Öz
Özet
Amaç. Bu çalışmanın amacı, endoskopik ve patolojik olarak alt özofageal sfinkter (AÖS) gevşekliği ve özofajit saptanan hastalarda larengeal semptom ve bulgu sıklığının araştırılmasıdır. Yöntem. Hastanemiz Gastroenteroloji kliniğinde değişik nedenlerle özofagogastroskopi yapılarak AÖS gevşekliği ve özofajit tespit edilen 51 hasta çalışmaya alındı. Bu hastalarda ses kısıklığı, boğaz ağrısı, boğazda takılma hissi, sık yutkunma hissi, boğazda yabancı cisim hissi, öksürük, yutma güçlüğü ve ağrılı yutma gibi larengofarengeal reflüyü düşündüren şikâyetler ve larengeal bulgular tespit edilerek değerlendirildi. Bulgular. Olguların semptomları incelendiğinde; 23 (%45,1) hastada ses kısıklığı, 34 (%66,7) hastada sık boğaz temizleme, 24 (%47,0) hastada boğaz ağrısı, 22 (%43,1) hastada boğazda takılma hissi, 16 (%31,4) hastada globus ve 13 (%25,4) hastada ise yutma güçlüğü saptandı. Hastaların larengoskopik muayenelerinde ise 24 (%47,0) hastada vokal kordlarda hiperemi, 11 (%21,5) hastada vokal kordlarda ödem, 26 (%50,1) hastada aritenoidlerde hiperemi, 5 (%9,8) hastada vokal kordda nodül ve 12 (%23,5) hastada ise pakidermi tespit edildi. Sonuçlar. Çalışmamızdan elde ettiğimiz sonuçlar, AÖS gevşekliği ve gastroözofageal reflüsü olan hastalarda larengeal semptom ve bulguların oldukça sık görüldüğünü ortaya koymaktadır. Bu nedenle, bu şikayetlerle doktora başvuran hastalarda, altta yatan patolojinin reflü olabileceği akıldan çıkarılmamalıdır.
Anahtar sözcükler: Alt özofageal sfinkter, larengofarengeal reflü, gastroözofageal reflü, ses kısıklığı
Abstract
Aim. The aim of this study is to determine the frequency of laryngeal symptoms and findings in patients that have lower esophageal sphincter (LES) incompetency and esophagitis. Methods. We included 51 patients that have undergone esophagogastroscopy in the Department of Gastroenterology, Ataturk Education and Research Hospital and diagnosed as lower esophageal sphincter (LES) incompetency and esophagitis after pathologic analysis. Symptoms that suggest laryngopharyngeal reflux like hoarseness, sore throat, chronic throat clearing, chronic cough, sensation of sticking in throat, globus and dysphagia and laryngeal findings were evaluated. Results. Of 51 patients, 23 (45.1%) had hoarseness, 34 (66.7%) had chronic throat clearing, 24 (47%) had sore throat, 22 (43.1%) had sensation of sticking, 16 (31,4%) had globus and 13 (25.4%) had dysphagia. In laryngoscopic evaluation, 24 (47%) had hyperemia of vocal folds, 11 (21.5%) had edema of vocal folds, 26 (50.9%) had hyperemia of arytenoids, 5 (9.8%) had nodule on vocal folds and 12 (23.5%) had pachydermia. Conclusions. Laryngeal symptoms and findings are very common among patients with LES incompetency and esophagitis. It must be kept in mind that reflux might be the underlying pathology in patients referred with laryngeal symptoms.
Keywords: Lower esophageal sphincter, laryngopharyngeal reflux, gastroesophageal reflux, hoarseness
Anahtar Kelimeler
Kaynakça
- Koufman JA.
- Laryngopharyngeal reflux is differrent from classic
- gastroesophageal reflux disease.Ear Nose & Throat Journal 2002; 81: 7-9.
- Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): A clinical investigation of 225 patients using ambulatory 24- hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101:1-78.
- Toohill RJ, Kulin JC. Role of reflux acid in pathogenesis of laryngeal disorders. Am J Med 1997; 103:100-6.
- Ossakow SJ, Ella G, Colturi T, Bogdasarian R, Nostrant TT. Esophageal reflux and dysmotility as the basis for persistent cervical symptoms. Ann Otol Rhinol Laryngol 1987; 96:387-92.
- Koufman JA, Wiener GJ, Wu WC, Castell DO: Reflux laryngitis and its sequelae: The diagnostic role of ambulatory 24 hour pH monitoring. J Voice 1988; 2: 78-9.
