.12-2.60) in the multivariate analysis. CONCLUSIONS: Approximately one-sixth of EE subjects were symptomatic. A multifactorial etiology, including factors unrelated to gastric acid secretion, was associated with the symptom presentation of EE subjects.


Assuntos
Esofagite Péptica/diagnóstico , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/epidemiologia , Doenças Assintomáticas , Comorbidade , Depressão/epidemiologia , Esofagite Péptica/epidemiologia , Esofagoscopia , Feminino , Gastrite Atrófica/epidemiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/epidemiologia , Hérnia Hiatal/complicações , Hérnia Hiatal/epidemiologia , Humanos , Japão/epidemiologia , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Preparações Farmacêuticas , Período Pós-Prandial , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Fumar/epidemiologia , Inquéritos e Questionários , Avaliação de Sintomas
12.
Saudi J Gastroenterol ; 24(4): 236-241, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29652032

RESUMO

Background/Aims: Gastroesophageal reflux disease (GERD) is a common condition that can lead to significant morbidity. Laryngopharyngeal reflux (LPR) is a distinct clinical entity that can occur simultaneously with GERD, necessitating additional treatment measures. The degree of overlap and clinical predictors of LPR among patients with GERD remains unknown. We aim to measure the prevalence of LPR in patients with GERD and identify clinical predictors. Patients and Methods: We performed a cross-sectional study involving patients with confirmed GERD according to the GERD questionnaire (GerdQ) using the reflux symptom index (RSI). Data on demographics, comorbidities, past and current medications, and GERD-related lifestyle measures were documented. The prevalence of LPR was calculated. Linear and logistic regression analyses were conducted to correlate GerdQ and RSI, and to identify clinical predictors of LPR, respectively. Results: A total of 80 patients with confirmed GERD were consecutively recruited and surveyed. Mean age was 43 (±16) and 60% were females. The majority of patients were Saudis (51%) and only 24% were smokers. The mean duration of GERD was 7 (±4.4) years and the average body mass index (BMI) was 36 ± 22. Sixty-six percent of the patients consumed coffee on regular basis. On simple and multiple linear regression analyses, a strong, positive correlation was observed between the GerdQ and RSI scores (coefficient = 1.13, 95%CI = 0.39-1.86), and ipratropium bromide inhaler was positively associated with RSI scores (coefficient = 13.12, 95%CI = 0.16-26.09). LPR was identified in 57 patients (71%). On simple and multiple logistic regression analyses, GerdQ scores (OR = 1.78, 95%CI = 1.13-2.80), BMI (OR = 1.07, 95%CI = 1.01-1.14), duration of GERD in years (OR = 1.42, 95%CI = 1.04-1.93), and the type of gender (OR = 49.67, 95%CI = 1.32-1870) appeared to increase the risk of LPR, whereas coffee consumption (OR = 0.0005, 95%CI = 1.82e-06, 0.13) appeared to be negatively associated with LPR. Conclusions: Contradictory to what is frequently reported, LPR commonly occurs and positively correlates with GERD. Several modifiable clinical predictors of LPR might exist, which highlight the importance of performing a complete clinical assessment of the patients with reflux symptoms.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/epidemiologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Refluxo Laringofaríngeo/etiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Arábia Saudita/epidemiologia , Índice de Gravidade de Doença , Estatística como Assunto , Inquéritos e Questionários
13.
Auris Nasus Larynx ; 45(5): 1033-1040, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29544872

