Produced | Xuanwu Hospital of Capital Medical University
Author | Li Pu, Otolaryngology Head and Neck Surgery
Editor | Li Dongmei
Do you have frequent dry throat, hoarseness, sore throat, chest pain, or heartburn? Could it be pharyngitis? Not too! This is actually a disease that otolaryngologists have paid more attention to in recent years - reflux pharyngitis.
Reflux pharyngitis, also known as laryngopharyngeal reflux, is a clinical syndrome caused by abnormal reflux of gastric contents into the throat above the upper esophageal sphincter.
In addition to pepsin and gastric acid, gastric contents also include bile acids and pancreatic enzymes. These reflux substances can directly stimulate and damage the mucous membrane of the throat, causing symptoms such as dry throat, sore throat, pharyngeal foreign body sensation, bad breath and hoarseness. Severe patients have frequent dry coughs, throat clearing, and nausea when brushing their teeth.
As a special type of chronic pharyngitis, reflux pharyngitis is often misdiagnosed as ordinary chronic pharyngitis. Drugs suitable for the treatment of the latter (such as antibiotics, heat-clearing and fire-dispelling Chinese patent medicines) cannot effectively target the cause of reflux pharyngitis, resulting in the patient's long-term illness after taking the medicine, which has a great impact on life and psychology.
With the deepening of otolaryngology physicians' understanding of reflux pharyngitis in recent years, it is found that the disease is relatively common in clinic, accounting for 10% of all patients in otolaryngology outpatient clinics, and 50% of patients with hoarseness.
Where does reflux pharyngitis come from?
From a medical point of view, it can be said that the reflux of gastric contents leads to the trouble of throat inflammation, which can be said to be caused by various factors. On the one hand, disease factors are a major problem in causing reflux. For example, obstructive sleep apnea hypopnea syndrome can also easily induce reflux and damage throat health. From the perspective of diet and mental factors, poor eating habits, depression and other mental disturbances can also easily cause reflux.
On the other hand, from the point of view of the factors that cause inflammation, the throat is more fragile and less able to resist acid. When the reflux material flows back into the throat, it will naturally irritate and damage the mucous membrane of the throat. In addition, by stimulating the esophageal vagus nerve, the refluxed substances can cause severe damage to the vocal cord mucosa due to coughing, and at the same time cause the relaxation reflex of the upper esophageal sphincter, which increases the gastric contents flowing into the throat.
Reflux pharyngitis does not stand on its own and can cause complications.
Reflux pharyngitis can cause laryngeal contact ulcers, subglottic stenosis, laryngospasm, dysphonia, pharyngitis, asthma, pneumonia, dyspnea at night and other symptoms. Especially recently, the disease has also been suspected to be a major factor in laryngeal cancer patients with no history of tobacco and alcohol exposure.
So how do you know as soon as possible that you have "encountered" reflux pharyngitis?
Diagnosis is mainly based on the patient's symptoms and endoscopy, but there is currently no recognized specific microscopic signs that can be used for a definite diagnosis.
Microscopic findings most closely associated with reflux pharyngitis include: arytenoid erythema, vocal cord erythema and edema, posterior commissure hypertrophy, and arytenoid edema.
In addition, the manifestations that are valuable for the diagnosis of reflux pharyngitis include cobblestone change in the posterior larynx, arytenoid interchondral bulge, congestion, granulomas, contact ulcers, subglottic stenosis, retroglottic stenosis, and vocal cord lesions.
Does prevention work, and how?
Reflux pharyngitis is a disease involving various manifestations of otolaryngology, respiratory and gastroenterology. At present, there is a lot of controversy about the treatment of this disease, and there is no unified and effective treatment plan. Currently recommended treatment options include drug therapy and behavioral therapy.
Drug therapy includes proton pump inhibitors (omeprazole, pandoprazole, etc.), H2 receptor blockers (cimetidine, famotidine), and intestinal motility drugs (mosapride). Proton pump inhibitors and intestinal motility drugs are usually taken half an hour before meals, while H2 blockers are often taken before bedtime. Drug treatment should be more than 3 months, generally 2-4 weeks before marked effect.
Behavioral therapy consists of lifestyle changes related to reflux, including:
1. Avoid eating too much, too much dinner or late night snacks;
2. Do not rest immediately after meals and raise the head of the bed appropriately;
3. Quit smoking and alcohol, eat less spicy, coffee and strong tea;
4. Avoid too tight belt;
5. Reduce high-fat and high-sugar foods;
6. Reduce the intake of citrus, bayberry and other acidic fruits.
