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Fernandez AM, Chan WW. Update on extraesophageal manifestations of gastroesophageal reflux. Curr Opin Gastroenterol 2024; 40:305-313. [PMID: 38662405 DOI: 10.1097/mog.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Symptoms/complications related to extraesophageal reflux (EER) are increasingly prevalent presentations and pose significant challenges for clinicians. We summarize and discuss clinical advances and developments in pathophysiology, testing and treatment algorithms of upper/lower airway manifestations of EER. RECENT FINDINGS Growing evidence supports likely multifactorial causes of laryngeal symptoms, including EER, oropharyngeal pathologies, allergic conditions, and cognitive-affective processes (brain-larynx interaction). Diagnostic paradigm for laryngopharyngeal reflux (LPR) is shifting towards a personalized approach with noninvasive strategies/prediction tools to risk-stratify patients for upfront reflux testing over empiric acid suppression trials. Management should be multipronged to include antireflux therapies and treatments targeting other causes. Lower airway complications of EER may result in lung dysfunction and poor transplant outcomes. Esophageal symptoms are often absent and routine esophageal/reflux testing to guide timely antireflux therapies may lead to improved outcomes. Modalities that leverage impedance technology may be important, given the potential role of nonacidic reflux. Novel impedance-based metrics such as mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index may provide adjunctive diagnostic values. SUMMARY Standardized approach to diagnosis/management of EER should include multidisciplinary care teams and consider different phenotypes, nonreflux contributors, and the complex gut-airway relationships. Prompt antireflux therapies after careful candidate selection may improve outcomes of these airway complications.
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Affiliation(s)
- Annel M Fernandez
- Department of Medicine, Brigham and Women's Hospital
- Harvard Medical School
| | - Walter W Chan
- Department of Medicine, Brigham and Women's Hospital
- Harvard Medical School
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Cui N, Dai T, Liu Y, Wang YY, Lin JY, Zheng QF, Zhu DD, Zhu XW. Laryngopharyngeal reflux disease: Updated examination of mechanisms, pathophysiology, treatment, and association with gastroesophageal reflux disease. World J Gastroenterol 2024; 30:2209-2219. [PMID: 38690022 PMCID: PMC11056915 DOI: 10.3748/wjg.v30.i16.2209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/02/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus. LPRD commonly presents with sym-ptoms such as hoarseness, cough, sore throat, a feeling of throat obstruction, excessive throat mucus. This complex condition is thought to involve both reflux and reflex mechanisms, but a clear understanding of its molecular mechanisms is still lacking. Currently, there is no standardized diagnosis or treatment protocol. Therapeutic strategies for LPRD mainly include lifestyle modifications, proton pump inhibitors and endoscopic surgery. This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms, patho-physiology and treatment of LPRD. We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.
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Affiliation(s)
- Na Cui
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ting Dai
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yang Liu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ya-Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jia-Yu Lin
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Qing-Fan Zheng
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Dong-Dong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xue-Wei Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Ataya J, Ismail A, Soqia J, Kousa A, Shahoud Z, Alhalabi R, Zaitouna M. Addressing knowledge gaps in allergies among Syrian hospital patients: a cross-sectional study. Sci Rep 2024; 14:2938. [PMID: 38316903 PMCID: PMC10844623 DOI: 10.1038/s41598-024-53471-9] [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: 05/18/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
Allergies have a significant impact on health and quality of life worldwide, yet there is limited research on the awareness and knowledge of allergies. This study aimed to explore the level of awareness and knowledge of allergies among visitors in Syrian hospitals. A cross-sectional study was conducted between May and September 2022, and a standardized international questionnaire was administered to 504 visitors in three hospitals in Syria. Data analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 23. The final sample comprised 504 questionnaires with 61.7% of participants achieving an average score. Statistical analysis revealed a significant difference in knowledge of allergy scores between the group with only elementary education (M = 3.76, SD = 1.67, p = 0.011), the group with no education (M = 3.65, SD = 1.65, p = 0.006), and the group with a university education (M = 4.44, SD = 1.25). Notably, no significant differences were found between the other educational groups. A one-way ANOVA was employed to assess the effect of place of living on knowledge of allergy, but no significant differences were observed between the groups (p = 0.462). Lastly, a significant negative correlation was detected between participant age and knowledge of allergy scores (r(502) = - 0.102, p = 0.022). Allergies represent a substantial global health concern that demands attention from healthcare providers, policymakers, and the public. This study emphasizes the importance of investing in health education and awareness campaigns to enhance knowledge and comprehension of allergies, particularly individuals with lower levels of education levels. By equipping individuals with the requisite information to effectively manage their allergies, their overall health and wellbeing can be improved.
