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Tanvir F, Nijjar GS, Aulakh SK, Kaur Y, Singh S, Singh K, Singla A, Sandhu APS, Luthra S, Antaal H. Gastroesophageal Reflux Disease: New Insights and Treatment Approaches. Cureus 2024; 16:e67654. [PMID: 39314570 PMCID: PMC11417972 DOI: 10.7759/cureus.67654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) remains a significant global health concern, with increasing prevalence and a substantial impact on quality of life. This narrative review explores recent advances in our understanding of GERD pathophysiology, diagnosis, and management. The complex interplay of factors contributing to GERD, including lower esophageal sphincter dysfunction, transient sphincter relaxations, and esophageal motility disorders, is discussed. Emerging diagnostic techniques, such as high-resolution manometry and impedance-pH monitoring, have enhanced our ability to accurately identify and characterize GERD. The review highlights the evolving landscape of GERD treatment, from conventional approaches like lifestyle modifications and proton pump inhibitors to novel strategies including potassium-competitive acid blockers, endoscopic therapies, and minimally invasive surgical techniques. The potential role of the microbiome in GERD pathogenesis and as a therapeutic target is examined. The concept of personalized medicine in GERD management is explored, considering genetic factors, biomarkers, and individual patient profiles. Complications of GERD, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma, are reviewed, emphasizing the importance of early detection and appropriate management. The economic burden and impact on the quality of due to GERD are also addressed. This comprehensive review underscores the multifaceted nature of GERD and the need for a personalized, multidisciplinary approach to its management. It highlights ongoing research efforts and emerging therapies that promise to improve outcomes for GERD patients, while also identifying areas requiring further investigation to optimize diagnosis and treatment strategies.
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Affiliation(s)
- Fnu Tanvir
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
| | | | - Smriti Kaur Aulakh
- Internal Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| | - Yasmeen Kaur
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Sumerjit Singh
- Radiology, Government Medical College Amritsar, Amritsar, IND
| | | | - Abhinandan Singla
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Ajay Pal Singh Sandhu
- Internal Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| | - Shivansh Luthra
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Harman Antaal
- Internal Medicine, Government Medical College Patiala, Patiala, IND
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Zhang C, Liu Z, Zhang J, Wang X, Wang J, Zhao J, Li J, Liu L. Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux. Laryngoscope 2023; 133:2104-2109. [PMID: 36453478 DOI: 10.1002/lary.30489] [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: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To compare the screening value of the Reflux Symptom Score (RSS) and the Reflux Symptom Index (RSI) for laryngopharyngeal reflux (LPR). METHODS All included patients attending the Department of Otolaryngology at the Sixth Medical Center of the PLA General Hospital from February 2022 to August 2022, completed the RSS and the RSI and underwent 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (24 h HEMII-pH) monitoring. The results of 24 h HEMII-pH were used as a diagnostic criterion for LPR, consistency between two questionnaires (RSS, RSI) and 24 h HEMII-pH was compared by the weighted Cohen's kappa statistic and the screening value of RSS and RSI for LPR was compared by receiver operating characteristics analysis. RESULTS A total of 77 patients, 58 males, and 19 females, were included. The Kappa values of between RSS, RSI, and 24 h HEMII-pH were 0.663 (p < 0.001) and 0.213 (p < 0.05), respectively. The sensitivity of RSS and RSI were 92.8% and 48.2%, respectively, the specificity was 71.4% and 80.9%. The negative predictive value and positive predictive value of RSI were 36.9%, 87.1%, and that of RSS were 78.9%, 89.6%. The area under curve of the RSS (0.783; 95% CI = 0.53, 0.75) is significantly higher than RSI (0.633; 95% CI = 0.72, 0.90). CONCLUSION The RSS has a higher consistency and better screening value for LPR compared to RSI. In addition, the RSS includes more reflux symptoms, which may reduce the number of missed diagnoses in patients with LPR to some extent. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2104-2109, 2023.
