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Pion T, Alnouri G, Sataloff RT. A New Risk of Using Alkaline Drops in Patients With Laryngopharyngeal Reflux. J Voice 2023; 37:801.e1-801.e2. [PMID: 34162496 DOI: 10.1016/j.jvoice.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Laryngopharyngeal reflux (LPR) is common in the otolaryngologist's office, and a multimodal treatment regimen is employed often. Counseling patients on lifestyle modifications is important. Alkaline water consumption has been recommended as a nonmedical "antacid" for its value in deactivating pepsin, a proteolytic enzyme responsible for laryngeal tissue inflammatory changes in LPR. Alkaline water can be found as premade bottled water, or it can be made at home by titrating regular-pH water with concentrated alkaline drops. We present a patient who mistakenly instilled the alkaline drops into her eye, causing alkali-related chemical burns to the sclera and cornea, which subsequently resulted in scar.
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Affiliation(s)
- Tyler Pion
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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2
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Zhang J, Wang X, Wang J, Zhao J, Zhang C, Liu Z, Li J. Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux. Laryngoscope 2022. [PMID: 36149876 DOI: 10.1002/lary.30408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the optimal time point for diagnosing laryngopharyngeal reflux (LPR) through combining 24-h hypopharyngeal-esophageal multichannel intraluminal impedance-pH (24-h HEMII-pH) monitoring and the multi-time point salivary pepsin test (MTPSPT). STUDY DESIGN Prospective uncontrolled trial. METHOD Patients with and without LPR symptoms were included as the test group and the control group, respectively. The patients in the test group underwent 24-h HEMII-pH and MTPSPT. The results of 24-h HEMII-pH were used as a diagnostic criterion for LPR, and the diagnostic value of salivary pepsin tests performed at different time points was compared by receiver operating characteristic (ROC) analysis. RESULTS A total of 153 patients were included. Based on 24-h HEMII-pH, the positive rate of LPR in the test group of patients was 84.00%. In the control group, only one person (3.57%) had a positive salivary pepsin test result. The area under the curve (AUC) of the MTPSPT was 0.827. In addition, we separately calculated the AUC of the combined salivary pepsin test at different time points, and found good diagnostic value (AUC = 0.799) when the test was combined with the waking, 1 and 2 h after breakfast and lunch, and 1 h after dinner tests. However, when the number of tests were further increased, the diagnostic value did not improve significantly. CONCLUSION Salivary pepsin testing combined with waking, 1 h and 2 h after breakfast and lunch, and 1 h after dinner has almost the same diagnostic value as MTPSPT, and testing at these time points can be an effective method for diagnosing LPR. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Jinhong Zhang
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China.,Department of Otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaoyu Wang
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jiasen Wang
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jing Zhao
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Chun Zhang
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China.,Department of Otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhi Liu
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jinrang Li
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China.,Department of Otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
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3
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Juszczak HM, Rosenfeld RM. Diet and Health in Otolaryngology. Otolaryngol Clin North Am 2022; 55:909-927. [PMID: 36088162 DOI: 10.1016/j.otc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diet is essential to health and can modulate inflammatory markers, the microbiota, and epigenetic outcomes. Proper nutrition is also key to good postsurgical outcomes. Diet is challenging to study, resulting in a relative dearth of influential studies. There is substantial evidence regarding the benefits of a whole food plant-predominant diet on health and longevity, in general, but limited evidence regarding otolaryngologic disorders. Diet may be associated with the risk of head and neck cancer, hearing loss, laryngopharyngeal reflux, and sinonasal symptoms. Evidence, however, is heterogenous and often insufficient for treatment recommendations. Many opportunities exist for future research and expansion..