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Affiliation(s)
- Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | | | - Jameel Soqia
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Alyamama Kousa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Zein Shahoud
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rawan Alhalabi
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mazen Zaitouna
- Faculty of Medicine, Damascus University, Damascus, Syria
- UMR1195, University Paris Sud, INSERM, University Paris-Saclay, Le Kremlin-Bicetre, France
- Service of Urology, Grand hospital of Est Francilian, Meaux, France
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Taş BM, Bekin Sarıkaya PZ, Şencan Z, Cömert E, Bayar Muluk N. Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body. Indian J Otolaryngol Head Neck Surg 2024; 76:530-535. [PMID: 38440497 PMCID: PMC10908712 DOI: 10.1007/s12070-023-04204-3] [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: 05/30/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
Background We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis. Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values. Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05). Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.
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Affiliation(s)
- Burak Mustafa Taş
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | | | - Ziya Şencan
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Ela Cömert
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
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Huang AE, Chan EP, Stave CM, Patel ZM, Hwang PH, Chang MT. Social Media Utilization in Otolaryngology: A Scoping Review. Laryngoscope 2023; 133:2447-2456. [PMID: 36807152 DOI: 10.1002/lary.30619] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/05/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology-head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable. DATA SOURCES AND METHODS A scoping review was performed of English-language peer-reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen. RESULTS 171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross-sectional or survey-based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n = 37 [21%]), and within subspecialties of otology (n = 38 [22%]) and rhinology/allergy (n = 25 [15%]). Facebook was most frequently used for study recruitment (n = 23 [13.5%]), YouTube for patient education (n = 15 [14.6%]), and Twitter for professional networking (n = 16 [9.4%]). CONCLUSION SM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well-controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 133:2447-2456, 2023.
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Affiliation(s)
- Alice E Huang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Christopher M Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, California, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Michael T Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
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Howell R, Tang A, Allen J, Altaye M, Amin M, Bayan S, Belafsky P, Cervenka B, deSilva B, Dion G, Ekbom D, Friedman A, Fritz M, Giliberto JP, Guardiani E, Harmon J, Kasperbauer JL, Khosla S, Kim B, Kuhn M, Kwak P, Ma Y, Madden L, Matrka L, Mayerhoff R, Piraka C, Rosen C, Tabangin ME, Wahab SA, Wilson K, Wright SC, Young V, Yuen S, Postma GN. Killian Jamieson Diverticulum, the Great Mimicker: A Case Series and Contemporary Review. Laryngoscope 2023; 133:2110-2115. [PMID: 36453465 DOI: 10.1002/lary.30508] [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: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To assess barium esophagram (BAS) as a diagnostic marker for patients with Killian Jamieson diverticula (KJD). METHODS Prospective, multicenter cohort study of individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative. Patient demographics, comorbidities, radiographic imaging reports, laryngoscopy findings, patient-reported outcome measures (PROM), and operative reporting were abstracted from a REDCap database and summarized using means, medians, percentages, frequencies. Paired t-tests and Wilcoxon Signed Rank test were used to test pre- to post-operative differences in RSI, EAT-10, and VHI-10 scores. Diagnostic test evaluation including sensitivity, specificity, positive, and negative predictive value with 95% confidence intervals were calculated comparing BAS findings to operative report. RESULTS A total of 287 persons were enrolled; 13 (4%) patients were identified with confirmed KJD on operative reports. 100% underwent open transcervical excision. BAS has a 46.2% (95% confidence interval [CI]: 23.2, 70.9) sensitivity and 97.8% (95% CI: 95.3, 99.0) specificity in detecting a KJD and 50% (95% CI: 25.4, 74.6) positive predictive value but 97.4% (95%CI: 94.8, 98.7) negative predictive value. Preoperatively, patients reported mean (SD) RSI and EAT-10 of 19.4 (9) and 8.3 (7.5) accordingly. Postoperatively, patients reported mean (SD) RSI and EAT-10 as 5.4 (6.2) and 2.3 (3.3). Both changes in RSI and EAT-10 were statistically significant (p = 0.008, p = 0.03). CONCLUSION KJD are rare and represent <5% of hypopharyngeal diverticula undergoing surgical intervention. Open transcervical surgery significantly improves symptoms of dysphagia. BAS has high specificity but low sensitivity in detecting KJD. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2110-2115, 2023.