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Affiliation(s)
- Chun Zhang
- Department of otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Zhi Liu
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jinhong Zhang
- Department of otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, 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
| | - Jinrang Li
- Department of otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - LianLian Liu
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
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Shen H, Han Y, Wu D, Hu L, Ma Y, Wu F, Tao Y, Liu Y. Trial of transcutaneous electrical acupoint stimulation in laryngopharyngeal reflux disease: study protocol for a randomized controlled trial. Trials 2022; 23:272. [PMID: 35395946 PMCID: PMC8991573 DOI: 10.1186/s13063-022-06193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients with persistent globus sensation, throat clearing, chronic cough, hoarseness, and other throat symptoms account for a large proportion of patients in ears, nose, and throat clinics. Laryngopharyngeal reflux disease (LPRD) is increasingly valued by otolaryngologists. Transcutaneous electrical acupoint stimulation (TEAS) is possibly a new method for the treatment of LPRD. This trial aims to determine whether TEAS combined with proton pump inhibitor (PPI) is better than PPI alone in the treatment of LPRD. Methods This prospective randomized controlled trial will be implemented in a tertiary hospital in China. Seventy patients diagnosed with LPRD will be randomly assigned to the TEAS + PPI group (intervention group) or PPI group (control group), at a ratio of 1:1. In addition to using PPI, the intervention group will receive TEAS at four groups of acupoints, and each group will be treated for 15 min, once for 60 min, five times a week, for 12 weeks, 60 times. The main outcome will be changes in the Reflux Symptom Index scores at 4, 12, and 24 weeks after treatment. The secondary outcomes will include changes in the reflux finding score, Laryngopharyngeal Reflux-Health-related Quality of Life score, and throat pain visual analog scale score. Discussion This trial will explore the feasibility of TEAS combined with PPI for the treatment of LPRD and provide potential evidence for its effectiveness and safety. The results of this study will be published in a peer-reviewed journal. Trial registration Chinese Clinical Trial Registry ChiCTR2100046755. Registered on May 28, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06193-0.
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Affiliation(s)
- Hailong Shen
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Yanxun Han
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Di Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, People's Republic of China
| | - Lihong Hu
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Yunxia Ma
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Feihu Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, People's Republic of China
| | - Ye Tao
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Yehai Liu
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China.
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Kow CS, Hasan SS. Could melatonin be used in COVID-19 patients with laryngopharyngeal reflux disease? J Med Virol 2020; 93:92-93. [PMID: 32519764 PMCID: PMC7300529 DOI: 10.1002/jmv.26150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
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A new approach to vocal cord leukoplakia and evaluation of proton pump ınhibitor treatment. Eur Arch Otorhinolaryngol 2019; 276:467-471. [DOI: 10.1007/s00405-018-05273-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/26/2018] [Indexed: 12/18/2022]
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Wood J, Hussey D, Woods C, Astill D, I Watson D, Lee B, Carney A. Does gene expression in laryngeal subsites differ between patients with laryngopharyngeal reflux and controls? Clin Otolaryngol 2017. [DOI: 10.1111/coa.12918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- J.M. Wood
- Flinders ENT; Adelaide SA Australia
- Flinders University Department of Surgery; Flinders Centre for Cancer Prevention and Control; Adelaide SA Australia
| | - D.J. Hussey
- Flinders University Department of Surgery; Flinders Centre for Cancer Prevention and Control; Adelaide SA Australia
| | - C.M. Woods
- Flinders ENT; Adelaide SA Australia
- Flinders University Department of Surgery; Flinders Centre for Cancer Prevention and Control; Adelaide SA Australia
| | - D. Astill
- Department of Anatomical Pathology; Flinders University and Flinders Medical Centre; Adelaide SA Australia
| | - D. I Watson
- Flinders University Department of Surgery; Flinders Centre for Cancer Prevention and Control; Adelaide SA Australia
| | - B. Lee
- Flinders ENT; Adelaide SA Australia
| | - A.S. Carney
- Flinders ENT; Adelaide SA Australia
- Flinders University Department of Surgery; Flinders Centre for Cancer Prevention and Control; Adelaide SA Australia
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Kenny C. Assessment practices of Irish speech and language therapists in the evaluation of voice disorders. LOGOP PHONIATR VOCO 2017; 42:12-21. [PMID: 28049390 DOI: 10.3109/14015439.2015.1121291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is commonly accepted that the evaluation of voice disorders ought to include extensive perceptual, psychometric, and instrumental measurements. This serves to encapsulate the wide-reaching effects of such a disorder, from the physical impairment in voice production to the psycho-social impact of having a dysphonic voice. In spite of this, no international gold standard exists by which voice disorders should be evaluated, and so speech and language therapists (SLTs) are often tasked with developing an assessment battery for use in their own clinics. The purpose of this study is to determine whether the evaluation of voice disorders by Irish SLTs on a national scale is suitably comprehensive, with particular reference to the guidelines published by the European Laryngological Society. A total of 49 SLTs working in a variety of settings responded anonymously to an electronic survey regarding their assessment practices. Results indicate that therapists are comprehensive in non-instrumental evaluation of voice, but lack both access to and training in instrumental assessment techniques.
