Impacto adicional de práticas não farmacológicas associadas ao tratamento medicamentoso nos sintomas do refluxo laringofaríngeo
| Ano de defesa: | 2018 |
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| Autor(a) principal: | |
| Orientador(a): | |
| Banca de defesa: | |
| Tipo de documento: | Dissertação |
| Tipo de acesso: | Acesso aberto |
| Idioma: | por |
| Instituição de defesa: |
Universidade Federal de São Paulo (UNIFESP)
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| Programa de Pós-Graduação: |
Não Informado pela instituição
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| Departamento: |
Não Informado pela instituição
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| País: |
Não Informado pela instituição
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| Palavras-chave em Português: | |
| Link de acesso: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6465488 https://repositorio.unifesp.br/handle/11600/52810 |
Resumo: | Gastroesophageal reflux (GER) is a spontaneous movement of the gastric contents of the stomach into the esophagus, considered physiological. When the reflux product reaches the supraesophageal regions - pharynx and larynx - symptoms of laryngopharyngeal reflux (LPR) occur, characterized by dysfunction in the upper esophageal sphincter (UES). The most frequent symptoms of LPR are: pharyngeal globus, throat clearing, halitosis, dysphonia, odynophagia, dysphagia, regurgitation, cough, among others; having as characteristic signs subglottic edema, ventricular obliteration, erythema/hyperemia, vocal fold edema, diffuse laryngeal edema, interaritenoid hypertrophy, granuloma/granulation tissue, thick endolaryngeal mucus, among others. LPR is a disease with a negative impact on quality of life. Objective: To evaluate the additional contribution of non-pharmacological measures simultaneous to drug treatment in the symptoms of laryngopharyngeal reflux. Method: This is a randomized clinical study, performed at the Unifesp - Escola Paulista de Medicina, in the Laryngology and Voice Ambulatory, which is part of the Department of Otorhinolaryngology and Head and Neck Surgery. The sample consisted of 32 patients, divided by lot in two groups, A and B, and both groups underwent pharmacological treatment. Only group A performed simultaneous treatment with the behavioral measures. The treatment lasted for 90 days, divided into three visits, the first one for the diagnosis through videolaryngoscopy and application of the scale of symptoms, the second to reinforce the adherence to the treatment, and the third to finish the study, with a new scale application of symptoms. For diagnosis of the patients, two otorhinolaryngologists, who filled out the Reflux Finding Score (RFS) scale, analyzed the videolaryngoscopy images. The reliability analysis of the total score of the RFS (signal scale) was done with the total sample, using the intraclass correlation coefficient (ICC). To assess the additional contribution of pharmacological measures concurrent to drug treatment in RLF symptoms, the groups A (medication + orientation) and B (medication) were compared in the initial moment in relation to age and signs and symptoms; after 15 days in relation to the adhesion and, after three months, in relation to the improvement of the symptoms. For all statistical tests used in these comparisons, the level of significance was set at 5%. Results:The sample consisted of 62% female, 69% workers, mean age 49.3 years (26 to 83 years). According to the scale of signs observed in videolaryngoscopy for LPR diagnosis, the value of the intraclass correlation coefficient referring to the concordance of the total Reflux Finding Score - RFS, in the study performed by two observers with 32 subjects were 0.560 (95% IC: 0.267 – 0.758), indicating moderate / satisfactory reliability. According to the assessment at baseline, the groups were similar in age; total score scale (mean=9.8 and standard deviation=2.57) and total symptom scale score (mean=15.1 and standard deviation=8.84). The RLF diagnosis was considered positive when the IHR criterion was> = 13 and or RFS > = 7, the symptoms presented approximately 18/32 (56.3%) and the signs were positive in 27/32 (84.4%). Patients in both groups were similar about adherence to treatment: 93.8% of patients took the medication regularly, 84.4% did not feel discomfort with medication and 81.3% stated that they were easily able to perform behavioral measures. In the whole sample there was an improvement in the intensity of the symptoms (total score), from the pre-post treatment moment in the whole sample (p=0.001). The reduction of the total score scale was statistically significant in Group A (p=0.031) and in Group B (p=0.008). When analyzing in which of the groups the patients improved, no statistically significant difference was found (p=0.659). Conclusion: There was similar improvement in symptoms in the two groups of patients, those receiving exclusive pharmacological treatment and those receiving concomitant non-pharmacological guidance, however, no additional impact of behavioral measures was observed in this group of patients with symptoms of laryngopharyngeal reflux. |