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Affiliation(s)
- Rebecca Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alice Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jacqui Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Milan Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Semirra Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California, USA
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Greg Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dale Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mark Fritz
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jeffrey Harmon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sid Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California, USA
| | - Paul Kwak
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Lyndsay Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Ross Mayerhoff
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Cyrus Piraka
- Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Clark Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shaun A Wahab
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Keith Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - S Carter Wright
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Vyvy Young
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Sonia Yuen
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, USA
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Lechien JR, Maniaci A, Gengler IM, Mayo-Yanez M, Vaira LA. Asthma, chronic rhinosinusitis and laryngopharyngeal reflux. Am J Otolaryngol 2023; 44:103953. [PMID: 37331128 DOI: 10.1016/j.amjoto.2023.103953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/19/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Jerome R Lechien
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Antonino Maniaci
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Catania 95123, Italy
| | - Isabelle M Gengler
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Miguel Mayo-Yanez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Luigi A Vaira
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Italy; Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Italy
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Alamyar S, Azzi E, Srour-Alphonse P, House R, Cvetkovski B, Kritikos V, Bosnic-Anticevich S. Uncovering the Burden of Rhinitis in Patients Purchasing Nonprescription Short-Acting β-Agonist (SABA) in the Community. PHARMACY 2023; 11:115. [PMID: 37489346 PMCID: PMC10366934 DOI: 10.3390/pharmacy11040115] [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: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023] Open
Abstract
Asthma and rhinitis are common comorbidities that amplify the burden of each disease. They are both characterized by poor symptom control, low adherence to clinical management guidelines, and high levels of patient self-management. Therefore, this study aims to investigate the prevalence of self-reported rhinitis symptoms in people with asthma purchasing Short-Acting Beta Agonist (SABA) reliever medication from a community pharmacy and compare the medication-related behavioral characteristics among those who self-report rhinitis symptoms and those who do not. Data were analyzed from 333 people with asthma who visited one of eighteen community pharmacies in New South Wales from 2017-2018 to purchase SABA and completed a self-administered questionnaire. Participants who reported rhinitis symptoms (71%), compared to those who did not, were significantly more likely to have coexisting gastroesophageal reflux disease (GERD), overuse SABA, and experience side effects. They may have been prescribed daily preventer medication but forget to take it, and worry about its side effects. They were also more likely to experience moderate-to-severe rhinitis (74.0%), inaccurately perceive their asthma as well-controlled (50.0% self-determined vs. 14.8% clinical-guideline defined), and unlikely to use rhinitis medications (26.2%) or daily preventer medication (26.7%). These findings enhance our understanding of this cohort and allow us to identify interventions to improve patient outcomes.