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Affiliation(s)
- Ciarán Kenny
- a Speech and Language Therapy Department , Tallaght Hospital , Dublin , Ireland
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8
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Allen J, Belafsky PC. Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cumpston EC, Blumin JH, Bock JM. Dual pH with Multichannel Intraluminal Impedance Testing in the Evaluation of Subjective Laryngopharyngeal Reflux Symptoms. Otolaryngol Head Neck Surg 2016; 155:1014-1020. [DOI: 10.1177/0194599816665819] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/20/2016] [Accepted: 08/03/2016] [Indexed: 12/14/2022]
Abstract
Objectives Minimal data exist to define the use of contemporary dual pH with multichannel intraluminal impedance (MII) probes integrating both pharyngeal acid and impedance sensors to evaluate laryngopharyngeal reflux (LPR) symptoms in a laryngology clinic population. This study was performed to review a series of patients tested with dual pH-MII for suspected LPR symptoms and to analyze pH-MII data findings for this patient cohort. Study Design Case series with planned data collection. Setting Tertiary laryngology clinic. Subjects and Methods Patients with symptoms suggestive of possible LPR (dysphonia, chronic cough, globus sensation, subglottic stenosis,) were evaluated with a dual pH-MII system, as well as previously validated reflux finding score (RFS) and reflux symptom index (RSI) instruments. Results A total of 109 patients were evaluated with dual pH-MII studies between 2010 and 2015, with 51 (47%) studies interpreted as “positive” for evidence of significant LPR, 43 (39%) as “negative,” and 15 (14%) as “equivocal.” Dual pH-MII data analysis showed that positive studies had an average of 2.84 pharyngeal acid exposures below pH 4 (vs 0.28 for negative) and 46 episodes of proximal reflux exposure (either acid or nonacid) by impedance detection (vs 30.6 for negative). RSI scores were significantly different between positive and negative studies, while RFS scores were not. Conclusions Dual pH-MII analysis is a useful supplementary tool to provide objective evidence of pharyngeal reflux exposure in patients with suspected LPR. RSI scores appear to correlate with objective evidence of acid exposure in the pharynx, while RFS scores do not.
