인후두 역류질환으로 오인된 식도 이완불능증 1예

A Case of Esophageal Achalasia Misconceived as Laryngopharyngeal Reflux Disease

  • 노승호 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 이용우 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 박진수 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 이상혁 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실)
  • Noh, Seung Ho (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Yong Woo (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Jin Su (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Sang Hyuk (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2017.01.05
  • 심사 : 2017.03.12
  • 발행 : 2017.06.30

초록

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.

키워드

참고문헌

  1. Belafsky PC, Postma GN, Amin MR, Koufman JA. Symptoms and findings of laryngopharyngeal reflux. Ear, Nose & Throat Journal 2002;81(9):10. https://doi.org/10.1177/014556130208100103
  2. Choi H. Laryngopharyngeal reflux disease. The 2nd digestive disease research lecture. Korea University Digestive Research Institute 1999:25-32.
  3. Remacle M, Lawson G. Diagnosis and management of laryngopharyngeal reflux disease. Current Opinion in Otolaryngology & Head and Neck Surgery 2006;14(3):143-9. https://doi.org/10.1097/01.moo.0000193189.17225.91
  4. Simpson CB. Management of laryngopharyngeal reflux disease. Current Opinion in Otolaryngology & Head and Neck Surgery 1999;7(6):343. https://doi.org/10.1097/00020840-199912000-00009
  5. Roman S, Tutuian R. Esophageal hypertensive peristaltic disorders. Neurogastroenterology & Motility 2012;24(s1):32-9. https://doi.org/10.1111/j.1365-2982.2011.01837.x
  6. Carroll TL, Fedore LW, Aldahlawi MM. pH Impedance and highresolution manometry in laryngopharyngeal reflux disease highdose proton pump inhibitor failures. The Laryngoscope 2012;122(11):2473-81. https://doi.org/10.1002/lary.23518
  7. Reynolds J, Parkman H. Achalasia. Gastroenterology Clinics of North America 1989;18(2):223-55.
  8. Kessing BF, Bredenoord AJ, Smout AJ. Erroneous diagnosis of gastroesophageal reflux disease in achalasia. Clinical Gastroenterology and Hepatology 2011;9(12):1020-4. https://doi.org/10.1016/j.cgh.2011.04.022
  9. Lee SH, Huh SH. Recent trends of laryngopharyngeal reflux disease. Korean J Otorhinolaryngol-Head Neck Surg 2011;54(8):519-25. https://doi.org/10.3342/kjorl-hns.2011.54.8.519
  10. Vaezi MF. Therapy insight: gastroesophageal reflux disease and laryngopharyngeal reflux. Nature Clinical Practice Gastroenterology & Hepatology 2005;2(12):595-603. https://doi.org/10.1038/ncpgasthep0358
  11. Habermann W, Schmid C, Neumann K, DeVaney T, Hammer HF. Reflux symptom index and reflux finding score in otolaryngologic practice. Journal of Voice 2012;26(3):e123-7. https://doi.org/10.1016/j.jvoice.2011.02.004
  12. Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). The Laryngoscope 2001;111(8):1313-7. https://doi.org/10.1097/00005537-200108000-00001
  13. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. Journal of Clinical Gastroenterology 1986;8:52-8. https://doi.org/10.1097/00004836-198606001-00008
  14. Moawad FJ, Wong RK. Modern management of achalasia. Current opinion in gastroenterology 2010;26(4):384-8. https://doi.org/10.1097/MOG.0b013e32833aaf4a
  15. Ko WJ, Lee BM, Park WY, Kim JN, Cho J-H, Lee TH, et al. Jackhammer esophagus treated by a peroral endoscopic myotomy. The Korean Journal of Gastroenterology 2014;64(6):370-4. https://doi.org/10.4166/kjg.2014.64.6.370