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Affiliation(s)
- Sara Alamyar
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Elizabeth Azzi
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
- GSK Australia, Pty., Ltd., Ermington, NSW 2115, Australia
| | - Pamela Srour-Alphonse
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rachel House
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney Local Health District, Sydney, NSW 2050, Australia
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Alsayed B, Alatawi A, Alatawi OM, Alatawi RH, Alfuhaymani AM, Aljohani JK. Association of Asthma Control With Caregivers' Knowledge and Practices for Children With Asthma in the Tabuk Region of Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e35162. [PMID: 36949969 PMCID: PMC10028399 DOI: 10.7759/cureus.35162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/21/2023] Open
Abstract
Introduction Asthma is a chronic heterogeneous inflammatory disease that affects millions of individuals around the globe. Standardized asthma management is crucial to maintain and control the disease. Caregivers are the leading players in managing asthma during childhood. Studies are lacking in the Tabuk region. The aim of this study was to elucidate knowledge levels and common practices of caregivers of pediatric patients with asthma in the Tabuk region of Saudi Arabia and its impact on asthma control. Methodology A validated cross-sectional survey of the population of the Tabuk region was conducted from July 1, 2022, to September 30, 2022. Convenience sampling via an internet-based questionnaire within the study area was deployed, followed by phone interviews. Results A total of 393 caregivers completed the questionnaire, and the data were analyzed. The median age of asthmatic children was nine years, and most of them were males (60.8%). Most caregivers had a higher education (62.1%). The symptoms of allergic rhinitis were found in almost 80% of children. Pulmonary function tests were performed in 42.5% of children, and only one-third underwent radioallergosorbent (RAST) skin testing. About half the children had an asthmatic attack and an emergency department visit once during the previous 12 months, and most were hospitalized during that period. Most caregivers showed good knowledge (score=7) about symptoms of asthma and factors that could worsen the child's asthma, as well as good asthma control practices (score ≥7). Children with poorly controlled asthma were younger, had significant allergic rhinitis symptoms (30%), and underwent pulmonary function tests (60%). Conclusion In the Tabuk region, the extent of asthma control was significantly associated with caregivers' knowledge and practices for children with asthma. Future public education campaigns should focus on closing the observed knowledge and practice gaps to reduce the impact of childhood asthma.
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Affiliation(s)
- Badr Alsayed
- Internal Medicine, University of Tabuk, Tabuk, SAU
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10
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Gao J, Luo R, Ruan B, Liu Z, Long R, Jiang C, Cheng S, Wang Y, Su L, Li P. [Consistency analysis of pepsin immunohistochemistry and pepsin test box in the diagnosis of laryngopharyngeal reflux]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:97-102;106. [PMID: 36756822 PMCID: PMC10208864 DOI: 10.13201/j.issn.2096-7993.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 02/10/2023]
Abstract
Objective:To analyze the consistency of pepsin assay kit, pepsin IHC, reflux symptom index(RSI) and reflux finding score(RFS) in the diagnosis of laryngopharyngeal reflux disease(LPRD). Methods:The clinical data of 61 inpatients with laryngeal diseases who were admitted to the Department of Otolaryngology, the First Affiliated Hospital of Kunming Medical University from May 2020 to December 2021 were retrospectively analyzed. The RSI and RFS scores, the Formwitz score of pepsin immunohistochemistry, and the results of pepsin detection kit were recorded. ICC group correlation coefficient and Kappa consistency analysis was used for three detection methods. Results:Among 61 patients, 30 cases were positive and 31 cases were negative for the pepsin test kit, with a positive rate of 49.18%. The positive rate of pepsin immunohistochemistry was 45.90%(28/61), and the diagnostic agreement rate between the two was 70.49%. The consistency between them was high(κ=0.409). The positive rate of RSI and RFS in diagnosing LPRD was 62.30%(38/61), and the consistency rate was 73.77% with pepsin detection kit. The consistency between them was high(κ=0.486). Taking pepsin IHC as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 71.43%(20/28), 69.70%(23/33), 66.67%(20/30) and 74.19%(23/31), respectively. Using RSI and RFS scales as reference criteria, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 89.29%(25/28), 60.61%(20/33), 65.79%(25/38) and 86.96%(20/23), respectively. Analysis of correlation coefficient within ICC group: ICC value was 0.628, 95% confidence interval(0.497-0.741), the three methods have good consistency. Conclusion:The RSI and RFS scale scores were in good agreement with the pepsin test kit, and the pepsin test kit was also in good agreement with pepsin immunohistochemistry. As a non-invasive diagnostic technique, the pepsin test kit can be widely used in the diagnosis of pharyngeal reflux in combination with pepsin immunohistochemistry and RSI and RFS scale.
