This is an automatically translated article.
Posted by Doctor Mai Vien Phuong - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.
Laryngeal reflux is defined as the reflux of gastric contents into the larynx and pharynx. There are limited results to evaluate the effectiveness of reflux treatments (including diet and lifestyle changes, medical therapy, anti-reflux surgery) for laryngeal reflux.
1. The role of lifestyle changes in the treatment of reflux laryngitis
Dietary and lifestyle modifications are effective interventions for GERD, despite the fact that there are few robust published data. According to the treatment used in a UK county general hospital, dietary and behavioral modifications are also found to be very effective in managing laryngeal reflux.
Trào ngược các thành phần từ dạ dày có thể gây nên bệnh lý viêm thanh quản trào ngược
2. Medical treatment
Considering the poor sensitivity and specificity of all available diagnostic tests, an empiric treatment trial is the first step in confirming laryngopharyngeal reflux and treating it accordingly. However, there is no accepted regimen for the most effective treatment of patients with laryngeal reflux.
Since their introduction in the 1980s, PPIs have demonstrated the most potent inhibition of gastric acid secretion, showing a distinct advantage (for cure and symptom relief) compared with H2 receptor antagonists. Thus, H2-receptor antagonists have limited their role primarily to patients with nocturnal acidosis despite twice-daily PPI treatment, or for long-term management of symptoms. reflux on an 'as needed' basis. Prokinetic agents, although little evaluated, are generally considered not useful in laryngeal reflux.
Các thành phần ở dạ dày có thể trào ngược lên thanh quản gây bệnh lý viêm thanh quản trào ngược
3. Different pharmacological options for the treatment of laryngeal reflux:
Summary of various medical therapies in laryngopharyngeal reflux disease with proven or uncertain efficacy.
| Các thuốc đã được chứng minh | Không chắc chắn | |
| PPI | Liều gấp đôi trong 12 tuần ở bệnh nhân có các triệu chứng bệnh trào ngược dạ dày thực quản thanh quản và điển hình | Bệnh nhân không có triệu chứng bệnh trào ngược dạ dày thực quản điển hình |
| H2RA | Hữu ích trong liệu pháp bổ sung ở những bệnh nhân bị đột phá axit về đêm | Thay thế cho liệu pháp PPI |
| Prokinetic | Thường được coi là vô ích | |
| Alginate | Hữu ích trong liệu pháp bổ sung làm rào cản cơ học | |
| Các thuốc điều chỉnh thần kinh | Baclofen có tác dụng giảm tổng số lần trào ngược | Arbaclofen groarbil, lesogaberan (ít dữ liệu có sẵn) |
|
Chất giảm trào ngược Chất điều chỉnh cơn đau nội tạng |
TCA, SSRI có hiệu quả ở bệnh nhân thực quản quá mẫn cảm |
Abbreviations: GERD, gastroesophageal reflux disease; H2RA, a histamine-2 receptor antagonist; PPIs, proton pump inhibitors; SSRIs, selective serotonin reuptake inhibitors; TCA, tricyclic antidepressant.
4. The role of proton pump inhibitors
PPI therapy is considered the mainstay of care in patients with GERD; however, its effectiveness in the treatment of laryngeal reflux remains questionable.
In clinical practice, consistent with the assumption that the upper gastrointestinal tract is more sensitive to acid reflux than the esophagus, it is believed that patients with reflux-associated laryngitis require higher doses and trials. PPIs took longer to achieve improvement in laryngeal symptoms than those with typical GERD symptoms. On the other hand, placebo-controlled trials have not demonstrated any therapeutic benefit of PPIs. In 2006, a prospective multicentre randomized study, involving 145 patients with endoscopic symptoms and signs of laryngopharyngeal reflux, showed no benefit in patients treated with esomeprazole 40. mg x 2 times/day for 4 months versus placebo.
In addition, the Cochrane systematic review of 302 studies did not find any high-quality trials that met the inclusion criteria to evaluate the effectiveness of antireflux therapy for hoarseness. A systematic review and meta-analysis of randomized controlled trials failed to demonstrate superiority of PPIs over placebo in the treatment of suspected laryngeal reflux.
See also: Drug treatments in laryngeal reflux disease Part 2
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