Laryngopharyngeal Reflux
| Autor: | Brown J; McLaren Oakland, Shermetaro C; Mclaren Oakland Hospital |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | 2022 Jan. |
| Abstrakt: | The term laryngopharyngeal reflux (LPR) describes the anatomical location of the disease as well as its cause. According to Sataloff, “laryngopharyngeal reflux incorporates a complex spectrum of abnormalities.” The airway is subdivided anatomically beginning with the oropharynx, then the hypopharynx, supraglottis, glottis, subglottis, and finally, the trachea. The area of concern, and what brings most patients into the clinic, is the effect of reflux on vocal cords or glossitis. Reflux is normally sequestered within the stomach and sometimes escapes into the distal esophagus, which has been described in other literature. In healthy individuals, there are four barriers to reflux encroaching on the larynx: the lower esophageal sphincter, upper esophageal sphincter, esophageal peristalsis, and epithelial resistance factors. Dysfunction in any of the above will lead to symptoms of laryngopharyngeal reflux. The upper esophageal sphincter is the final gatekeeper in antireflux. The area of the distal pharynx and proximal esophageal sphincter only opens for specific physiologic demands, such as swallowing under tonic contraction. This is made up of the cricopharyngeus, thyropharyngeus, and the proximal cervical esophagus muscles, forming a c-shaped sling that attaches to the cricoid cartilage. The tonic pressure induced by these muscles can be decreased with general anesthesia, sleep state, and cigarette consumption. The lower esophageal sphincter is located at the gastroesophageal junction whose contracture leads to circular closure and prevention of egress of stomach acid. The diaphragmatic crura make up this critical antireflux mechanism. The esophagus, with the help of gravity and peristalsis, can clear the acid that makes its way more proximal than expected. A mucus layer is present along the esophagus that is a barrier to large molecules, such as pepsin, but does not help prevent acid penetration. Also present is the aqueous layer, which helps form a protective alkaline buffer. (Copyright © 2022, StatPearls Publishing LLC.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|