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Affiliation(s)
- Evan C. Cumpston
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joel H. Blumin
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan M. Bock
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Waxman J, Yalamanchali S, Valle ES, Pott T, Friedman M. Effects of Proton Pump Inhibitor Therapy for Laryngopharyngeal Reflux on Posttreatment Symptoms and Hypopharyngeal pH. Otolaryngol Head Neck Surg 2014; 150:1010-7. [PMID: 24647643 DOI: 10.1177/0194599814525577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/05/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the effect of twice-daily proton pump inhibitor (PPI) treatment on the relationship between laryngopharyngeal pH environment and symptoms in patients with laryngopharyngeal reflux (LPR). STUDY DESIGN AND SETTING Retrospective analysis of records from consecutive patients seen at a single clinical site between 2009 and 2012. SUBJECTS AND METHODS Forty-three records of patients diagnosed with LPR who underwent pre- and posttreatment pH studies were included. Prior to treatment, all had a Reflux Symptom Index (RSI) > 13 and an abnormal pH study. Patients were treated for ≥ 4 weeks with twice-daily PPIs. Following treatment, patients completed a second RSI and pH study. RESULTS Most patients (67.4%) had symptom normalization; however, most patients (60.5%) did not have pH normalization. For all patients whose symptoms did not normalize, pH scores also did not normalize; 32.6% of patients showed no subjective or objective treatment response. For individuals whose symptoms normalized but whose pH scores did not normalize, there was a significant decrease in upright pH score. For the entire group, pretreatment symptom and upright pH scores were strongly positively correlated. Improvements in symptom and upright pH scores following treatment were moderately positively correlated. CONCLUSION Laryngopharyngeal pH failed to normalize for most individuals after PPI treatment; only pH improvement was necessary for symptom normalization. Many patients had no treatment response. Laryngopharyngeal reflux patients may make up a heterogeneous group, and PPI responsivity may help explain conflicting results from previous studies. Posttreatment pH monitoring is recommended in studies investigating the efficacy of PPI therapy for LPR.
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Affiliation(s)
- Jonathan Waxman
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Sreeya Yalamanchali
- ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Elizabeth Shay Valle
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Thomas Pott
- ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Michael Friedman
- ChicagoENT, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA Rush University Medical Center, Chicago, Illinois, USA
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Lee JS, Lee YC, Kim SW, Kwon KH, Eun YG. Changes in the quality of life of patients with laryngopharyngeal reflux after treatment. J Voice 2014; 28:487-91. [PMID: 24598356 DOI: 10.1016/j.jvoice.2013.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/23/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE/HYPOTHESIS To assess changes in the symptoms and quality of life (QOL) of patients diagnosed with laryngopharyngeal reflux (LPR) after proton pump inhibitor (PPI) treatment. STUDY DESIGN Prospective study. METHODS One hundred eighty patients diagnosed with LPR were evaluated. All patients were prescribed Lansoprazole (15 mg) twice daily for 12 weeks. The Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Short-Form 36-Item Health Survey version 2.0 (SF-36), and LPR-health-related quality of life (HRQOL) were collected from each patient at the initial visit and at 4- and 12-week follow-up visits. RESULTS Significant improvement was observed in RSI and RFS scores after treatment. The LPR-HRQOL score also showed gradual improvement after PPI treatment in the voice, cough, throat clearing, swallowing, and overall impact of acid reflux. Although each domain of the SF-36 had a low score at the baseline visit, seven domains of the SF-36 had improved, except for the physical functioning domain. CONCLUSIONS We found that RSI, RFS, and most categories in the LPR-HRQOL and SF-36 improved 12 weeks after initiating PPI treatments. These findings indicate that PPI treatment for 3 months could improve the QOL of patients diagnosed with LPR.
