非酸反流与反流性喉炎：机制、诊断与治疗的新视角。

文献信息

中文摘要

非酸反流可能是反流性咽炎发病机制中的一个潜在促进因素。其可能的损伤相关机制可部分解释难以治疗的临床表现，并造成诊断和治疗上的挑战，进而影响患者的生活质量。近年来，非酸反流在难治性反流性咽炎中可能具有的重要作用已成为该领域的一个突出话题，揭示了一种超越传统胃酸损伤模型的新型病理生理机制。这一潜在机制涵盖多种活性成分的独立及协同损伤效应，包括胆汁酸、胰酶、胃蛋白酶和气体反流。它涉及多条通路，如细胞内再激活、紧密连接破坏、炎症级联反应和缺氧性损伤。本文提供了一篇叙述性综述，讨论非酸反流在反流性咽炎发病机制中的潜在作用，重点阐明与非酸反流各成分相关的致病机制、当前诊断技术的进展与局限，以及综合干预策略。本综述可能对优化反流性咽炎的分层管理及减轻难治性患者的症状负担具有潜在的临床转化价值。

英文摘要

Non-acid reflux may serve as a potential contributing factor in the pathogenesis of reflux pharyngitis. Its plausible injury-related mechanisms may partly explain difficult-to-treat clinical presentations and contribute to diagnostic and therapeutic challenges, with consequent impacts on patients' quality of life. Recently, the potentially significant role of non-acid reflux in refractory reflux pharyngitis has emerged as a prominent topic in this field, unveiling a novel pathophysiological mechanism that transcends the traditional gastric acid damage model. This underlying mechanism encompasses the independent and synergistic damaging effects of various active components, including bile acids, pancreatic enzymes, pepsin and gas reflux. It involves multiple pathways, such as intracellular reactivation, disruption of tight junctions, inflammatory cascade responses, and hypoxic injury. This article provides a narrative review discussing potential roles of non-acid reflux in the pathogenesis of reflux pharyngitis, focusing on elucidating the pathogenic mechanisms associated with each component of non-acid reflux, the advancements and limitations of current diagnostic techniques, and comprehensive intervention strategies. This review may hold potential clinical translational value for optimizing the hierarchical management of reflux pharyngitis and alleviating the symptom burden in refractory patients.