Acta Otorhinolaryngol Ital. 2006 October; 26(5): 260–263.
Laryngeal carcinoma and laryngo-pharyngeal reflux dia
J Galli, G Cammarota,1 M Volante, E De Corso, G Almadori, and G Paludetti
ENT Department, “A. Gemelli” Polyclinic, Catholic University, Rome
1Medicine Department, “A. Gemelli” Polyclinic, Catholic University, Rome, Italy
Address for correspondence: Dr. J. Galli Istituto di Clinica ORL, Università Cattolica del Sacro Cuore, largo A. Gemelli 8, 00168 Roma, Italy
Summary
A correlation between laryngo-pharyngeal reflux and laryngeal carcinoma is currently debated. Chronic inflammation is a mutagen factor confirmed in the cancerogenesis of various tumours. Aim of the prent study was to evaluate, in an objective and concutive
way, with 24h multi-electrode pH-metry the prence of proximal and distal oesophageal reflux in patients prenting pre-cancerosis or squamous cell laryngeal and/or pharyngeal carcinomas. From our data, a strict correlation emerged between laryngo-pharyngeal reflux and neoplasias of the upper aiways, documented through multi-electrode pH-metry. Data emerging from this study would em to support the theory that the protracted exposure (> 20 years) to biliary reflux would reprent a statistically significant added risk factor in the precancerous lesions and squamous pharyngo-laryngeal carcinoma as it occurs at oesophageal level. Moreover, a significant statistical association (p < 0.0001) emerged between laryngeal carcinoma and previous gastro-rection (odds ratio 3.8).
Keywords: Acid and biliary reflux, Gastro-rection, Laryngeal carcinoma
鸭蛋的做法
Introduction
Although widely studied in the literature, particularly throughout the last 10 years, the possible correlation between laryngo-pharyngeal reflux (LPR) and laryngeal carcinoma is currently debated.
二战海战电影
In fact, although the high prence of LPR in patients affected by laryngeal carcinoma (between 68% 1 and 87% typc2 in the world literature), the complex multi-factoriality of neoplastic transformation does not yet permit to establish a causal relationship between cancer and reflux 3.
Among the possible cancerogenesis mechanisms, the most important are chronic inflammation, free radical action and the synergism with the well-known exogenous risk factors. Chronic inflammation, in particular, with the regular alternation of tissue damage and repair phas reprents a mutagen factor in the cancerogenesis of many tumours. The chronic exposure of the laryngeal mucosa to reflux, that generally occurs during spontaneous reductions of continence of the superior oesophageal sphincter, in post-prandial eructations, during decreas in sphincter pressure associated with deglutition, especially in the night in supine position 4, could be at the root of the chronic inflammation mechanism.
However the damage induced by the gastric cretions would, be mediated by the it main
车载音乐排行components, HC1 and pepsin, that act in a combined way (chlorhydro-peptic complex) 5.
The damaging action of the chlorhydric-peptic complex occurs at the level of the junctional intercellular structures of the epithelium, with an increa in permeability and conquently an increa in the intercellular acidity, active ion and water recall inside the cell through the Na-K2-C1 co-transportation, alteration of the osmotic balance and, conquently, cellular death. Besides this classical mechanism that expects the alternation of the damage, cellular death and tissue repairing there is also the most modern one that considers the free radicals, products from the neutrophil leucocytes recalled in situ from the inflammation mediators as the main cau of cellular damage and necrosis 6.
Finally, the direct action of the reflux on the laryngeal mucosa at the same time with other inflammatory factors (voice abu, chronic cough, vomit, relapsing infections of the upper airways) would have a predisposing effect upon the mutagen action of the well-known cancerogenic exogenous factors (cigarette smoke and alcohol).武则天姐姐
Moreover, over the last few years, besides the chlorhydric-peptic complex, considered the main damaging agent for oesophageal and laryngo-pharyngeal mucosa, also the involvement of the duodenal cretion components, has emerged in the damaging action of the reflux. In particular, the mixed duodenal-gastric reflux would prent elements of both cretions; different investigations have shown how their combined damaging action could develop in particular conditions, related above all to the pH values of the environment 7 8.
In particular, among all components of the biliary reflux able to damage the laryngeal mucosa, it is to mention: the trypsin, which, when it is not activated by pepsin, remains active for about one hour at various levels of pH favouring, with its proteolytic properties, the detachment of the surface cells from the epithelium, through the digestion of the intercellular connection necessary to intercellular 9 cohesion; the bile acids, that damage the mucosa solubilizing the membrane lipids on account of their detergent properties, and penetrating through it thanks to their lipophilic condition, causing disorganization of the membrane structure and alteration of the cell functions 10 11.
人蛇之恋
Some Authors 贾母12 have also suggested that, in the alkaline reflux, cancerogenic substances could form as a conquence of bacterial colonization of the stomach caud by the prence of the gastric-duodenal reflux or by decread acid cretion. Some Authors have demonstrated a correlation between the entity of the reflux and the increasing bacterial growth 13. In fact, bacteria would determine, first of all, the transformation of the saliva or diet nitrates in nitrites, that subquently, would be conjugated with the amines or the amids, generating nitro compod compounds as nitrosamine or nitrosamides, which are powerful cancerogenic substances on account of their DNA alkylating action 14. The amines necessary for this process could come from swallowed food or from the same alkaline reflux, becau the intra-gastric bile acids reprent an excellent source of amid. Moreover, from the conjugation of the nitrites with the conjuncted bile acids, taurocholic and glycocholic, that are the bile acids the most reprented in the alkaline reflux, N-nitrosotaurocholic and the N-nitrosoglycocholic acids could be formed, that have already shown in a cancerogenic and mutagenic action 15.
劝酒词
