咽喉異常感症之抗胃酸逆流嘗試療法

Anti-reflux Therapeutic Trial for Globus Pharyngis

陳建志(Jiann-Jy Chen)

《台灣耳鼻喉頭頸外科雜誌》 42卷5期 (2007/10) Pp. 150-158

https://doi.org/10.6286/2007.42.5.150

摘要

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。

關鍵字

咽喉異常感症 ； 胃食道逆流 ； 咽喉逆流 ； 抗胃酸逆流嘗試療法

並列摘要

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.

並列關鍵字

globus pharynges ； gastroesophageal reflux disease ； laryngopharyngeal reflux ； anti-reflux therapeutic trial