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Affiliation(s)
- Jingyu Gao
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Renjing Luo
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Biao Ruan
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Zhuohui Liu
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Ruiqing Long
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Chaowu Jiang
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Sheng Cheng
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Yan Wang
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Lu Su
- Department of Otolaryngology,Kunming Yan'an Hospital
| | - Peng Li
- Department of General Surgery,Kunming Yan'an Hospital
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Yu L, Li R, Du L, Zhao Y. The diagnostic value of pepsin concentration in saliva for laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 2022; 279:5783-5789. [PMID: 35689682 DOI: 10.1007/s00405-022-07472-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore the diagnostic efficacy of pepsin concentration in saliva for laryngopharyngeal reflux (LPR) disease. METHODS In this study, we recruited 40 participants with abnormal sensation of throat into the study who visited our hospital from March 2020 to December 2020. The 24 h multichannel intraluminal impedance and pH monitoring (24 h MII-pH), reflux symptom index (RSI) and reflux finding score (RFS), pepsin concentration in saliva were collected. The Cohen's kappa test and receiver-operating characteristic (ROC) curves were performed to determine and compare the sensitivity and specificity of five diagnostic methods: RSI; RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration. RESULTS The area under the curve (AUC) of RSI, RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration were 0.767, 0.733, 0.870, 0.750,0.867, respectively. That is, the pepsin concentration has maximum AUC (the cutoff point is 219.47 (ng/mL); the sensitivity and 1-specificity is 0.300, 0.933, respectively.). The positive predictive value was 90.3% (28/31), and the negative predictive value was 77.8% (7/9). The Cohen's kappa coefficients of the five diagnostic subgroups were: RSI 0.486 (95% CI 0.207-0.764, P = 0.001); RFS 0.333 (95% CI 0.021-0.644, P = 0.032); RSI + RFS: 0.517 (95% CI 0.205-0.829, P = 0.001); pepsin concentration: 0.699 (95% CI 0.379-0.931, P = 0.001); RSI + RFS + pepsin concentration: 0.500 (95% CI 0.181-0.819, P < 0.001). CONCLUSION The pepsin concentration has the maximum AUC area and highest consistency with the 24 h MII-pH. Therefore, it has certain value in the screening and diagnosis of diseases related to LPR disease.
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Affiliation(s)
- Lei Yu
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Rui Li
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Linnan Du
- Chemical Engineering Institute, Shijiazhuang University, Shijiazhuang, China
| | - Yuliang Zhao
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Mahmud Mohayuddin N, Azman M, Wan Hamizan AK, Zahedi FD, Carroll TL, Mat Baki M. Reflux Finding Score Using HD Video Chromoendoscopy: A Diagnostic Adjunct in Suspected Laryngopharyngeal Reflux? J Voice 2022:S0892-1997(22)00164-3. [PMID: 35896429 DOI: 10.1016/j.jvoice.2022.06.008] [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: 04/10/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To explore the use of real-time virtual chromoendoscopy (i-scan) in characterizing the mucosal changes present in subjects with suspected laryngopharyngeal reflux (LPR) and to compare the inter-rater and intra-rater agreement of Reflux Finding Scores (RFS) from both laryngologists and general otolaryngologists (ORL) observing exams using both white light endoscopy (WLE) and i-scan. METHODS This is a cross-sectional study that included 66 subjects: 46 symptomatic and 20 asymptomatic of suspected LPR based on the reflux symptom index (RSI). Subjects underwent flexible video laryngoscopic evaluation of the larynx utilising both WLE and i-scan during one continuous exam. Subjects also underwent 24-hour oropharyngeal pH-monitoring (Dx-pH). Two laryngologists and two general otolaryngologists evaluated the anonymized videos independently using RFS. Dx-pH results were interpreted using the pH graph, report and RYAN score. Subjects were then designated into one of three groups: no reflux, acid reflux and alkaline reflux. RESULTS For the symptomatic group, no mucosal irregularities or early mucosal lesions were observed except in one subject who had granulation tissue. The mean RFS using WLE and i-scan were, respectively: 11.8 (SD 6.1) and 11.3 (SD 5.6) in symptomatic and 7.3 (SD 5.7) and 7.3 (SD 5.2) in asymptomatic group. The inter-rater agreement of RFS using WLE and i-scan for both groups were good with intraclass correlation, ICC of 0.84 and 0.88 (laryngologists); and 0.85 and 0.81 (ORL). The intra-rater agreement among all four raters were good to excellent and similar for both WLE and i-scan (ICC of 0.80 to 0.99). 47 of 66 subjects had evidence of LPR on Dx-pH results which more specifically showed 39 subjects had "acid reflux" and 8 had "alkaline reflux". Sixteen subjects demonstrated a positive RYAN score but showed none were significantly correlated with their RFS. CONCLUSIONS This study reports the first utilization of real-time video chromoendoscopy with i-scan technology through high-definition flexible endoscopes to attempt to characterize laryngopharyngeal findings in patients suspected of having LPR. Both general otolaryngologists and laryngologists were equally capable of reliably calculating the RFS using both WLE and i-scan, however no significant improvement in agreement or change in RFS was found when i-scan technology was employed. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Nurhamizah Mahmud Mohayuddin
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Mawaddah Azman
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Aneeza Khairiyah Wan Hamizan
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Farah Dayana Zahedi
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Thomas Leigh Carroll
- Brigham and Women's Hospital, Division of Otolaryngology-Head and Neck Surgery and Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston Massachusetts
| | - Marina Mat Baki
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia.
