Laryngopharyngealer Reflux

Zusammenfassung

Die Prävalenz von laryngopharyngealem Reflux (LPR) wird in der Allgemeinbevölkerung mit bis zu 31 % angegeben. Bei Patienten mit Stimmproblemen bzw. Kehlkopferkrankungen tritt ein LPR bei ca. 50 % der Patienten als Begleiterscheinung auf. Typische refluxbedingte Erkrankungen am Larynx sind eine chronische Laryngitis und das Kontaktgranulom. Nicht abschließend geklärt ist die Rolle des LPR bei der Genese des Stimmlippenkarzinoms. Für die Diagnose des LPR gibt es noch keine evidenzbasierten Daten, er kann jedoch üblicherweise klinisch aus der Kombination typischer Symptome (Heiserkeit, chronischer Hustenreiz/Räuspern, Globusgefühl/Dysphagie) und dem charakteristischen laryngoskopischen Bild (ein Schleimhauterythem bzw. eine Schleimhauthyperplasie mit Fältelung der Interarytenoidregion und ein Stimmlippenödem) gestellt werden. Gelegentlich wird eine LPR zusätzlich durch eine pharyngeale 24h-pH-Metrie-Untersuchung gesichert. Die Therapie des LPR umfasst mehrere Bereiche, wie z.B. diätetische Maßnahmen, die medikamentöse Therapie mit Protonenpumpeninhibitoren (PPIs) und ggf. eine chirurgische Intervention. Bei symptomatischen Patienten erfolgt oft eine Therapie mit PPIs, bei der der HNO-Arzt im engen Dialog mit dem Gastroenterologen steht.

Abstract

The prevalence of laryngopharyngeal reflux (LPR) is around 31 % in the general population. Patients with a dysphonia or other laryngeal diseases are accompanied up to 50 % by an LPR. Typical reflux associated diseases of the larynx are a chronical laryngitis and a contact granuloma. The role of LPR is still not clarified in the development of a glottic carcinoma. There still doesn’t exist evidence based data for the diagnosis of a LPR. Therefore LPR is usually clinically diagnosed by a combination of typical symptoms like hoarseness, chronic coughing, relapsing throat clearing, globus pharyngis and dysphagia as well as through the laryngoscopic characteristics like mucosal erythema, mucosal hyperplasia with plication of the interarytenoid region and an edema of the vocal cords. Occasionally the LPR can be ensured with the additional method of the pharyngeal 24-hour pH-monitoring. The therapy of the LPR is a multimodal for example dietary arrangements, medication with proton pump inhibitors and where indicated a surgical intervention. The treatment of a symptomatic patient is administered by proton pump inhibitors in a close dialog with the ENT practitioner and the gastroenterologist.

