Zusammenfassung
In den vergangenen Jahren hat die Refluxerkrankung an Bedeutung gewonnen, da eine Vielzahl von Erkrankungen und Symptomen des oberen Aerodigestivtrakts mit ihr in Verbindung gebracht werden. Es muss dabei der extraösophageale Reflux (EER) vom klassischen gastroösophagealen Reflux (GERD) abgegrenzt werden. Zur Diagnostik des EER stehen verschiedene Verfahren zur Verfügung. Neben der Berücksichtigung typischer Refluxsymptome und typischer Schleimhautveränderungen im Pharynx und Larynx kann eine Säurebelastung des oberen Ösophagus, des Kehlkopfs und des Larynx auch mit verschiedenen pH-Metrie-Systemen gemessen werden. Zudem hat sich mittlerweile auch die transnasale flexible Ösophagoskopie, nicht zuletzt wegen der Möglichkeit, refluxbedingte Schleimhautveränderungen zu erkennen, mancherorts in der Refluxdiagnostik etabliert. Im folgenden Beitrag werden diese Möglichkeiten vor dem Hintergrund der eigenen Erfahrung und des internationalen Schrifttums beschrieben.
Abstract
Reflux disease has gained in importance over the last decade since we know that many of the symptoms and diseases of the upper aerodigestive tract might be associated with reflux. However, a distinction needs to be made between extraesophageal reflux (EER) and gastroesophageal reflux disease (GERD). There are several techniques available for the diagnosis of EER. Furthermore, there are various pH monitoring devices to determine acid contamination of the larynx and the pharynx. In addition, flexible transnasal esophagoscopy is a practicable technique for the rapid examination of reflux, its cause as well as the diagnosis of reflux-induced mucosal changes in the esophagus. The present article describes the instruments used for the diagnosis of reflux against the background of our own experience and the international literature.
Literatur
Andersson O, Ryden A, Ruth M et al (2010) Development and validation of a laryngopharyngeal reflux questionaire, the pharyngeal Reflux Questionaire. Scand J Gastroenterol 45:147–159
Andrus JG, Dolan RW, Anderson TD, Transnasal Esophagoscopy (2005) A high yield diagnostic tool. Laryngoscope 115:993–996
Atkinson M, Chak A (2010) Screening for Barrett’s Esophagus. Tech Gastrointest Endosc 12:62–66
Ayazi S, Lipham C, Hagen A et al (2009) A new technique for measurement of pharyngeal pH: normal values and discriminating pH Threshold. J Gastrointest Surg 13:1422–1429
Belafsky PC, Postma GN, Koufman JA (2001) The validity and reliability of reflux finding score RFS. Laryngoscope 111:1313–1317
Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptome index. J Voice 16:274–277
Chheda NN, Seybt MW, Schade RR, Postma GN (2009) Normal values for pharyngeal ph monitoring. Ann Otol Rhinol Laryngol 118:166–171
Falcone MT, Garrett CG, Slaughter JC, Vaezi M (2009) Transnasal esophagoscopy findings: interspecialty comparison. Otolaryngol Head Neck Surg 140:812–815
Friedman M, Schalch P, Vidyasagar R, Kakodkar KA (2007) Wireless upper esophageal monitoring for laryngopharyngeal reflux (LPR). Otolaryngol Head Neck Surg 137:471–476
Gugatschka M, Schoekler B, Kiesler K, Friedrich G (2008) Korrelieren die klinischen Symptome und lupenlaryngoskopischen Befunde des laryngo-pharyngealen reflux miteinander? Laryngorhinootologie 78:867–869
Heermann IF, Scarpignato C (2009) Funktionelle Endoskopie. HNO 57:1221–1236
Hill RK, Simpson BS, Velasquez R, Larson N (2004) Pachydermia is not diagnostic of active laryngopharyngeal reflux disease. Laryngoscope 114:1557–1561
Jecker P, Orloff LA, Mann WJ (2005) Extraesophageal reflux and upper aerodigetive trakt diseases. ORL 67:185–189
Jecker P, Orloff LA, Wohlfeil M, Mann WJ (2006) Gastroesophageal reflux disease (GERD), extraesophageal reflux disease (EER) and recurrent chronic rhinosinusitis. Eur Arch Otorhinolaryngol 263:664–667
Jecker P, Schuon R, Morales C, Wohlfeil M (2008) Normalwertbestimmung des extraösophagealen Reflux (EER) in der 24 h-2-Kanal-pH-Metrie. HNO 56:1040–1045
Korkmaz M, Tarhan E, Unal H et al (2007) Esophageal mucosal sensitivity: possible links with clinical presentations in patients with Erosive Esophagitis and Laryngopharyngeal Reflux. Dig Dis Sci 52:451–456
Koufman JA (2002) Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J 81, 89(Suppl 2):24–26
Mc Murray JS, Gerber M, Stern Y et al (2001) Role of laryngoscopy, dual pH-monitoring, and laryngeal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otol Rhinol Laryngol 110:299–304
McPartlin DW, Nouraei SA, Tatla T et al (2005) How we do it: transnasal fiberoptic oesophagoscopy. Clin Otolaryngol 30:547–550
Musser J, Kelchner L, Neils-Strunjas J, Montrose M (2011) A comparison of rating scales used in the diagnosis of extraesophageal reflux. J Voice (im Druck)
Poelmans J, Tack J (2005) Extraesophageal manifestation of gastroesophageal reflux. Gut 54:1492–1499
Postma GN, Cohen JT, Belafsky PC et al (2005) Transnasal esophagoscopy: revisited (over 700 consecutive cases). Laryngoscope 115:321–323
Reavis KM, Morris CD, Gopal DV et al (2004) Laryngopharyngeal reflux symptoms better predict the presence of esophageal adenocarcinoma than typical gastroesophageal reflux symptoms. An Surg 239:849–858
Shaw GY (2000) Application of 24-hour multiprobe pH monitoring in the presence of extraesophageal manifestation of gastroesophageal reflux. Ann Otol Rhinol Laryngol Suppl 184:15–17
Vandenplas Y, Salvatore S, Vieira MC, Hauser B (2010) Will Esophageal Impedance Replace pH monitoring? Pediatrics 119:118–122
Vincent DAJ, Garrett JD, Radionoff SL et al (2000) The proximal probe in esophageal pH monitoring: development of a normative database. J Voice 14:247–254
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Jecker, P. Möglichkeiten der Refluxdiagnostik durch den Hals-Nasen-Ohren-Arzt. HNO 60, 186–192 (2012). https://doi.org/10.1007/s00106-011-2431-8
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DOI: https://doi.org/10.1007/s00106-011-2431-8