RESUMO

OBJECTIVE: This was a first cross-sectional single-center study to research the relation between globus pharyngeus, OSA and GERD. Since previous clinical studies have demonstrated a relationship between globus phayrngeus and GERD, however, no reported study on the relation between globus pharyngeus, sleep disorders including OSA, and GERD. METHODS: Seventeen patients underwent general and otorhinolaryngological examinations and responded to several questionnaires (ESS, PSQI, HADS, and Globus pharyngeus VAS score) at their first visit, and underwent a gastroesophageal test for 24-h pH monitoring and in-laboratory PSG one to two months later. RESULTS: No significant differences were seen in ESS, PSQI, or HADS scores between the groups. The acid exposure time was not significantly different among the groups. The percentage of esophageal reflux time was higher than the percentage of laryngopharyngeal reflux time through the total time as well as the supine period. This indicated that GERD occurred more frequently than laryngopharyngeal reflux. The entire results showed concurrent OSA in 10 cases (59%) and concurrent GERD in 7 cases (41%). The cases with OSA were treated by CPAP or oral appliance, and those treatments were effective for globus pharyngeus. CONCLUSION: Although the relation between OSA and globus phayngeus is still controversial, these findings suggest that OSA may be a previously undetected cause of globus pharyngeus. By improving OSA, it may offer an additional option of treatment for those globus pharyngeus cases combined with OSA.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Doenças Faríngeas/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Técnicas de Diagnóstico do Sistema Digestório , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/fisiopatologia , Humanos , Hipofaringe , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/fisiopatologia , Polissonografia , Apneia Obstrutiva do Sono/fisiopatologia , Inquéritos e Questionários
14.
J Biol Regul Homeost Agents ; 32(1 Suppl. 2): 41-47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29436209

RESUMO

Introduction: Gastroesophageal reflux (GER) is a common disease usually limited to the oesophagus. Laryngopharyngeal reflux (LPR) is an inflammatory reaction of the mucosa of pharynx, larynx, and other associated upper respiratory organs, caused by a reflux of stomach contents outside the oesophagus. LPR is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated sometimes empirically and without a correct diagnosis. However, there is disagreement between specialists about its definition and management: gastroenterologists consider LPR to be a substantially rare manifestation of gastroesophageal reflux disease (GERD), whereas otolaryngologists believe that LPR is an independent, but common in their practice, disorder. Patients suffering from LPR firstly consult their general practitioners, but a multidisciplinary approach may be fruitful to define a unified strategy based on specific medications and behavioural changes. The present Supplement would review the topic, considering LPR and GER characteristics, pathophysiology, diagnostic work-up, and new therapeutic strategies also comparing different specialist points of view and patient populations. In particular, new insights derive from an interesting gel compound, containing magnesium alginate and E-Gastryal® (hyaluronic acid, hydrolysed keratin, Tara gum, and Xantana gum). In particular, two very large Italian surveys were conducted in real-world setting, such as outpatient clinics. The most relevant outcomes are presented and discussed in the current Issue. Actually, laryngopharyngeal reflux (LPR) is considered an extraesophageal manifestation of the gastroesophageal reflux disease (GERD). Both GERD and its extraesophageal manifestation are very common in clinical practice. Both disorders have a relevant burden for the society: about this topic most of pharmaco-economic studies were conducted in the United States. In population-based studies, 19.8% of North Americans complain of typical symptoms of GERD (heartburn and regurgitation) at least weekly (1). Also in the late 1990s, GERD accounted for $9.3 to $12.1 billion in direct annual healthcare costs in the United States, higher than any other digestive disease. As a result, acid-suppressive agents were the leading pharmaceutical expenditure in the United States. The prevalence of GERD in the primary care setting becomes even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD is also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits (2, 3) Extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years.


Assuntos
Refluxo Gastroesofágico , Refluxo Laringofaríngeo , Refluxo Gastroesofágico/economia , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/terapia , Humanos , Refluxo Laringofaríngeo/economia , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/terapia , Prevalência , Inquéritos e Questionários
15.
Biomed Res Int ; 2017: 3918214, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29098155

RESUMO

This study examines the relationship between laryngopharyngeal reflux (LPR) symptoms and oropharyngeal pH levels in singers. We hypothesized that reported symptoms would correlate with objective measures of pH levels from the oropharynx, including the number and total duration of reflux episodes. Twenty professional/semiprofessional singers completed the Reflux Symptom Index (RSI) and underwent oropharyngeal pH monitoring. Mild, moderate, or severe pH exposure was recorded during oropharyngeal pH monitoring. Correlations were performed to examine potential relationships between reflux symptoms and duration of LPR episodes. Symptom severity did not correlate with pH levels; however, we found a number of covariances of interest. Large sample sizes are necessary to determine if true correlations exist. Our results suggest that singers may exhibit enhanced sensitivity to LPR and may therefore manifest symptoms, even in response to subtle changes in pH. This study emphasizes the importance of sensitive and objective measures of reflux severity as well as consideration of the cumulative time of reflux exposure in addition to the number of reflux episodes.


