medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-15-48-57medsovet-6425Research ArticleЗАБОЛЕВАНИЯ ПИЩЕВОДА И ЖЕЛУДКАESOPHAGEAL AND GASTRIC DISEASESДиагностика ларингофарингеального рефлюкса: обзорLaryngopharyngeal reflux diagnostics: review articlehttps://orcid.org/0000-0002-6247-619XАнготоеваИ. Б.AngotoevaI. B.

к.м.н., доцент кафедры оториноларингологии

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Cand. Sci. (Med.), Associate Professor of the Department of Otorhinolaryngology 

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

angotoeva@mail.ruhttps://orcid.org/0000-0001-9805-8566АйларовА. К.AylarovA. K.

аспирант кафедры оториноларингологии

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Postgraduate Student of the Department of Otorhinolaryngology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

dr.ailarov@yandex.ruhttps://orcid.org/0000-0001-7242-2593КосяковС. Я.KosyakovS. Ya.

д.м.н., профессор, заведующий кафедрой оториноларингологии

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Dr. Sci. (Med.), Professor, Head of the Department of Otorhinolaryngology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

serkosykov@yandex.ruhttps://orcid.org/0000-0002-3681-4132ЛоранскаяИ. Д.LoranskayaI. D.

 д.м.н., профессор, заведующая кафедрой гастроэнтерологии

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Dr. Sci. (Med.), Professor, Head of the Department of Gastroenterology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

gastrormapo@yandex.ruhttps://orcid.org/0000-0002-0923-8424РумянцеваЕ. Е.RumyantsevaE. E.

 врач-оториноларинголог

630005, Новосибирск, ул. Гоголя, д. 42, оф. 321

Otorhinolaryngologist

42, 321 Office, Gogol St., Novosibirsk, 630005

rum_e@mail.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationАндромед-клиникаРоссияAndromed-ClinicRussian Federation2021161020210154857Copyright © Анготоева И.Б., Айларов А.К., Косяков С.Я., Лоранская И.Д., Румянцева Е.Е., 20212021Анготоева И.Б., Айларов А.К., Косяков С.Я., Лоранская И.Д., Румянцева Е.Е.Angotoeva I.B., Aylarov A.K., Kosyakov S.Y., Loranskaya I.D., Rumyantseva E.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6425

Ларингофарингеальный рефлюкс (ЛФР) является актуальной, современной проблемой для практики лор-врача, так как большинство жалоб приводит пациента в первую очередь к оториноларингологу. ЛФР – это внепищеводное проявление гастроэзофагеальной рефлюксной болезни (ГЭРБ), которое приводит к  рецидивирующему течению симптомов, возникающих в результате непосредственного действия желудочного содержимого на слизистую оболочку гортаноглотки при попадании через верхний пищеводный сфинктер, а также снижению качества жизни. Пациенты с ЛФР составляют от 4 до 10% амбулаторных пациентов, посещающих лор-врача. Основная проблема при установлении диагноза ЛФР связана с отсутствием золотого стандарта диагностики, которая может привести к  назначению неправильного, неэффективного лечения. Существуют значительные разногласия по  поводу подходящего способа диагностики ЛФР. К  методам диагностики ГЭРБ, проводимой гастроэнтерологами, относятся: оценка жалоб, сбор анамнеза, эзофагогастродуоденоскопия, внутрипищеводная pH-метрия, манометрия пищевода, импеданс-pH-метрия с размещением двух зондов – в пищеводе и глотке, рентгеноскопия желудочнокишечного тракта с барием, желудочно-пищеводная сцинтиграфия, ультразвуковое исследование брюшной полости, а также определение пепсина в слюне. Но остается открытым вопрос: позволяют ли все эти методы исследования установить наличие ЛФР. Интерпретация существующих исследований затруднена из-за неопределенных диагностических критериев ЛФР, различных показателей ответа на лечебные мероприятия и значительного эффекта лечения плацебо. Поэтому методы диагностики ЛФР требуют дальнейшего изучения и разработки.

Laryngopharyngeal reflux (LPR) is an actual, modern problem for the practice of an ENT doctor, because majority of complaints lead the patient, first of all, to an otorhinolaryngologist. LPR is an extraesophageal manifestation of gastroesophageal reflux disease (GERD), which leads to a recurrent course of symptoms resulting from the direct action of gastric contents on the mucous membrane of the laryngopharynx when ingested through the upper esophageal sphincter, as well as a decrease in the quality of life. Patients with LPR represent 4% to 10% of outpatients visiting an ENT physician. The main problem of diagnosing of LPR is that there are not any exact researches for this disease, such as PCR-test or biopsy. GERD diagnostic methods performed by gastroenterologists include: assessment of complaints, esophagogastroduodenoscopy (EGDS), intraesophageal pH-metry, esophageal manometry, impedance-pH-metry with the placement of 2 probes in the esophagus and pharynx, gastrointestinal fluoroscopy (GI) with barium, gastroesophageal scintigraphy, abdominal ultrasound (abdominal ultrasound), and pepsin test. All these tests are widely using for diagnosis and sometimes helps us. But the question remains: do all these research methods allow to establish the presence of LPR? Interpretation of existing studies is difficult due to the ambiguous diagnostic criteria for LPR, varying rates of response to treatment, and the significant effect of placebo treatment. Therefore, diagnostic methods for LFR require further study and development.

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The authors declare that there are no conflicts of interest present.