Schlüsselwörter

Reflux - Larynx - Laryngopharyngealer Reflux - LPR - PPIs

Key words

reflux - larynx - laryngopharyngeal reflux - LPR - PPIs

• Literatur

• 1 Koop H, Labenz J, Bittinger M. et al. Leitline gastroösophagealen Refluxkrankheit. S2k-Leitlinie Gastroösophageale Refluxkrankheit. Bayerisches Ärzteblatt; 10/ 2015
• 2 Bajbouj M. Diagnosis and therapy of atypical reflux symptoms when PPI therapy fails. HNO 2012; 60: 193-199
• 3 Koufman JA. Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J 2002; 81 (09) (Suppl. 02) 7-9
• 4 Schreiber S, Garten D, Sudhoff H. Pathophysiological mechanisms of extraesophageal reflux in otolaryngeal disorders. Eur Arch Otorhinolaryngol 2009; 266: 17-24
• 5 Gupta R, Sataloff RT. Laryngopharyngeal reflux: current concepts and questions. Curr Opin Otolaryngol Head Neck Surg 2009; 17: 143-148
• 6 Vaezi MF. Laryngeal manifestations of gastroesophageal reflux disease. Curr Gastroenterol Rep 2008; 10: 271-277
• 7 Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2000; 123: 385-388
• 8 Pearson JP, Parikh S, Orlando RC. et al. Review article: reflux and its consequences – the laryngeal, pulmonary and oesophageal manifestations. Conference held in conjunction with the 9th International Symposium on Human Pepsin (ISHP) Kingston-upon-Hull, UK, 21–23 April 2010. Aliment Pharmacol Ther 2011; 33 (Suppl. 01) 1-71
• 9 Devaney KO, Rinaldo A, Ferlito A. Vocal process granuloma of the larynx-recognition, differential diagnosis and treatment. Oral Oncol 2005; 41: 666-669
• 10 Carroll TL, Gartner-Schmidt J, Statham MM. et al. Vocal process granuloma and glottal insufficiency: an overlooked etiology?. Laryngoscope 2010; 120: 114-120
• 11 Farwell DG, Belafsky PC, Rees CJ. An endoscopic grading system for vocal process granuloma. J Laryngol Otol 2008; 122: 1092-1095
• 12 Halstead LA. Gastroesophageal reflux: A critical factor in pediatric subglottic stenosis. Otolaryngol Head Neck Surg 1999; 120: 683-684
• 13 Vaezi MF, Qadeer MA, Lopez R. et al. Laryngeal cancer and gastroesophageal reflux disease: a case-control study. Am J Med 2006; 119: 768-776
• 14 Reiter R, Brosch S. Chronic laryngitis – associated factors and voice assesement. Laryngorhinootologie 2009; 88: 181-185
• 15 Coca-Pelaz A. MD Relationship between reflux and laryngeal cancer. Head Neck 2013; 35: 1814-1818
• 16 Orenstein SR. An overview of reflux-associated disorders in infants: apnea, laryngospasm, and aspiration. Am J Med 2001; 111 (Suppl. 08) A 60-63
• 17 Kenn K, Balkissoon R. Vocal cord dysfunction: what do we know?. Eur Respir J 2011; 37: 194-200
• 18 Eryuksel E, Dogan M, Golabi P. et al. Treatment of laryngopharyngeal reflux improves asthma symptoms in asthmatics. J Asthma 2006; 43: 539-542
• 19 Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007; 56: 1654-1664
• 20 Reiter R, Hoffmann TK, Pickhard A. et al. Hoarseness— causes and treatments. Dtsch Arztebl Int 2015; 112: 329-337
• 21 Groome M. et al. Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux. Laryngoscope 2007; 117: 1424-1428
• 22 Martinucci I. et al. Optimal treatment of laryngoharyngeale reflux disease. Ther Adv Chronic Dis 2013; 4: 287-301
• 23 de Bortoli N. et al. How many cases of laryngopharyngeale reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?. World J Gastroenterol 2012; 18: 4363-4370
• 24 Nason KS. et al. A cross-sectional analysis of the prevalence of Barrett esophagus in otolaryngology patients with laryngeal symptoms. J Clin Gastroenterol 2013; 47: 762-768
• 25 Belafsky PC, Rees CJ. Laryngopharyngeal reflux: the value of otolaryngology examination. Curr Gastroenterol Rep 2008; ; 10: 278-282
• 26 Johnston N, Bulmer D, Gill GA. et al. Cell biology of laryngeal epithelial defenses in health and disease: further studies. Ann Otol Rhinol Laryngol 2003; 112: 481-491
• 27 Koufman JA. et al. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngology–Head and Neck Surgery 2002; ; 127: 32-35
• 28 Pehl C, Keller J, Merio R. et al. 24-Stunden-Ösophagus-pH-Metrie. Z Gastroenterol 2003; 41: 545-556
• 29 Koufman JA. The otolaryngologic manifestations of gatroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101 (04) Pt 2 (Suppl. 53) 1-78
• 30 Bajbouj M. et al. New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal pH-metry in extraesophageal gastroesophageal reflux disease. World J Gastroenterl 2015; 21: 982-987
• 31 Reiter R. Kommentar. Laryngo-Rhino-Otol 2017; 96: 1-2