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Affiliation(s)
- Hailey M Juszczak
- Department of Otolaryngology-Head and Neck Surgery, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
| | - Richard M Rosenfeld
- Department of Otolaryngology-Head and Neck Surgery, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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4
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Lechien JR, Crevier-Buchman L, Distinguin L, Iannella G, Maniaci A, De Marrez LG, Saussez S, Hans S. Is Diet Sufficient as Laryngopharyngeal Reflux Treatment? A Cross-Over Observational Study. Laryngoscope 2021; 132:1916-1923. [PMID: 34606102 DOI: 10.1002/lary.29890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the efficacy of low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet as single treatment for patients with laryngopharyngeal reflux (LPR). STUDY DESIGN Cross-over observational study. METHODS Patients with LPR diagnosis at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH-monitoring were prospectively recruited from the reflux clinic of three University Hospitals. Patients were instructed to follow low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet for 6 to 12 weeks. Pre- to post-treatment symptom and finding changes were evaluated with reflux symptom score (RSS) and reflux sign assessment. Findings were compared to those of a control period where patients did not receive any treatment or diet. Diet was evaluated with refluxogenic diet score (REDS). RESULTS Fifty patients completed the study (19 males). Otolaryngological, digestive, and total RSS scores significantly improved from baseline to 6-week post-diet, while there were no significant changes during the control period. At 6-week post-diet, 37 (74%) patients reported significant symptom improvement or relief. Among them, symptoms continued to improve from 6 to 12 weeks in 27 cases, corresponding to a diet success rate of 54%. The REDS was predictive of the baseline RSS (P = .031). CONCLUSION Low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet is an alternative cost-effective therapeutic approach for patients with LPR. Patients with higher REDS reported higher baseline symptom score. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jerome R Lechien
- Department of otolaryngology, Elsan Hospital, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
| | - Lea Distinguin
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
| | - Giannicola Iannella
- Department of otolaryngology, Elsan Hospital, Paris, France.,Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department of "Organi di Senso", University "Sapienza", Rome, Italy
| | - Antonino Maniaci
- Department of otolaryngology, Elsan Hospital, Paris, France.,Department of Medical, Surgical Sciences and Advanced Technologies G.F Ingrassia, ENT Section, University of Catania, Catania, Italy
| | - Lisa G De Marrez
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
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The Association between Free Sugars Consumption and Laryngopharyngeal Reflux: A Cross-Sectional Study among Chinese Adolescents. Nutrients 2021; 13:nu13093012. [PMID: 34578890 PMCID: PMC8468888 DOI: 10.3390/nu13093012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022] Open
Abstract
There is a lack of evidence to show prevalence of laryngopharyngeal reflux (LPR) and the association between LPR and dietary factors. Adolescents consume the most amount of free sugars among the Chinese population. We conducted this study to investigate the prevalence of LPR in Chinese adolescents and explore the association between free sugars consumption and LPR. A cross-sectional study was conducted on 1517 middle school students in Hunan, China. An online questionnaire was applied to collect data on the condition of LPR, consumption of free sugars and other self-reported covariates. Height, weight and waist circumference were collected by anthropometric measurements. Logistic regression was applied to assess the association between LPR and free sugars consumption. The mean and standard deviation of free sugars consumption was 53.14 ± 44.75 (g/d). The prevalence of LPR was 8.11%. A positive association was observed between LPR and higher free sugars consumption after adjusted multiple covariates, with adjusted odds ratio (95% confident interval) of 1.656 (1.125–2.438). The prevalence of LPR among Chinese adolescents was high. Further analytic studies with strict design are required to test the association between LPR and free sugar consumption. Systematic strategies and policies should to be developed to reduce the intake of free sugars in order to prevent LPR.
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Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel) 2021; 9:624. [PMID: 34073835 PMCID: PMC8225071 DOI: 10.3390/healthcare9060624] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
While the association between dysphagia and malnutrition is well established, there is a lack of clarity regarding the nutritional status and mealtime satisfaction of those consuming texture-modified diets (TMDs). This systematic review summarises and critically appraises the nutritional status and mealtime satisfaction of adults consuming TMDs. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE and Scopus. Nutritional status, mealtime satisfaction and costs were identified as primary outcomes. Eligible studies were grouped according to outcome measurement. In total, 26 studies met the inclusion criteria. Twenty studies evaluated the nutritional status by weight change or using malnutrition screening tools and found the consumption of TMDs correlated with weight loss or malnutrition. Nine studies evaluated mealtime satisfaction, with two reporting poor satisfaction for people on thickened fluids (TFs). Nutrition intervention through adjusting texture and consistency and nutrition enrichment showed positive effects on weight and mealtime satisfaction. The majority of the studies were rated as 'neutral' quality due to the limited number of experiments. TMD consumers had compromised nutritional status and poor mealtime satisfaction. More research input is required to identify promising strategies for improving the nutritional status and mealtime satisfaction of this population. Food services need to consider texture, consistency and fortification in designing menus for people on TMDs to avoid weight loss and malnutrition, and to enhance mealtime enjoyment.