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Affiliation(s)
- Jun Seok Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Kim
- Department of Otolaryngology-Head and Neck Surgery, VHS Medical Center, Seoul, Republic of Korea
| | - Kee Hwan Kwon
- Department of Otolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
| | - Young Gyu Eun
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
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Witt DR, Chen H, Mielens JD, McAvoy KE, Zhang F, Hoffman MR, Jiang JJ. Detection of chronic laryngitis due to laryngopharyngeal reflux using color and texture analysis of laryngoscopic images. J Voice 2013; 28:98-105. [PMID: 24314831 DOI: 10.1016/j.jvoice.2013.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if pattern recognition of hue and textural parameters can be used to identify laryngopharyngeal reflux (LPR). METHODS Laryngoscopic images from 20 subjects with LPR and 42 control subjects without LPR were obtained. LPR status was determined using the reflux finding score. Color and texture features were quantified using hue calculation and two-dimensional Gabor filtering. Five regions were analyzed: true vocal folds, false vocal folds, epiglottis, interarytenoid space, and arytenoid mucosae. A multilayer perceptron artificial neural network with varying numbers of hidden nodes was used to classify images according to pattern recognition. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic utility, and intraclass correlation coefficient analysis was performed to determine interrater reliability. RESULTS Classification accuracy when including all parameters was 80.5% ± 1.2% with an area under the ROC curve of 0.887. Classification accuracy decreased when including only hue (73.1% ± 3.5%; area under the curve = 0.834) or texture (74.9% ± 3.6%; area under the curve = 0.852) parameters. Interrater reliability was 0.97 ± 0.03 for hue parameters and 0.85 ± 0.11 for texture parameters. CONCLUSIONS This preliminary study suggests that a combination of hue and texture features can be used to detect chronic laryngitis due to LPR. A simple, minimally invasive assessment would be a valuable addition to the currently invasive and somewhat unreliable methods currently used for diagnosis. Including more data will likely improve classification accuracy. Additional investigations will be performed to determine if results are in accordance with those provided by pH probe monitoring.
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Affiliation(s)
- Daniel R Witt
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Huijun Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai EENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jason D Mielens
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kieran E McAvoy
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fan Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai EENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Otolaryngology-Head and Neck Surgery, Shanghai EENT Hospital, Fudan University, Shanghai, People's Republic of China.
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Tsou YK, Lien JM, Chen CK, Lin CH, Chen HY, Lee MS. Esophagogastroduodenoscopy with conscious sedation does not interfere with catheter-based 24-h pH monitoring. World J Gastroenterol 2013; 19:1805-1810. [PMID: 23555169 PMCID: PMC3607757 DOI: 10.3748/wjg.v19.i11.1805] [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: 10/24/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring.
METHODS: Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011. All of the data were collected prospectively and analyzed retrospectively. Thirty-six patients (72%, group A) underwent pH monitoring shortly after esophagogastroduodenoscopy (EGD) with conscious sedation, and 14 patients (28%, group B) underwent pH monitoring without conscious sedation. The 24-h pH data from two time periods were analyzed: the first 4 h (Period I) and the remaining time of the study (Period II).
RESULTS: The mean age of the patients was 49.6 ± 12.5 years; 20 patients (40%) were men. The baseline data, including age, sex, body mass index, reflux esophagitis, the Reflux Symptom Index, and the Reflux Findings Score, were comparable between the two groups. The percentage of total time with a pH < 4 and the frequency of acid reflux during Period I were not significantly different between the two groups, as measured using both pharyngeal (0.03% ± 0.10% vs 0.07% ± 0.16%, P = 0.32; and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h, P = 0.33, respectively) and esophageal probes (0.96% ± 1.89% vs 0.42% ± 0.81%, P = 0.59; and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h, P = 0.49, respectively). The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and II in group A patients, as measured using both pharyngeal (0.03% ± 0.10% vs 0.23% ± 0.85%, P = 0.21; and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h, P = 0.22, respectively) and esophageal probes (0.96% ± 1.89% vs 1.11% ± 2.57%, P = 0.55; and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h, P = 0.55, respectively).
CONCLUSION: EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.
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Role of flexible transnasal esophagoscopy and patient education in the management of globus pharyngeus. J Formos Med Assoc 2012; 111:171-5. [PMID: 22423671 DOI: 10.1016/j.jfma.2011.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 01/27/2011] [Accepted: 02/09/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/PURPOSE Globus pharyngeus and dysphagia are common complaints of patients referred to ear, nose, and throat (ENT) clinics. We aimed to establish an efficient method to rule out the presence of malignancy in patients with globus pharyngeus and dysphagia. METHODS The use of flexible transnasal esophagoscopy (TNE) was evaluated in 30 patients with globus pharyngeus and 6 patients with dysphagia. The patients were immediately informed of the findings on TNE examination, and then treatments were planned. All patients were treated with lansoprazole for 2 weeks and provided education on lifestyle changes at the initial examination and at the 3-month follow-up. RESULTS The patients reported an improvement in symptoms of globus pharyngeus after treatment (p<0.001). Follow-up TNE confirmed improvement with less dysphagia, erythema, and vocal cord edema evident (all p<0.001). CONCLUSION The use of TNE and patient education are efficient management strategies for patients with symptoms of globus pharyngeus and dysphagia.