• 32 Gupta R, Sataloff RT. Laryngopharyngeal reflux: current concepts and questions. Curr Opin Otolaryngol Head Neck Surg 2009; 17: 143-148
• 33 Hawkshaw MJ, Pebdani P, Robert T. Sataloff, Reflux Laryngitis: An Update, 2009–2012. Journal of Voice 2013; 27: 486-494
• 34 Campagnolo. et al. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest ResearchInt Arch Otorhinolaryngol 2014; 18: 184-191
• 35 Kotby MN, Hassan O, El-Makhzangy AM. et al. Gastroesophageal reflux/laryngopharyngeal reflux disease: a critical analysis of the literature. Eur Arch Otorhinolaryngol 2010; 267: 171-179
• 36 Wiener GJ, Koufman JA, Wu WC. et al. Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with ambulatory pH monitoring. Am J Gastroenterol 1989; 84: 1503-1508
• 37 Pickhard A, Smith E, Rottscholl R. et al. Disorders of the larynx and chronic inflammatory diseases. Laryngo-Rhino-Otol 2012; 91: 758-766
• 38 Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002; 16: 274-277
• 39 Belafsky PC. et al. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001; 111 (08) 1313-131
• 40 Sifrim D. et al. Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance. Gut 1999; 44: 47-54
• 41 Martinucci I. et al. Optimal treatment of laryngoharyngeale reflux diseaese. Ther Adv Chronic Dis 2013; 4: 287-301
• 42 Steward DL, Wilson KM, Kelly DH. et al. Proton pump inhibitor therapy for chronic laryngo-pharyngitis: a randomized placebo-control trial. Otolaryngol Head Neck Surg 131: 342-350
• 43 Chao Zhang, Zhi-Wei Hu, Chao Yan. et al. Nissen fundoplication vs proton pump inhibitors forlaryngopharyngeal reflux based on pH-monitoring and symptom-scale. World J Gastroenterol 2017; 23: 3546-3535
• 44 Wie Chunhui. A meta-analysis for the role of proton pump inhibitor therapyin patients with laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2016; 273: 3795-3801
• 45 Vaezi MF, Richter JE, Stasney CR. et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope 116: 254-260
• 46 Mössner J. The indications, applications, and risks of proton pump inhibitors— a review after 25 years. Dtsch Arztebl Int 2016; 113: 477-483
• 47 Weber B, Portnoy JE, Castellanos A. et al. Efficacy of Anti-Reflux Surgery on RefractoryLaryngopharyngeal Reflux Disease in Professional Voice Users: A Pilot Study. Journal of Voice 2014; 28: 492-500
• 48 Pickhard A, Smith E, Rottscholl R. et al. Disorders of the larynx and chronic inflammatory diseases. Laryngo-Rhino-Otol 2012; 91: 758-766
• 49 Damrose EJ, Damrose JF. Botulinum toxin as adjunctive therapy in refractory laryngeal granuloma. J Laryngol Otol 2008; 122: 824-828
• 50 Karkos PD. et al. Vocal process granulomas: a systematic review of treatment. Ann Otol Rhinol Laryngol 2014; 123: 314-320
• 51 Devany KO. et al. Vocal process granuloma of the larynx-recognition, differential diagnosis and treatment. Oral ocl 2005; 41: 666-669
• 52 Carroll TL, Gartner-Schmidt J, Statham MM. et al. Vocal process granuloma and glottal insufficiency: an overlooked etiology?. Laryngoscope 2010; 120: 114-120
• 53 Kenn K, Hess MM. Vocal cord dysfunction: an important differential diagnosis of bronchial asthma. Dtsch Ärztebaltt Int 2008; 105: 699-704
• 54 Woolnough K, Blakey J, Pargeter N. et al. Acid supression does not reduce symptoms from vocal cord dysfunction, where gasro-laryngeal reflux is a known trigger. Respirology 2013; 18: 553-554
• 55 Idrees M, FitzGerald JM. Vocal cord dysfunction in bronchial asthma. A review article. J Asthma 2015; 52: 327-335
• 56 Kollarik M, Brozmanova M. Cough and gastroesophageal reflux:insight from animal models. Pulm Pharmacol Ther 2009; 2: 130-134
• 57 Smith JA, Houghton LA. The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflex. Cough 2013; 16: 1-12
• 58 Athansiadis T. et al. Chronic cough: an otorhinolaryngology perspective. Curr Opin Otolaryngol Head Neck Surg 2013; 21: 517-522
• 59 Lorenz KJ, Grieser L, Ehrhart T. et al. Laryngectomised patients with voice prosthesis: influence of supra-esophageal reflux on voice quality and quality of life. HNO 2011; 5: 179-187
• 60 Lorenz KJ, Grieser L, Ehrhart T. et al. Role of reflux in traxheoesophagela fistula problem after laryngectomy. Ann Otol Rhinol Laryngol 2010; 119: 719-728
• 61 Lorenz KJ. et al. Role of reflux-induced epithelial-mesenchymal transition in periprosthetic leakage after prosthetic voice rehabilitation. Head Neck 2015; 37: 530-536
• 62 Reichel O. et al. Laryngopharyngeal reflux disease (LPRD) in children. Laryngorhinootology 2017; 96: 485-496