- Muderris T, Gokcan MK, Yorulmaz I. The clinical value of pharyngeal pH monitoring using a double-probe, triple-sensor catheter in patients with laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg. 2009; 135:163-7.
- Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Eqide MS. Mechanisms of gastroesophgeal reflux in patients with reflux esophagitis. N Engl J Med 1982; 307:1547-52.
- Behar J, Baincani P, Sheehan DG. Evaluation of esophageal tests in the diagnosis of esophagitis. Gastroenterology 1976; 71: 9-15.
- Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter pressures and gastroesophageal reflux:an apperent paradox that is not unusal. Am J Gastroenterol 1995; 90: 280-4.
- Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology 1995; 109: 601-10.
- Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanism of lower esophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 1988; 29: 1020-8.
- Özlügedik S, Yorulmaz I. Laryngopharyngeal reflux. T Klin J Surgery 2002; 7: 31-7.
- Mattioli S, Pilotti V, Spangaro M, Grigioni WF, Zannoli R, Felice V, Conci A, Gozetti G: Reliability of 24-hour home esophageal pH monitoring in diagnosis of gastroesophageal reflux. Dig Dis Sci 1989; 34: 71-8.
- Bardan E. Pharyngoesophageal monitoring. Am J Med 2003; 115: 78-80
- Belafsky PC. Abnormal endoscopic pharyngeal and laryngeal findings attributable to reflux. Am J Med 2003; 115: 90-6.
- Beaver ME, Stasney CR, Weitzel E, Stewart MG, Donovan DT, Parke RB Jr, Rodriguez M. Diagnosis of laryngopharyngeal reflux disease with digital imaging. Otolaryngol Head Neck Surg 2003; 128: 103-8.
- Koufman J, Sataloff RT, Toohill R. Laryngopharyngeal Reflux:Concensus conference report. J Voice 1996; 10: 215-6.
- Ylitalo R, Lindestad PA, Ramel S. Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal reflux. Laryngoscope 2001; 111: 1735-41.
- Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2002; 123: 385-8.
- Carrau RL, Khidr A, Crawley JA, Hillson EM, Davis JK, Pashos CL. The impact of laryngopharyngeal reflux on patient-reported quality of life. Laryngoscope 2004; 114: 670-4.
- Ott DJ, Ledbetter MS, Koufman JA, Chen MY. Globus pharyngeus:Radiographic evaluation and 24–hour pH monitoring of the pharynx and esophagus in 22 patients. Radiology 1994; 191: 95-7.
- Smit CF, van Leeuwen JA, Mathus-Vliegen LM, Devriesse PP, Semin A, Tan J, Schouwenburg PF. Gastropharyngeal and gastroesophageal reflux in globus and hoarseness. Arch Otolaryngol Head Neck Surg 2000; 126: 827-30.
- Hamdan AL, Sharara AI, Younes A, Fuleihan N. Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. Acta Otolaryngol 2001; 121: 868-72.
- Fraser AG, Morton RP, Gillibrand J. Presumed laryngopharyngeal reflux: invastigate or treat? J Laryngol Otol 2000; 114:441-7.
Öz
Amaç. Bu çalışmanın amacı, endoskopik ve patolojik olarak alt özofageal sfinkter (AÖS) gevşekliği ve özofajit saptanan hastalarda larengeal semptom ve bulgu sıklığının araştırılmasıdır. Yöntem. Hastanemiz Gastroenteroloji kliniğinde değişik nedenlerle özofagogastroskopi yapılarak AÖS gevşekliği ve özofajit tespit edilen 51 hasta çalışmaya alındı. Bu hastalarda ses kısıklığı, boğaz ağrısı, boğazda takılma hissi, sık yutkunma hissi, boğazda yabancı cisim hissi, öksürük, yutma güçlüğü ve ağrılı yutma gibi larengofarengeal reflüyü düşündüren şikâyetler ve larengeal bulgular tespit edilerek değerlendirildi. Bulgular. Olguların semptomları incelendiğinde; 23 (%45,1) hastada ses kısıklığı, 34 (%66,7) hastada sık boğaz temizleme, 24 (%47,0) hastada boğaz ağrısı, 22 (%43,1) hastada boğazda takılma hissi, 16 (%31,4) hastada globus ve 13 (%25,4) hastada ise yutma güçlüğü saptandı. Hastaların larengoskopik muayenelerinde ise 24 (%47,0) hastada vokal kordlarda hiperemi, 11 (%21,5) hastada vokal kordlarda ödem, 26 (%50,1) hastada aritenoidlerde hiperemi, 5 (%9,8) hastada vokal kordda nodül ve 12 (%23,5) hastada ise pakidermi tespit edildi. Sonuçlar. Çalışmamızdan elde ettiğimiz sonuçlar, AÖS gevşekliği ve gastroözofageal reflüsü olan hastalarda larengeal semptom ve bulguların oldukça sık görüldüğünü ortaya koymaktadır. Bu nedenle, bu şikayetlerle doktora başvuran hastalarda, altta yatan patolojinin reflü olabileceği akıldan çıkarılmamalıdır
Anahtar Kelimeler
Alt özofageal sfinkter larengofarengeal reflü gastroözofageal reflü ses kısıklığı
Kaynakça
- Koufman JA.