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Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2011. [DOI: 10.1007/174_2011_340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Erickson E, Sivasankar M. Simulated reflux decreases vocal fold epithelial barrier resistance. Laryngoscope 2010; 120:1569-75. [PMID: 20564752 DOI: 10.1002/lary.20983] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The vocal fold epithelium provides a barrier to the entry of inhaled and systemic challenges. However, the location of the epithelium makes it vulnerable to damage. Past research suggests, but does not directly demonstrate, that exposure to gastric reflux adversely affects the function of the epithelial barrier. Understanding the nature of reflux-induced epithelial barrier dysfunction is necessary to better recognize the mechanisms for vocal fold susceptibility to this disease. Therefore, we examined the effects of physiologically relevant reflux challenges on vocal fold transepithelial resistance and gross epithelial and subepithelial appearance. STUDY DESIGN Ex vivo, mixed design with between-group and repeated-measures analyses. METHODS Healthy, native porcine vocal folds (N = 52) were exposed to physiologically relevant acidic pepsin, acid-only, or pepsin-only challenges and examined with electrophysiology and light microscopy. For all challenges, vocal folds exposed to a neutral pH served as control. RESULTS Acidic pepsin and acid-only challenges, but not pepsin-only or control challenges significantly reduced transepithelial resistance within 30 minutes. Reductions in transepithelial resistance were irreversible. Challenge exposure produced minimal gross changes in vocal fold epithelial or subepithelial appearance as evidenced by light microscopy. CONCLUSIONS These findings demonstrate that acidic environments characteristic of gastric reflux compromise epithelial barrier function without gross structural changes. In healthy, native vocal folds, reductions in transepithelial resistance could reflect reflux-related epithelial disruption. These results might guide the development of pharmacologic and therapeutic recommendations for patients with reflux, such as continued acid-suppression therapy and patient antireflux behavioral education.
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Affiliation(s)
- Elizabeth Erickson
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
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Oates J, Winkworth A. Current knowledge, controversies and future directions in hyperfunctional voice disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2008; 10:267-277. [PMID: 20840042 DOI: 10.1080/17549500802140153] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Taking the preceding five papers in this special issue of the International Journal of Speech-Language Pathology as a starting point, this paper synthesizes key aspects of hyperfunctional voice disorders (HFVD). Aetiological and contributing factors, defining features, prevention, assessment and intervention are canvassed, while controversial issues and future directions in research and clinical practice are discussed. Despite disagreements and inconsistencies in terminology surrounding HFVD, there is broad agreement that musculoskeletal tension is the hallmark of these voice disorders. There is also reasonable consensus that the pathogenesis and persistence of HFVD are associated with multiple and overlapping factors, some of which are likely to interact in as yet unknown ways. In addition to dysregulated laryngeal muscle functioning, key processes in the psychosocial and sensory domains are canvassed as likely contributors to HFVD. Vocal fatigue is considered as an intriguing relative of HFVD, the role of laryngopharyngeal reflux is debated and the proposition that particular individuals are psychologically and/or physiologically predisposed to HFVD is discussed. New directions in assessment highlight the use of client-centred measures to consider insider perspectives of psychological factors, vocal effort and vocal fatigue. Emerging psychosocial and physical-manipulative interventions are emphasized and the future educational needs of voice care professionals are considered.
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Oates J, Winkworth A. Characterising hyperfunctional voice disorders: Etiology, assessment, treatment and prevention. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2008; 10:193-194. [PMID: 20840036 DOI: 10.1080/17549500802140948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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