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咽喉異常感症之抗胃酸逆流嘗試療法

Anti-reflux Therapeutic Trial for Globus Pharyngis

Abstracts


背景:咽喉異常感症(globus pharyngis)是耳鼻喉科門診常見的疾病,症狀期在2週以上者的鑑別診斷會比不足2週者多,最常見的病因是胃食道逆流。本文提出如何在缺乏雙極24小時食道pH值監測計的情況下,利用抗胃酸逆流嘗試療法作為疑似病患的治療經驗。 材料及方法:回溯性地收集作者自2006年7月1日到2007年2月28日期間在桃園及新竹地區共1家區域醫院與2家地區醫院的門診中所有咽喉異常感症的病患共計174名,排除症狀期不足2週者33名、甲狀腺疾患5名、Sjögren氏症候群1名及肝臟囊腫1名後,尚餘134名(男78,女56),年齡51.8±13.0歲(23~85歲)。根據理學檢查的發現,嘗試給予特定的治療,其中接受抗胃酸逆流嘗試療法者共計90名(女36,男54)。訂定2007年4月底為資料收集的最後期限。 結果:接受抗胃酸逆流嘗試療法者中,成功者66名,治療週數為2.5 ± 1.7 (0.5~8);治療失敗已轉科者9名,皆轉診至胃腸科行上消化道內視鏡檢;失去追蹤者15名。 結論:當病史詢問或理學檢查疑似胃食道逆流,或其他非抗胃酸逆流之嘗試療法失敗者,均建議給予4週的抗胃酸逆流嘗試療法;失敗者,建議施行上消化道內視鏡檢以早期排除器質性的病灶,例如食道的腫瘤。

Parallel abstracts


BACKGROUND: Globus pharyngis is a common disease at otorhinolaryngology clinics. There are more differential diagnoses in patients with symptom of at least 2 weeks duration than those with less than 2 weeks duration. The commonest etiology is gastroesophageal reflux disease. Due to the vacancy of a continuous dual-probe esophageal pH monitor, an anti-reflux therapeutic trial is recommended in this paper. METHODS: One hundred and seventy four patients with globus pharyngis were retrospectively enrolled at my clinics in one regional hospital and two local hospitals in Tao-Yuan county and Hsin-Chu county between June 2006 and February 2007. After 33 cases with less than 2 weeks duration, 5 cases with thyroid disease, one case with Sjögren syndrome, and one case with hepatic cyst were excluded, a total of 134 patients were enrolled, including 78 males and 56 females. Their ages ranged from 23 to 85 years (51.8 ± 13.0). According to the findings on physical examination, they were given specific therapeutic trials. Of the 134 study patients, 90 patients (54 males and 36 females) received an anti-reflux therapeutic trial. The data were collected and summarized until the end of April 2007. RESULTS: Of the anti-reflux therapeutic trial patients, 66 were cured with a therapeutic trial duration of 2.5 ± 1.7 weeks (range 0.5 to 8 weeks), 9 with therapeutic trial failure were transferred to the Department of Gastroenterology for upper digestive endoscopy and 15 were lost to follow-up. CONCLUSION: A four-week anti-reflux therapeutic trial is recommended for suspected gastroesophageal reflux or non-anti-reflux therapeutic failure. If anti-reflux therapeutic trial fails, upper digestive endoscopy is recommended to rule out organic lesions early, e.g., esophageal neoplasm.

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