Abstract：
OBJECTIVE: Symptoms/complications related to extraesophageal reflux (EER) are increasingly prevalent presentations and pose significant challenges for clinicians. We summarize and discuss clinical advances and developments in pathophysiology, testing and treatment algorithms of upper/lower airway manifestations of EER.
RESULTS: Growing evidence supports likely multifactorial causes of laryngeal symptoms, including EER, oropharyngeal pathologies, allergic conditions, and cognitive-affective processes (brain-larynx interaction). Diagnostic paradigm for laryngopharyngeal reflux (LPR) is shifting towards a personalized approach with noninvasive strategies/prediction tools to risk-stratify patients for upfront reflux testing over empiric acid suppression trials. Management should be multipronged to include antireflux therapies and treatments targeting other causes. Lower airway complications of EER may result in lung dysfunction and poor transplant outcomes. Esophageal symptoms are often absent and routine esophageal/reflux testing to guide timely antireflux therapies may lead to improved outcomes. Modalities that leverage impedance technology may be important, given the potential role of nonacidic reflux. Novel impedance-based metrics such as mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index may provide adjunctive diagnostic values.
CONCLUSIONS: Standardized approach to diagnosis/management of EER should include multidisciplinary care teams and consider different phenotypes, nonreflux contributors, and the complex gut-airway relationships. Prompt antireflux therapies after careful candidate selection may improve outcomes of these airway complications.
RESULTS: Growing evidence supports likely multifactorial causes of laryngeal symptoms, including EER, oropharyngeal pathologies, allergic conditions, and cognitive-affective processes (brain-larynx interaction). Diagnostic paradigm for laryngopharyngeal reflux (LPR) is shifting towards a personalized approach with noninvasive strategies/prediction tools to risk-stratify patients for upfront reflux testing over empiric acid suppression trials. Management should be multipronged to include antireflux therapies and treatments targeting other causes. Lower airway complications of EER may result in lung dysfunction and poor transplant outcomes. Esophageal symptoms are often absent and routine esophageal/reflux testing to guide timely antireflux therapies may lead to improved outcomes. Modalities that leverage impedance technology may be important, given the potential role of nonacidic reflux. Novel impedance-based metrics such as mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index may provide adjunctive diagnostic values.
CONCLUSIONS: Standardized approach to diagnosis/management of EER should include multidisciplinary care teams and consider different phenotypes, nonreflux contributors, and the complex gut-airway relationships. Prompt antireflux therapies after careful candidate selection may improve outcomes of these airway complications.
摘要：
目的：与食管外反流（EER）相关的症状/并发症越来越普遍，对临床医生构成重大挑战。我们总结和讨论病理生理学的临床进展和发展，EER上/下气道表现的测试和治疗算法。
结果：越来越多的证据支持喉部症状可能的多因素原因，包括EER,口咽病理学，过敏状况,和认知-情感过程（脑-喉相互作用）。咽喉反流（LPR）的诊断范式正在向个性化方法转变，该方法具有非侵入性策略/预测工具，以对患者进行预先反流测试而不是经验酸抑制试验的风险分层。管理应多管齐下，包括抗反流治疗和针对其他原因的治疗。EER的下气道并发症可能导致肺功能障碍和不良的移植结果。食管症状通常不存在，常规食管/反流测试指导及时抗反流治疗可能会改善预后。利用阻抗技术的模式可能很重要，考虑到非酸性回流的潜在作用。新颖的基于阻抗的指标，例如平均夜间基线阻抗和吞吐后引起的蠕动波指数，可以提供辅助诊断值。
结论：EER诊断/管理的标准化方法应包括多学科护理团队，并考虑不同的表型，非反流贡献者，和复杂的肠道-气道关系。仔细选择候选药物后，及时进行抗反流治疗可能会改善这些气道并发症的预后。
结果：越来越多的证据支持喉部症状可能的多因素原因，包括EER,口咽病理学，过敏状况,和认知-情感过程（脑-喉相互作用）。咽喉反流（LPR）的诊断范式正在向个性化方法转变，该方法具有非侵入性策略/预测工具，以对患者进行预先反流测试而不是经验酸抑制试验的风险分层。管理应多管齐下，包括抗反流治疗和针对其他原因的治疗。EER的下气道并发症可能导致肺功能障碍和不良的移植结果。食管症状通常不存在，常规食管/反流测试指导及时抗反流治疗可能会改善预后。利用阻抗技术的模式可能很重要，考虑到非酸性回流的潜在作用。新颖的基于阻抗的指标，例如平均夜间基线阻抗和吞吐后引起的蠕动波指数，可以提供辅助诊断值。
结论：EER诊断/管理的标准化方法应包括多学科护理团队，并考虑不同的表型，非反流贡献者，和复杂的肠道-气道关系。仔细选择候选药物后，及时进行抗反流治疗可能会改善这些气道并发症的预后。
