Laryngopharyngeal reflux

Under laryngitis gastric refers to a non-bacterial, inflammatory reaction of the mucosa of the larynx and surrounding throat by a reflux (Latin refluxus " reflux " ) of gastric secretion, particularly in the gastric acid and pepsin are essential ingredients. The name of the disease is derived from the Latin name of the stomach ( gaster ). Other designations are posterior laryngitis, laryngopharyngeal reflux ( LPR), NERD (Non esophageal disease refluxe = not -oesophageal reflux disease) or EERD (extra refluxe esophageal disease).

Discomfort

Typical symptoms are:

• Voice problems and hoarseness
• Feeling of a lump in the throat
• Hawking
• Chronic cough

Findings

In lupenlaryngoskopischen image mainly hyperplasia of mucous membranes fall predominantly on the posterior ( back ) portions of the larynx, Ösophaguseingangs and revenge rear and side walls. Typical is a bright color and pleating of the mucosa, due to the thickening of the piriform recess unfolds less well. Depending on sun habits can be observed by predominantly nocturnal reflux favoring one side. In recent experimental studies negative effects of the reflux could be detected on the microstructure of the laryngeal mucosa. Thus, the gastric juice leads to a reduced resistance of the Mucosabarriere with the result easier penetration of pollutants into deeper cell layers. Another study showed changes in the immune system of the mucosa ( in so-called killer cells) as a result of reflux.

Diagnostics

Standard is still the endoscopic image, even if some studies have shown that the results can be highly variable and therefore lead to different interpretations at different investigators. As investigation of apparatus for the direct detection of reflux is one of the 24-hour pH -metry, where the classical probes with measuring points in the stomach and lower esophagus are not optimal, since only one measurement point in the hypopharynx can detect the reflux in the target region. Therefore, special probes with corresponding configuration are better suited. For a general investigation of cause ( eg, hiatal hernia ) a gastroscopy is required (see also reflux esophagitis ). Also, already a non- obstructive snoring can be reflux -promoting, since a significant pressure gradient arises at Thorax-/Halsraum from the stomach through the airway obstruction. The thoracic vacuum at ( of failed ) Inspiration increases significantly the gastric juice is sucked upwards. Therefore, if necessary, is also a polysomnography in the sleep laboratory, optimally with Somnoendoskopie required.

Distribution and socio -economic consequences

According to research about 20 % of Americans are affected by a reflux to the throat. Pahn found at 1,000 patients who visited the outpatient clinic because of a voice disorder, gastric in 41% signs of laryngitis, while, conversely, 10% of patients with reflux also complained about globus sensation, throat clearing and abnormal sensations in the laryngeal. There are therefore estimates of the socio - economic impact of this disease: after an audit by the British National Health Services annually about 4 % (equivalent to approximately € 24 million ) was spent in expenditure on proton pump inhibitors for this reflux shape Also there are studies on the reduced quality of life gastric by laryngitis. In addition, patients with laryngitis gastrica an increased risk for development of carcinoma of the larynx. Therefore, patients with a gastric laryngitis, especially when other risk factors such as nicotine and alcohol consumption, tracked over time.

Therapy

Medical therapy is the treatment with proton pump inhibitors (PPI ), the treatment of choice. Since the harmful for the larynx reflux mainly occurs at night, is (also) a nightly gift meaningful. Dietary measures (including avoidance of late, difficult to digest meals close to bedtime) are supportive, such as a high storage in the bed. According to recent studies on patients who do not respond to PPI therapy, also plays present in the refluxate, pepsin as the cause of changes with potential carcinogem a major role. In relevant Snoring CPAP therapy leads to a significant improvement in the laryngeal mucosa image. Each other symptoms ( esophagus, bronchus) additional, organ-specific therapeutic measures are required. When induced by mucosal exposure, secondary voice disorder after an improvement in the mucosal changes a voice therapy is indicated. In a retrospective study of 105 patients with initially diagnosed, reflux -related hoarseness was collected by questionnaire that 82 % of clients reporting no improvement of hoarseness after PPI administration, 18% a slight improvement. The authors conclude that probably the reflux rather have played no role in triggering the hoarseness of the patients studied, but other factors are triggering.