Posterior laryngitis: a disease with different aetiologies affecting health-related quality of life:a prospective case–control study

Background: Laryngo-pharyngeal reflux (LPR) is assumed to be the most common cause of posterior laryngitis (PL). Since LPR is found in healthy subjects, and PL patients are not improved by acid-reducing therapy, other aetiologies to PL must be considered. The aims of this study in PL were to investigate the prevalence of acid reflux in the proximal oesophagus and functional gastrointestinal symptoms, to analyse motilin levels in plasma, and to assess health-related quality of life (HRQOL) before and after treatment. Methods: Forty-six patients (26 women), with verified PL, median age 55 (IQR 41–68) years, were referred to oesophago-gastro-duodenoscopy and 24-h pH monitoring. Plasma motilin was analysed. The 36-item Short-Form questionnaire was completed at inclusion and at follow-up after 43±14 months, when also the Visual Analogue Scale for Irritable Bowel Syndrome was completed. Values were compared to controls. Treatment and relief of symptoms were noted from medical records. Results: Thirty-four percent had proximal acid reflux and 40% showed signs of distal reflux. Ninety-four percent received acid-reducing treatment, with total relief of symptoms in 17%. Patients with reflux symptoms had lower plasma motilin levels compared to patients without reflux symptoms (p = 0.021). The HRQOL was impaired at inclusion, but improved over time. Patients, especially men, had more functional gastrointestinal symptoms than controls. Conclusions: This study indicates that a minority of patients with PL has LPR and is cured by acid-reducing therapy. Disturbed plasma motilin levels and presence of functional gastrointestinal symptoms are found in PL. The impaired HRQOL improves over time

Posterior Laryngitis- Aetiology,Treatment and Health-Related Quality of Life

Posterior laryngitis (PL) is defined as an inflammation involving the posterior part of the glottal region in conjunction with symptoms. The cause is multifactorial. The aims of the work presented in this thesis were to examine symptoms, physical signs, different aetiologies and health-related quality of life (HRQOL) in patients with PL and/or oesophageal dysmotility. In paper I, a group of patients diagnosed as having PL were examined, treated and followed, to determine whether follow-up is needed. Their current HRQOL was registered. In paper II, we investigated how many of the patients diagnosed with PL who had acid reflux in the proximal part of the oesophagus, altered motilin levels, and symptoms associated with functional gastrointestinal disease. Their HRQOL was registered before and after treatment. In paper III, patients with PL were scrutinized for the presence of gonadotropin-releasing hormone (GnRH) antibodies. In paper IV, patients with diabetes mellitus were examined to see whether blood levels of motilin were related to symptoms and signs of dysfunction in the oesophagus and stomach. Approximately 90% of the patients, investigated for reflux, were treated with proton pump inhibitors. Of the patients not investigated for reflux, 85% received acid-suppressing treatment. One-third of the investigated patients in paper II had objectively measured reflux. Patients with typical reflux symptoms had abnormal levels of motilin compared to those without these symptoms. Antibodies against GnRH and gastrointestinal symptoms were found to a greater extent in patients than in controls. There was a significant correlation between the percentage of simultaneous contractions in the oesophagus, and basic and peak plasma motilin values in patients with diabetes mellitus. HRQOL, especially in women, was low. Taken together, PL is associated with acid reflux in the proximal oesophagus, endocrine disturbances, functional gastrointestinal disease and reduced HRQOL. By improving follow-up, and optimising investigations and treatment, HRQOL can be improved

Antibodies Against Gonadotropin-Releasing Hormone in Patients with Posterior Laryngitis

Patients with functional gastrointestinal disorders express antibodies against gonadotropin-releasing hormone (GnRH) in serum. One common cause of posterior laryngitis (PL) is extra-esophageal reflux, but a functional etiology has also been suggested. The aim of this study was to scrutinize patients with PL with regard to the presence of GnRH antibodies and to examine the association between antibodies and symptoms and reflux. Consecutive PL patients were included after examination. Serum was analyzed for the presence of antibodies using an enzyme-linked immunosorbent assay (ELISA) method and expressed as relative units (RU). Two age- and gender-matched healthy subjects per case served as controls. The prevalence of IgM GnRH antibodies in patients was 35% compared with 28% in controls (P = 0.06), with higher levels in patients (0.8 (0.3-2.2) RU) than in controls (0.2 (0.1-0.6) RU) (P = 0.007). The corresponding IgG antibody prevalences were 43% and 4%, respectively (P = 0.001), with no difference in levels (P = 0.70). There was no association between antibodies and clinical findings

Voice and swallowing after total laryngectomy

Background: Voice and swallowing problems are often seen in patients with advanced larynx cancer, after total laryngectomy (TL) and chemo/radiotherapy. The aim of this study was to determine the occurrence of voice and swallowing problems in patients who have been laryngectomised and investigate if these symptoms were related to age, time after TL, radiotherapy and TNM-classification. In addition, we studied how often the patients changed their voice prostheses and the need of therapeutic interventions after TL. Methods: Forty-five patients were included in the study and completed the Swedish version of the Sydney Swallow Questionnaire and the Voice Handicap Index-T. Results: Swallowing problems were reported by 89% of the patients and moderate-to-severe voice handicap was reported by 66%. Most of the subjects who had dysphagia also presented voice problems (rs = 0.67 p ≤ .01). Additional therapeutic interventions to manage problems with voice and/or swallowing after TL were required in 62% of the patients. Conclusions: Swallowing and voice problems after TL are common. Thus, the preoperative information and assessment of these functions, as well as the treatment and the post-operative rehabilitation should be evaluated and optimised to provide better functional results after treatment of advanced larynx cancer

Motilin concentrations in relation to gastro intestinal dysmotility in diabetes mellitus.

AIM: Dysmotility in the upper gastro intestinal (GI) tract are common problems in diabetics. Many peptides are involved in the regulation of the motility. The aim of this study was to examine whether plasma levels of motilin were related to dysfunction in the oesophagus and stomach in a well-defined diabetic patient group. METHODS: Nineteen patients with symptoms from the GI tract who had been examined with oesophageal manometry, gastric emptying scintigraphy and deep-breathing test were included. They received a fat-rich meal, after which blood samples were collected and analysed for motilin concentrations. RESULTS: Symptoms of abdominal fullness and gastro oesophageal reflux significantly associated with delayed gastric emptying, whereas no symptom correlated to oesophageal dysmotility. Plasma levels of motilin were increased after the fat-rich meal (p=0.000), with no difference between the groups. Abnormal manometry was characterized by aperistalsis and/or simultaneous contractions. The percentage of simultaneous contractions correlated to basic and peak motilin values (r(s)=0.898, p=0.006 and r(s)=0.842, p=0.017, respectively). Gastric emptying did not influence motilin concentrations. CONCLUSION: Plasma motilin concentrations vary with abnormalities of oesophageal motility in diabetics, but not with abnormalities of gastric emptying