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Abstract：
Bile acids in refluxate contribute to esophageal and laryngeal symptoms and are quantifiable. The aim of this study was to compare salivary bile acid concentrations across healthy controls and symptomatic patients (esophageal or laryngeal) with or without objective gastroesophageal reflux disease (GERD). This prospective study enrolled adults into three groups: esophageal symptoms (heartburn, regurgitation, chest pain); laryngeal symptoms (cough, throat clearing, sore throat, dysphonia); and controls. Symptomatic patients primarily underwent prolonged wireless reflux monitoring off acid suppression and were categorized as symptomatic no GERD (acid exposure time <4%) or esophageal/laryngeal symptoms with GERD (acid exposure time ≥4%). Controls did not undergo reflux monitoring nor upper endoscopy. Saliva samples were provided for bile acid analysis via ultraperformance liquid chromatography tandem mass spectrometry. Thirty-five participants were enrolled (mean age 47.4 years [SD 18.9], 16 [46%] male), including 10 controls and 25 symptomatic: 9 no GERD, 5 esophageal symptoms + GERD, and 11 laryngeal symptoms + GERD. Total salivary bile acids were highest in the laryngeal symptoms + GERD group (24.2 nM [SD 24.7]) compared to other groups (controls: 5.8 [6.0], P = 0.03; symptomatic no GERD: 3.1 [4.4]; P < 0.01; esophageal symptoms + GERD: 7.1 [7.1], P = 0.10). Bile acids were elevated in 45% (5/11) of the laryngeal symptoms + GERD group compared to 0% of the other three groups (P < 0.01). Salivary bile acids were higher among patients with laryngeal symptoms and objective GERD versus other groups. Salivary bile acids are a quantifiable biomarker with diagnostic potential for laryngopharyngeal reflux.
摘要：
回流液中的胆汁酸会导致食道和喉部症状，并且可以量化。这项研究的目的是比较健康对照组和有或没有客观胃食管反流病（GERD）的有症状患者（食管或喉部）的唾液胆汁酸浓度。这项前瞻性研究将成年人分为三组：食道症状（胃灼热，返流,胸痛）;喉部症状（咳嗽，清嗓子,喉咙痛,发音障碍)；和对照。有症状的患者主要接受长时间的无线反流监测，以消除酸抑制，并分为无GERD症状（酸暴露时间<4％）或食管/喉部症状伴GERD（酸暴露时间≥4％）。对照组没有进行反流监测，也没有进行上内窥镜检查。唾液样品通过超高效液相色谱串联质谱法提供用于胆汁酸分析。35名参与者被纳入(平均年龄47.4岁[SD18.9]，16[46%]男性)，包括10个对照和25个有症状的：9个没有GERD，5食管症状+GERD,和11个喉部症状+GERD。总唾液胆汁酸在喉部症状+GERD组中最高（24.2nM[SD24.7]），与其他组相比（对照：5.8[6.0]，P=0.03；症状无GERD：3.1[4.4]；P<0.01；食管症状+GERD：7.1[7.1]，P=0.10）。喉部症状+GERD组胆汁酸升高45％（5/11），其他三组为0％（P<0.01）。与其他组相比，有喉部症状和客观GERD的患者的唾液胆汁酸较高。唾液胆汁酸是一种可量化的生物标志物，具有诊断咽喉反流的潜力。