Assuntos
Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/fisiopatologia , Orofaringe/química , Canto , Adolescente , Adulto , Idoso , Feminino , Humanos , Concentração de Íons de Hidrogênio , Refluxo Laringofaríngeo/diagnóstico , Masculino , Pessoa de Meia-Idade , Orofaringe/fisiopatologia , Adulto Jovem
16.
Med Arch ; 71(3): 215-218, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28974837

RESUMO

INTRODUCTION: Laryngopharyngeal reflux disease (LPRD) referes to an inflammatory reaction of the mucous membrane of pharynx, larynx and other associated respiratory organs, caused by a reflux of stomach contents into the esophagus. LPRD is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated through different fields of medicine, often without a proper diagnosis. In gastroenterology it is still considered to be a manifestation of GERD, which stands for gastroesophageal reflux disease. Patients suffering from LPRD communicate firstly with their primary physicians, and since further treatment might ask for a multidisciplinary approach, it is important to have a unified approach among experts when treating these patients. GOAL: This paper is written with the intention to assess the frequency of symptoms of LPR in family medicine, possible diagnostics and adequate treatment in primary health care. MATERIALS AND METHODS: This is a prospective, descriptive cohort study. Authors used "The Reflux Symptom Index" (RSI) questionnaire. Examinees were all patients who reported to their family medicine office in Gracanica for the first time with new symptoms during a period of one year. Patients with positive results for LPR (over 13 points) were treated in accordance with the suggested algorithm and were monitored during the next year. RESULTS: Out of 2123 examinees who showed symptoms of LPR, 390 tested positive according to the questionnaire. This group of examinees were treated in accordance with all suggested protocols and algorithms. 82% showed signs of improvement as a response to basic treatment provided by their physicians. CONCLUSION: Almost every fifth patient who reports to their family medicine physician shows symptoms of LPR. On primary health care levels it is possible to establish some form of prevention, diagnostics and therapy for LPR in accordance with suggested algorithms. Only a small number of patients requires procedures which fall under other clinical fields.


Assuntos
Refluxo Laringofaríngeo/epidemiologia , Algoritmos , Bósnia e Herzegóvina/epidemiologia , Medicina de Família e Comunidade/estatística & dados numéricos , Humanos , Estudos Prospectivos , Inquéritos e Questionários
17.
Arch Endocrinol Metab ; 61(4): 348-353, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28658344

RESUMO

OBJECTIVE: This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. SUBJECTS AND METHODS: A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. RESULTS: The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. CONCLUSION: This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.


Assuntos
Bócio Subesternal/epidemiologia , Refluxo Laringofaríngeo/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Bócio/complicações , Bócio/epidemiologia , Bócio/fisiopatologia , Bócio/cirurgia , Bócio Subesternal/complicações , Bócio Subesternal/fisiopatologia , Bócio Subesternal/cirurgia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico por imagem , Laringoscopia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tireoidectomia
18.
Otolaryngol Head Neck Surg ; 156(5): 893-900, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28457223

RESUMO

Objectives We aimed to confirm the presence of pepsinA in the nasal secretions and tissues of chronic rhinosinusitis (CRS) patients and reveal the relationship between CRS and laryngopharyngeal reflux (LPR). Study Design Cross-sectional study. Setting The study was conducted at the Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University. Subjects and Methods A total of 32 CRS patients with or without nasal polyps (CRSwNP and CRSsNP, respectively) and 10 normal controls were enrolled in our study. We investigated the expression of pepsinA in the nasal tissues, secretions, and blood plasma from the subjects by immunohistochemical staining, Western blot, or ELISA. Additionally, the expressions of MUC4, MUC5AC, MUC5B, MUC8, and pepsinogenA in nasal tissue were evaluated by quantitative real-time polymerase chain reaction. Results Immunohistochemistry and Western blot revealed that the pepsinA expression levels in the turbinate mucosa in CRSwNP/CRSsNP patients, which were largely restricted to the epithelial layer or glandular mucous cells in nasal tissues, were significantly higher than those in controls and in the polyp tissues of CRSwNP patients ( P < .05). In addition, the concentration of pepsinA in nasal secretions was significantly increased in the CRSwNP (147.85 ± 53.69 ng/mL, P < .001) and CRSsNP (134.12 ± 36.23 ng/mL, P < .001) groups as compared with the controls (68.69 ± 19.28 ng/mL). Although MUC5AC, MUC5B, and MUC8 expression differed among the groups, no correlation between pepsinA and mucin genes was found. Conclusion The results of this study provided evidence of an association between LPR and CRS, although no correlation was found to exist between LPR and mucin genes in CRS patients.


