背景:喉咽反流相关症状包括各种头颈部表现。最近有人推测它参与了眼部疾病,目前在这方面没有共识。本手稿的目的是回顾反流在眼部体征和症状发展中的作用,及其生理病理机制。
方法:一种基于首选报告项目的系统方法,用于修改人群的系统评价和荟萃分析清单,干预,比较,结果框架用于构建评估可能关联的研究的审查过程,有明确的诊断方法,咽喉反流和眼部体征和症状。在不同的索引数据库(PubMed/MEDLINE,Cochrane图书馆,Scielo和WebofScience),并通过带有关键字的元搜索者旅行数据库:回流,喉炎,咽喉,胃食管,眼,眼睛,症状,标志,结膜炎,角膜炎,泪囊炎,干眼症.
结果:七项研究符合纳入标准,其中评估了原发性获得性鼻泪管阻塞和眼表疾病。眼胃蛋白酶浓度的局部增加(>2.5ng/mL)可能通过其直接蛋白水解活性和促炎细胞因子的局部表达影响眼表。H.Pylori,通过类似的机制到达泪管,与促炎和血管活性物质的释放有关,这将导致粘膜损伤和慢性炎症。眼表疾病指数似乎与反流严重程度直接相关,以41.67分作为疾病预测因子。
结论:喉咽反流在眼部疾病发展中的作用尚未得到证实,数据有限且不均匀。从理论上讲,胃蛋白酶可能通过下咽-鼻气态反流事件到达泪管区域。为了探索这种潜在的关系,需要使用客观测试进行诊断并对泪液和鼻粘膜进行胃蛋白酶检测的未来研究。
BACKGROUND: Laryngopharyngeal reflux-associated symptoms embrace a wide variety of head and neck manifestations. Its participation in eye disorders has recently been postulated, and there is currently no consensus in this regard. The aim of this manuscript is to
review the role of reflux in the development of ocular signs and symptoms, and its physio-pathological mechanisms.
METHODS: A systematic approach based on the preferred reporting Items for a systematic
review and meta-analysis checklist with a modified population, intervention, comparison, and outcome framework was used to structure the
review process of studies that evaluated the possible association, with clear diagnostic methods, of laryngopharyngeal reflux and ocular signs and symptoms. Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and through the meta-searcher Trip Database with the keywords: reflux,
laryngitis, laryngopharyngeal, gastroesophageal, ocular, eye, symptoms, signs, conjunctivitis, keratitis, dacryocystitis, dry eye.
RESULTS: Seven studies met the inclusion criteria, in which the primary acquired nasolacrimal duct obstruction and the ocular surface disease were evaluated. The local increase of eye pepsin concentration (>2.5 ng/mL) may affect ocular surface though its direct proteolytic activity and the local expression of proinflammatory cytokines. The H. Pylori, with a similar mechanism to reach the lacrimonasal duct, would be associated with the release of proinflammatory and vasoactive substances that would lead to a mucosa injury and chronic inflammation. Ocular Surface Disease Index seems to correlate directly with the reflux severity, with cut-off of 41.67 score as predictor for disease.
CONCLUSIONS: The role of laryngopharyngeal reflux in the development of ocular disorders has not yet been demonstrated and data are limited and heterogeneous. It seems theoretically conceivable that pepsin may reach lachrymal duct area through hypopharyngeal-nasal gaseous reflux events. Future studies using objective testing for diagnosis and pepsin detection into the tear and nasal mucosa are needed in order to explore this potential relationship.