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张 青, 谢 萌, 郭 瑞, 马 思, 刘 小, 杨 敏, 李 娜, 刘 海, 任 晓, 罗 花. [Effect of proton pump inhibitort on salivary pepsin concentration in patients with laryngopharyngeal reflux]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:965-970. [PMID: 34886597 PMCID: PMC10128359 DOI: 10.13201/j.issn.2096-7993.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Objective:To investigate the effect of proton pump inhibitor(PPI) treatment on salivary pepsin concentration in laryngopharyngeal reflux(LPR). Methods:152 patients with suspected LPR complaining non-specific symptoms such as foreign body sensation, dry throat, phlegm and other non-specific symptoms were enrolled, in the Second Affiliated Hospital of Xi'an Jiaotong University from August 2019 to December 2020. According to the scores of reflux symptom index(RSI) and reflux finding score(RFS), all the patients were divided into LPR (+) group and LPR (-) group, RSI (+) group and RSI (-) group, RFS (+) group and RFS (-) group . Patients in the LPR (+) group were reassessed after 1 month of PPI treatment. Saliva samples were collected from all the patients at initial diagnosis and follow-up diagnosis after treatment. The salivary pepsin concentration was determined by enzyme linked immunosorbent assay (ELISA). The differences of RSI, RFS scores and salivary pepsin concentrations before and after treatment were compared. Results:The median concentration of salivary pepsin in LPR (+) group was significantly higher than that in LPR (-) group, and (73.01 ng/mL vs 25.66 ng/mL, P<0.01), the median concentration of salivary pepsin in RFS (+) group were significantly higher than that in RFS (-) group(78.00 ng/mL vs 35.79 ng/mL, P<0.01) Furthermore, the median scores of RSI (11.00 vs 7.00, P<0.05) and RFS (9.00 vs 7.00, P<0.01) of LPR (+) patients notably decreased after PPI treatment for 1 month, and the salivary pepsin median concentration was memorably lower than that before treatment(53.60 ng/mL vs 46.49 ng/mL, P<0.05). Meanwhile, the scores of symptoms such as pharyngeal paraesthesia, heartburn, chest pain, stomachache, and the scores of signs such as false vocal fold, erythema or congestion, vocal fold edema, posterior commissure hypertrophy and thick endolaryngeal mucus were conspicuously lower after treatment than those before treatment(P<0.05). Conclusion:After 1 month of PPI treatment, the scores of partial symptoms and signs, and the salivary pepsin concentrations of LPR patients decreased significantly, suggesting that pepsin plays an important role in the pathogenesis of LPR, and pepsin may be closely related to the symptoms and signs such as pharyngeal paraesthesia and vocal fold edema.
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Affiliation(s)
- 青青 张
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 萌 谢
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 瑞昕 郭
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 思敬 马
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 小红 刘
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 敏娟 杨
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 娜 李
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 海琴 刘
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 晓勇 任
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 花南 罗
- 西安交通大学第二附属医院耳鼻咽喉头颈外科病院(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
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