Z Gastroenterol 2015; 53(02): 101-107
DOI: 10.1055/s-0034-1385554
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Clinical impact of esophageal function tests and argon plasma coagulation in heterotopic gastric mucosa of the esophagus and extraesophageal reflux symptoms – a prospective study

Klinische Wertigkeit von ösophagealen Funktionstests und Argon-Plasma-Koagulation bei Magenschleimhautheterotypien im Ösophagus und extraösophagealen Reflux-Symptomen – eine prospektive Untersuchung
T. Frieling
,
R. Kuhlbusch-Zicklam
,
C. Weingardt
,
J. Heise
,
C. Kreysel
,
M. Blank
,
D. Müller
Weitere Informationen

Publikationsverlauf

04. Juni 2014

13. Oktober 2014

Publikationsdatum:
10. Februar 2015 (online)

Abstract

Background/Aims: Globus, chronic cough, mucous obstruction and hoarseness are frequently interpreted and classified as manifestation of extraesophageal reflux (EER) or laryngopharyngeal reflux (LPR). Recent studies have indicated that ablation of heterotopic gastric mucosa of the proximal esophagus (HGMPE) by argon plasma coagulation (APC) significantly reduces EER/LPR symptoms.

Methods: In a prospective study we evaluated 14 patients with HGMPE and EER/LPR symptoms by esophageal function testing (esophageal manometry, combined 24 h-pH-metry-impedance – oropharyngeal-pH measurement), standardized symptom questionnaire (visual analogue scales), and esophagealgastroduodenoscopy (EGD). The patients were stratified into 3 groups: GERD (n = 5), functional heartburn (n = 5) and non-GERD-non-functional heartburn (n = 4). Patients (n = 12) received endoscopic ablation of HGMPE by APC.

Results: 73 % of the patients responded to APC with a reduction of frequency and intensity of their EER/LPR symptoms. The response to APC varied between the quality of symptoms and was most frequently seen in globus, swallowing difficulty and mucous obstruction. The magnitude of symptom reduction was highest in heartburn, sore throat, and globus. The response to APC was comparable between the three groups of patients irrespective of GERD and the presence or absence of reflux symptoms. Although 50 % of the patients showed an increased Ryan Score as measured by acid reflux in the posterior oropharynx, comparison between responders and non-responders to APC showed no significant differences with regard to symptom quality, acid and non-acid reflux, LES resting pressure, esophageal motility and Ryan Score.

Conclusion: The study indicates that a large proportion of patients with HGMPE and EER/LPR symptoms responded to APC. However, we could not demonstrate a clinical or functional parameter that differentiated between responders and non-responders to APC or could predict the response to APC.

Zusammenfassung

Hintergrund/Ziele: Globus, chronischer Husten, Schleimbildung und Heiserkeit werden häufig als Folge eines extraösophagealen Refluxes (EER) oder laryngoösophagealen Refluxes (LPR) interpretiert. Neuere Studien haben eine signifikante Reduktion von EER/LPR-Symptomen nach Argon-Plasma-Koagulation (APC) von heterotoper Magenschleimhaut im proximalen Ösophagus (HDMPE) nachgewiesen.

Methoden: In einer prospektiven Studie wurden 14 Patienten mit HGMPE und EER/LPR Symptomen mittels Ösophagusfunktionstests (Ösophagusmanometrie, kombinierte 24 h-pH-Metrie-Impedanzmessung – oropharyngeale pH-Metrie), standardisierter Symptomenbefragung (visuell-analog Skalen) und Ösophagogastroduodenoskopie (EGD) untersucht. Die Patienten wurden in 3 Gruppen stratifiziert: GERD (n = 5), funktionelles Sodbrennen (n = 5) und Patienten ohne GERD und ohne funktionelles Sodbrennen (n = 4). Die Patienten (n = 12) wurden durch APC der HGMPE behandelt.

Ergebnisse: 73 % der Patienten zeigten eine Verbesserung nach APC mit Reduktion der Frequenz und Intensität der EER/LPR-Symptome. Die Wirkung der APC variierte in Bezug auf die Symptomenqualität und -intensität und trat am häufigsten für Globus, Schluckbeschwerden und Schleimbildung auf und war am stärksten für Sodbrennen, Heiserkeit und Globus. Die Symptomenverbesserung nach APC war zwischen den 3 klinischen Gruppen unabhängig von GERD und dem Vorkommen von Reflux-Symptomen vergleichbar. Obwohl 50 % der Patienten einen positiven Ryan-Score durch Messung des sauren Refluxes im posterioren Oropharynx aufwiesen, zeigte der Vergleich zwischen Respondern und Non-Respondern auf APC keine signifikanten Unterschiede bez. Symptomenqualität, sauren oder nicht-sauren Reflux, LES-Ruhedruck, Ösophagusmotilität und Ryan-Score.

Schlussfolgerung: Die Studie zeigt, dass ein hoher Anteil von Patienten mit HGMPE und EER/LPR Symptomen auf die APC-Therapie anspricht. Demgegenüber konnten wir keinen klinischen oder funktionellen Parameter finden, der zwischen Respondern und Non-Respondern auf APC differenzierte oder den Erfolg der APC-Therapie vorhersagte.

 
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