孤立的喉咽症状不能预测客观反流证据：圣地亚哥共识路径选择性前期检测的国际多中心验证研究
ISOLATED LARYNGOPHARYNGEAL SYMPTOMS DO NOT PREDICT OBJECTIVE REFLUX EVIDENCE: AN INTERNATIONAL MULTICENTER VALIDATION STUDY OF THE SAN DIEGO CONSENSUS PATHWAY FOR SELECTIVE UPFRONT TESTING.
文献信息
| PMID | 42754970 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Walter W Chan |
| 作者单位 | Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. |
| 期刊 | The American journal of gastroenterology |
| SCI 分区 | Q1 |
| IF | 9.4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 喉咽症状（LPS）指上呼吸消化道症状，具有反流病理生理学的病因学潜力。我们旨在描述LPS的临床表现/评估特征，并在国际LPS患者队列中识别喉咽反流病（LPRD）的预测因素。
方法： 我们纳入了在3个世界区域5个国际三级中心因LPS就诊接受食管检测的成年患者。获取了人口统计学、临床症状、经过验证的患者报告结局工具和食管检测数据。比较了不同LPS表现中客观胃食管反流病（GERD）证据的诊断率。进行了单变量和多变量分析，以比值比（OR）和95%置信区间（CI）报告。
结果： 在408例患者中（年龄53.3±0.7岁，70%女性），135例（33.1%）为孤立性LPS，273例（66.9%）为LPS伴典型反流症状。LPS伴典型症状者的症状负担更高（p≤0.004），客观GERD证据也更高（29.7% vs 17.0%，p=0.006），在孤立性LPS和LPS伴典型症状中，无线监测与pH-阻抗监测的诊断率相似（p=0.36）。在评估确定性GERD预测因素的多变量逻辑回归中，典型症状（OR 2.71，CI 1.33-5.55，p=0.006）、食管裂孔疝（OR 1.80，CI 1.24-2.62，p=0.002）和体重指数（OR 1.08，CI 1.03-1.14，p=0.002）是确定性GERD的独立预测因素，但LPS类型和严重程度不能预测LPRD。在世界各地区，亚洲患者尽管GERD证据较低，但症状负担更高。
结论： 与LPS伴典型症状不同，孤立性LPS的临床表现不能预测LPRD。我们的发现支持圣地亚哥共识关于孤立性LPS选择性前期检测的建议。
英文摘要
BACKGROUND: Laryngopharyngeal symptoms (LPS) refer to upper aerodigestive tract symptoms with etiologic potential for reflux pathophysiology. We aimed to characterize the clinical presentation/evaluation of LPS and identify predictors of laryngopharyngeal reflux disease (LPRD) in an international cohort of patients with LPS.
METHODS: We included adult patients with LPS presenting for esophageal testing at 5 international tertiary centers in 3 world regions. Demographics, clinical symptoms, validated patient-reported outcome instruments and esophageal testing data were obtained. The diagnostic yield of objective gastroesophageal reflux disease (GERD) evidence was compared across LPS presentations. Univariate and multivariable analyses were performed, reported as odds ratios (OR) and 95% confidence intervals (CI).
RESULTS: Of 408 patients (age 53.3±0.7 years, 70% female), 135 (33.1%) had isolated LPS and 273 (66.9%) had LPS with typical reflux symptoms. Symptom burden was higher in LPS with typical symptoms (p≤0.004), as was objective GERD evidence (29.7% vs 17.0%, p=0.006), with similar diagnostic yields between wireless and pH-impedance monitoring in both isolated LPS and LPS with typical symptoms (p=0.36). On multivariable logistic regression evaluating predictors for conclusive GERD, typical symptoms (OR 2.71, CI 1.33-5.55, p=0.006), hiatus hernia (OR 1.80, CI 1.24-2.62, p=0.002) and body mass index (OR 1.08, CI 1.03-1.14, p=0.002) and were independent predictors for conclusive GERD, but LPS type and severity did not predict LPRD. Across world regions, symptom burden was higher despite lower GERD evidence in Asian patients.
CONCLUSIONS: Clinical presentation of isolated LPS is not predictive of LPRD, unlike LPS with typical symptoms. Our findings support the San Diego Consensus recommendations for selective up-front testing in isolated LPS.