Assuntos
Refluxo Laringofaríngeo/metabolismo , Mucosa Nasal/metabolismo , Pólipos Nasais/metabolismo , Pepsina A/metabolismo , Rinite/metabolismo , Sinusite/metabolismo , Adulto , Idoso , Biomarcadores/metabolismo , Biópsia por Agulha , Western Blotting , China , Doença Crônica , Comorbidade , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Hospitais Universitários , Humanos , Imuno-Histoquímica , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/patologia , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/diagnóstico , Pólipos Nasais/epidemiologia , Reação em Cadeia da Polimerase/métodos , Rinite/epidemiologia , Rinite/patologia , Sinusite/epidemiologia , Sinusite/patologia
19.
Obes Surg ; 27(11): 2868-2872, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28451933

RESUMO

BACKGROUND: Food tolerance has been related to quality of life after bariatric surgery. However, long-term results about this issue are quite limited. The aim of this study was to evaluate the long-term food tolerance in obese patients submitted to surgery, comparing the results between gastric bypass (GBP), long alimentary modified biliopancreatic diversion (MBPD), and long alimentary modified duodenal switch (MDS). METHODS: A cross-sectional analytic study was performed. Food tolerance was studied with a questionnaire based on subjective alimentary satisfaction, tolerance to different foods, and frequency of vomiting and regurgitation. A food tolerance score was obtained (1 point being the worst possible tolerance and 27 points being a perfect one). Information was obtained with a telephone interview. RESULTS: One hundred ninety-six patients submitted to bariatric surgery were included. Ninety-nine patients were submitted to GBP, 54 to MBPD, and 43 to MDS. One hundred and sixty-one patients (82.1%) were not lost during a mean follow-up time of 87.9 months. Mean food tolerance score was 24.2. Tolerance satisfaction was good or excellent in 73.3% of the patients. Red meat was the worst tolerated food, but nearly 80% of the patients could tolerate it without any problem. Mean food tolerance score was 24.6, 24.0, and 23.7 for GBP, MBPD, and MDS, respectively. There were no significant differences between these procedures in food tolerance score, alimentary satisfaction, or frequency of vomiting. CONCLUSIONS: Long-term food tolerance after bariatric surgery is good. No differences between GBP, MBPD, and MDS were found.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Refluxo Laringofaríngeo/epidemiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Vômito/epidemiologia , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/reabilitação , Cirurgia Bariátrica/estatística & dados numéricos , Desvio Biliopancreático/efeitos adversos , Desvio Biliopancreático/métodos , Desvio Biliopancreático/reabilitação , Estudos Transversais , Comportamento Alimentar/fisiologia , Feminino , Seguimentos , Alimentos/efeitos adversos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Derivação Gástrica/reabilitação , Humanos , Refluxo Laringofaríngeo/etiologia , Masculino , Obesidade Mórbida/reabilitação , Qualidade de Vida , Inquéritos e Questionários , Vômito/etiologia
20.
Otolaryngol Head Neck Surg ; 156(2): 255-262, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27803078

RESUMO

Objective The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone. Data Sources EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Review Methods A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies. Results Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I2 value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies. Conclusion There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.


Assuntos
Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Refluxo Laringofaríngeo/tratamento farmacológico , Refluxo Laringofaríngeo/virologia , Inibidores da Bomba de Prótons/uso terapêutico , Infecções por Helicobacter/epidemiologia , Humanos , Refluxo Laringofaríngeo/epidemiologia , Prevalência
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