- Laryngopharyngeal reflux is differrent from classic
- gastroesophageal reflux disease.Ear Nose & Throat Journal 2002; 81: 7-9.
- Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): A clinical investigation of 225 patients using ambulatory 24- hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101:1-78.
- Toohill RJ, Kulin JC. Role of reflux acid in pathogenesis of laryngeal disorders. Am J Med 1997; 103:100-6.
- Ossakow SJ, Ella G, Colturi T, Bogdasarian R, Nostrant TT. Esophageal reflux and dysmotility as the basis for persistent cervical symptoms. Ann Otol Rhinol Laryngol 1987; 96:387-92.
- Koufman JA, Wiener GJ, Wu WC, Castell DO: Reflux laryngitis and its sequelae: The diagnostic role of ambulatory 24 hour pH monitoring. J Voice 1988; 2: 78-9.
- Muderris T, Gokcan MK, Yorulmaz I. The clinical value of pharyngeal pH monitoring using a double-probe, triple-sensor catheter in patients with laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg. 2009; 135:163-7.
- Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Eqide MS. Mechanisms of gastroesophgeal reflux in patients with reflux esophagitis. N Engl J Med 1982; 307:1547-52.
- Behar J, Baincani P, Sheehan DG. Evaluation of esophageal tests in the diagnosis of esophagitis. Gastroenterology 1976; 71: 9-15.
- Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter pressures and gastroesophageal reflux:an apperent paradox that is not unusal. Am J Gastroenterol 1995; 90: 280-4.
- Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology 1995; 109: 601-10.
- Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanism of lower esophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 1988; 29: 1020-8.
- Özlügedik S, Yorulmaz I. Laryngopharyngeal reflux. T Klin J Surgery 2002; 7: 31-7.
- Mattioli S, Pilotti V, Spangaro M, Grigioni WF, Zannoli R, Felice V, Conci A, Gozetti G: Reliability of 24-hour home esophageal pH monitoring in diagnosis of gastroesophageal reflux. Dig Dis Sci 1989; 34: 71-8.
- Bardan E. Pharyngoesophageal monitoring. Am J Med 2003; 115: 78-80
- Belafsky PC. Abnormal endoscopic pharyngeal and laryngeal findings attributable to reflux. Am J Med 2003; 115: 90-6.
- Beaver ME, Stasney CR, Weitzel E, Stewart MG, Donovan DT, Parke RB Jr, Rodriguez M. Diagnosis of laryngopharyngeal reflux disease with digital imaging. Otolaryngol Head Neck Surg 2003; 128: 103-8.
- Koufman J, Sataloff RT, Toohill R. Laryngopharyngeal Reflux:Concensus conference report. J Voice 1996; 10: 215-6.
- Ylitalo R, Lindestad PA, Ramel S. Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal reflux. Laryngoscope 2001; 111: 1735-41.
- Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2002; 123: 385-8.
- Carrau RL, Khidr A, Crawley JA, Hillson EM, Davis JK, Pashos CL. The impact of laryngopharyngeal reflux on patient-reported quality of life. Laryngoscope 2004; 114: 670-4.
- Ott DJ, Ledbetter MS, Koufman JA, Chen MY. Globus pharyngeus:Radiographic evaluation and 24–hour pH monitoring of the pharynx and esophagus in 22 patients. Radiology 1994; 191: 95-7.
- Smit CF, van Leeuwen JA, Mathus-Vliegen LM, Devriesse PP, Semin A, Tan J, Schouwenburg PF. Gastropharyngeal and gastroesophageal reflux in globus and hoarseness. Arch Otolaryngol Head Neck Surg 2000; 126: 827-30.
- Hamdan AL, Sharara AI, Younes A, Fuleihan N. Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. Acta Otolaryngol 2001; 121: 868-72.
- Fraser AG, Morton RP, Gillibrand J. Presumed laryngopharyngeal reflux: invastigate or treat? J Laryngol Otol 2000; 114:441-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 11 Mart 2010 |
| Yayımlandığı Sayı | Yıl 2010Cilt: 32 Sayı: 1 |