咽喉異物感症的原因

咽喉異物感是一種門診常見的主訴，回顧相關的文獻可以發現，女性患者較多，年齡分布自10歲至大於80歲，平均年齡38至49歲，症狀時間自3天至14年。病因可以分類為外因性、功能性、結構性、腫瘤性、發炎性、胃腸膽道、系統性、精神心理性與不明原因，其中最常見的是胃酸逆流，併發症最嚴重的是食道異物，而癒後最差的是食道癌。檢查方法包括病史詢問、理學檢查、4星期抗胃酸逆流之診斷性綜合治療、食道壓力計、雙極24小時食道pH監測計、X光攝影、食道攝影、糞便潛血測試、紗布球食道磨拭細胞學檢查、內視鏡、超音波檢查、實驗室檢查（血液、尿液、糞便及心電圖）及人格心理分析…等，其中第一線最重要的是病史詢問及理學檢查，診斷胃酸逆流最重要的工具是雙極24小時食道pH監測計，找出器質性病灶最重要的方法是內視鏡配合組織病理切片；在利用人格心理分析診斷精神心理性咽喉異物感症(globus hystericus)前，必須排除所有可能的器質性病灶。文末歸納出一個檢查流程，助於醫師找出病因以對症下藥。

關鍵字

咽喉異物感症；精神心理性咽喉異物感症；內視鏡；抗胃酸逆流之診斷性綜合治療；食道癌

並列摘要

”A lump in the throat” is a common chief compliant among outpatients. This symptom has a female predominance in the literature reviewed. The age of patients with this complaint ranges from 10 years to over 80 years and their average age ranges 38 years to 49 years. The duration of the symptom ranged from 3 days to 14 years. The etiology of globus pharygis can be classified into external, functional, anatomic, tumorous, inflammatory, gastroentero-biliary, systemic, hysterical and unknown origin. Acid reflux disease is the commonest cause, esophageal foreign body is the most serious complication and esophageal cancer has the poorest prognosis. Inspection includes history taking, physical examination, four weeks’ anti-reflux diagnostic therapy, esophageal manometry, dual-probe-24-hour pH monitoring, X-ray, esophagography, a stool occult blood test, abrasive esophageal cytology, endoscopy, ultrasonography, laboratory data (blood, urine, stool, and electrocardiography), personal psychoanalysis and more. History taking and the physical examination are the most important at first. Dual-probe-24-hour pH monitoring is the gold standard for acid reflux disease. Endoscopy with a pathological study is a key tool for any organic lesion. After any organic lesion is ruled out, a personal psychoanalysis can be performed for globus hystericus. Finally, a paradigm is concluded for analysis.

並列關鍵字

globus pharynges ； globus hystericus ； endoscopy ； anti-reflux diagnostic therapy ； esophageal cancer

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咽喉異物感症的原因

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