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Affiliation(s)
- Xiaojing Sharon Wu
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
| | - Anna Miles
- Faculty of Science, School of Psychology, Speech Science, The University of Auckland, Auckland 1010, New Zealand;
| | - Andrea J. Braakhuis
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
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7
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Wu XS, Miles A, Braakhuis A. Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2020; 8:E579. [PMID: 33371326 PMCID: PMC7767351 DOI: 10.3390/healthcare8040579] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (-273.8 kJ/d; 95%CI: -419.1 to -128.6, p = 0.0002) and protein (-12.4 g/d; 95%CI: -17.9 to -6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention.
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Affiliation(s)
- Xiaojing Sharon Wu
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
| | - Anna Miles
- Faculty of Science, School of Psychology, Speech Science, The University of Auckland, Auckland 1010, New Zealand;
| | - Andrea Braakhuis
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
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8
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Liu X, Jiang Y, Luo H, Liu H. Proton pump inhibitors for the treatment of laryngopharyngeal reflux disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23297. [PMID: 33285706 PMCID: PMC7717745 DOI: 10.1097/md.0000000000023297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Laryngopharyngeal Reflux disease refers to abnormal reflux of gastric contents through the esophagus into the throat, which irritates and damages the pharyngeal mucosa, and causes corresponding symptoms. Proton Pump Inhibitors are an important class of gastric acid secretion inhibitors after H2 receptor blockers, which can be used clinically to treat peptic ulcer, abnormal gastric acid secretion and other related diseases. The common clinical drugs include omeprazole, lansoprazole, rabeprazole and so on. Clinical practice has shown that Proton Pump Inhibitors have a good therapeutic effect on Laryngopharyngeal Reflux disease, but evidence of evidence-based medicine is lacking. The purpose of this protocol is to systematically evaluate the efficacy and safety of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease and to improve the evidence-based basis for the clinical application of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease. METHODS English computer retrieval database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese computer retrieval database (Wanfang Database, VIP Information Chinese Journal Service Platform, Chinese Biomedical Database) . In addition, Baidu Scholar and Google Scholar were manually searched for randomized controlled clinical studies on the treatment of laryngeal reflux disease with Proton Pump Inhibitors from the establishment of the database to July 2020. Two researchers independently extracted and evaluated the data of the included studies, and meta-analysis was conducted on the included literatures with RevMan5.3 software without language restrictions. RESULTS In this study, the efficacy and safety of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease are evaluated by the overall response rate, clinical symptom remission rate and other indicators. CONCLUSIONS This study will provide reliable evidence-based evidence for the clinical application of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease.OSF Registration number: DOI 10.17605 / OSF.IO / NY6SC.
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Affiliation(s)
- Xiangyi Liu
- Gansu University of Chinese Medicine
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu province
| | - Ying Jiang
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu province
| | - Haiyan Luo
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu province
| | - Haolin Liu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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9
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Kang CH, Zhang N, Lott DG. Muscle Tension Dysphagia: Contributing Factors and Treatment Efficacy. Ann Otol Rhinol Laryngol 2020; 130:674-681. [PMID: 33090008 DOI: 10.1177/0003489420966339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine factors contributing to disease etiology and treatment efficacy. STUDY DESIGN Original Report. SETTING Tertiary academic center. METHODS IRB approved prospective study of 20 patients with reported dysphagia who exhibited normal oropharyngeal and esophageal swallowing function as evidenced by videofluoroscopic swallow study, esophagogastroduodenoscopy, high-resolution esophageal manometry with stationary impedance, and Bravo pH probe off proton pump inhibitor. Patients underwent speech-language pathology intervention. RESULTS Atypical laryngeal muscle tension was present in 100% of patients. Forty percent of patients had diagnosed positive gastroesophageal reflux disease. Sixty-five percent of patients showed signs of non-specific laryngeal inflammation and laryngeal hyperresponsiveness during strobolaryngoscopy. All patients reported a mean of 90% recovery by the completion of voice therapy directed toward unloading muscle tension. CONCLUSION The study results suggest an association between laryngeal muscle tension and these patients' dysphagia symptoms regardless of associated conditions. Speech-language pathology intervention showed high treatment efficacy. LEVEL OF EVIDENCE 2c- Outcomes research.
