Laringofaringealni refluks: novosti u dijagnostici i liječenju

Andrijana Včeva, Tihana Mendeš, Anamarija Šestak, Željko Zubčić, Hrvoje Mihalj, Željko Kotromanović, Josip Maleš, Tin Prpić, Ivan Abičić, Matej Rezo, Vjeran Bogović, Stjepan Grga Milanković, Željko Vranješ, Ljiljana Širić, Tamara Kopf

U posljednjih pedeset godina globalizacija i urbanizacija značajno su promijenile način i stil života, a s njim i način i stil prehrane. Živimo užurbanim stilom života, svakodnevno smo izloženi brojnim stresnim situacijama, konzumiramo gotovu, brzo pripremljenu hranu, gazirana i alkoholna pića, a navedeno prati i prehrambena industrija koja, da bi produžila vijek trajanja namirnica, svu hranu dodatno zakiseljava. Kao posljedica loših prehrambenih navika, konzumiranja hrane kada bismo se trebali odmarati, stresa, ali i djelovanja prehrambene industrije došlo je do epidemije refluksne bolesti. Dio te bolesti jest i laringofaringealni refluks, bolest karakterizirana vraćanjem želučanog sadržaja u grkljan, ždrijelo i okolne organe, što dovodi do promuklosti, kašlja, otežanog gutanja i disanja te u konačnici nastanka dobroćudnih i/ili zloćudnih promjena grkljana. U većine oboljelih ključnu ulogu u nastanku promjena u grkljanu i drugim organima ima pepsin, a kiseli medij mu služi za održavanje proteolitičke aktivnosti. Osim pepsina, soli žučnih kiselina i drugi gastroduodenalni proteini mogu imati ulogu u nastanku upalnih promjena sluznice gornjega aerodigestivnog trakta. Terapiju laringofaringealnog refluksa u većini slučajeva započinjemo medikamentoznim liječenjem, što je krivo i neučinkovito. Stoga je važno naglasiti da liječenje laringofaringealnog refluksa uvijek mora započeti promjenom načina prehrane i promjenom stila života te reguliranjem stresa. Liječenje mora biti individualno i u liječenju ove bolesti mora sudjelovati multidisciplinarni tim u koji moraju biti uključeni nutricionist, psiholog i psihijatar.

In the last fifty years, globalization and urbanization have significantly changed our lifestyles and our eating habits. We live hectic lifestyles and are exposed to many stressful situations every day, we consume readymade, quickly prepared food, carbonated and alcoholic beverages. All of this is accompanied by the food industry, which also acidifies all the foods to prolong their shelflife. As a consequence of bad eating habits, consuming food when you should rest, stress, but also the activities of the food industry, there has been an epidemic of reflux disease. Part of this disease is laryngopharyngeal reflux, a disease characterized by the return of gastric contents to the throat and surrounding organs, which leads to hoarseness, coughing, swallowing and breathing difficulty, and ultimately the development of benign and / or malignant changes in the larynx. In most patients, pepsin plays a key role in developing changes in the larynx and other organs, and its acidic medium serves to maintain proteolytic activity. In addition to pepsin, bile acid salts and other gastroduodenal proteins may play a role in the development of inflammatory changes in the mucosa of the upper aerodigestive tract. In most cases, we start laryngopharyngeal reflux therapy with medication, however this is wrong and ineffective. Therefore, it is important to emphasize that treatment must always begin with a change in diet, lifestyle and stress regulation. The treatment of laryngopharyngeal reflux must be individual and should involve a multidisciplinary team with a nutritionist, a psychologist and a psychiatrist.