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Affiliation(s)
- Christina H Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nan Zhang
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David G Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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10
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Durazzo M, Lupi G, Cicerchia F, Ferro A, Barutta F, Beccuti G, Gruden G, Pellicano R. Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update. J Clin Med 2020; 9:E2559. [PMID: 32784573 PMCID: PMC7465150 DOI: 10.3390/jcm9082559] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is defined by the presence of symptoms induced by the reflux of the stomach contents into the esophagus. Although clinical manifestations of GERD typically involve the esophagus, extra-esophageal manifestations are widespread and less known. In this review, we discuss extra-esophageal manifestations of GERD, focusing on clinical presentations, diagnosis, and treatment. Common extra-esophageal manifestations of GERD include chronic cough, asthma, laryngitis, dental erosions, and gingivitis. Extra-esophageal involvement can be present also when classic GERD symptoms are absent, making the diagnosis more challenging. Although available clinical studies are heterogeneous and frequently of low quality, a trial with proton pump inhibitors can be suggested as a first-line diagnostic strategy in case of suspected extra-esophageal manifestations of GERD.
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Affiliation(s)
- Marilena Durazzo
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Giulia Lupi
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Francesca Cicerchia
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Arianna Ferro
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Federica Barutta
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Guglielmo Beccuti
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Gabriella Gruden
- Department of Medical Sciences, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy; (G.L.); (F.C.); (A.F.); (F.B.); (G.B.); (G.G.)
- 3th Internal Medicine Unit, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Città della Salute e della Scienza Hospital, C.so Bramante 88, 10126 Turin, Italy;
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11
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Lechien JR, Bobin F, Muls V, Horoi M, Thill MP, Dequanter D, Finck C, Rodriguez A, Saussez S. Saliva Pepsin Concentration of Laryngopharyngeal Reflux Patients Is Influenced by Meals Consumed Before the Samples. Laryngoscope 2020; 131:350-359. [PMID: 32510588 DOI: 10.1002/lary.28756] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the impact of diet on the saliva pepsin concentration of patients with laryngopharyngeal reflux (LPR). STUDY DESIGN Non-controlled Prospective Study. METHODS Patients with positive LPR regarding hypopharyngeal-esophageal impedance-pH monitoring (HEMII-pH) were enrolled from three European Hospitals. Patients collected three saliva samples, respectively, in the morning (fasting), and 1 to 2 hour after lunch and dinner. Patients carefully detailed foods and beverages consumed during meals and before the pepsin samples. The 3-month treatment was based on the association of diet, proton pump inhibitors, alginate, or magaldrate regarding the HEMII-pH characteristics. Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were used for assessing the pre- to posttreatment clinical evolution. The Refluxogenic Diet Score and the Refluxogenic Score of a Dish (RESDI) were used to assess the refluxogenic potential of foods and beverages. The relationship between saliva pepsin concentration, HEMII-pH, RESDI, RSS, and RSA was investigated through multiple linear regression. RESULTS Forty-two patients were included. The saliva pepsin concentration of the 24-hour period of testing was significantly associated with foods and beverages consumed during the testing period and the evening dinner (rs = 0.973, P < .001). RSS and RSA significantly improved throughout treatment. The level of saliva pepsin in the morning was a negative predictive factor of the therapeutic response regarding RSA and RSS (P < .036). CONCLUSIONS Foods and beverages may significantly impact the saliva pepsin concentration of patients with LPR. Patients with high-level saliva pepsin in the morning had lower therapeutic response compared with those with low-level saliva pepsin. LEVEL OF EVIDENCE 4 Laryngoscope, 131:350-359, 2021.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Francois Bobin
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Otolaryngology, Polyclinique Elsan de Poitiers, Poitiers, France
| | - Vinciane Muls
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Mihaela Horoi
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Paule Thill
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, University of Liège, Liège, Belgium
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the, International Federation of Oto-Rhino-Laryngological Societies, Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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