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Chen S, Chen Z, Jiang X, Lin C, Ji J. Modifiable risk factors mediate the effect of gastroesophageal reflux disease on stroke and subtypes: A Mendelian randomization study. J Stroke Cerebrovasc Dis 2024; 33:107612. [PMID: 38309380 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107612] [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: 11/21/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Previous observational studies have suggested that gastroesophageal reflux disease (GERD) increases the risk of stroke, but the specific underlying mechanisms are unclear. We investigated the causal associations of GERD with stroke and its subtypes using Mendelian randomization (MR), and evaluated the potential mediating effects of modifiable stroke risk factors in the causal pathway. METHODS Genetic instrumental variables for GERD were extracted from the latest genome-wide association study (GWAS) summary level data. We initially performed two-sample MR to examine the association of GERD with stroke and its subtypes, including ischemic stroke, intracranial hemorrhage, and the major subtypes of ischemic stroke. Two-step MR was further employed to investigate the mediating effect of 15 risk factors in the causal pathway. RESULTS We found significant causal associations of genetically predicted GERD with increased risk of stroke (OR: 1.22 95% CI: 1.126-1.322), ischemic stroke (OR: 1.19 95% CI: 1.098-1.299), and large-artery stroke (OR: 1.49 95% CI: 1.214-1.836). Replication and sensitivity analyses yielded consistent effect directions and similar estimates. Further mediation analyses indicated that hypertension (HTN), systolic blood pressure (SBP), and type 2 diabetes (T2D) mediated 36.0%, 9.0%, and 15.8% of the effect of GERD on stroke; 42.9%, 10.8%, and 21.4% for ischemic stroke, and 23.3%; 7.9%, and 18.7% for large-artery stroke, respectively. CONCLUSIONS This study supports that GERD increases susceptibility to stroke, ischemic stroke, and large-artery stroke, and is partially mediated by HTN, SBP, and T2D.
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Affiliation(s)
- Shixuan Chen
- Department of Rehabilitation Medicine, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou City Hospital of Integrated Western and Traditional Chinese Medicine, China
| | - Zhenzhen Chen
- Department of Nursing, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou City Hospital of Integrated Western and Traditional Chinese Medicine, China
| | - Xia Jiang
- Department of Rehabilitation Medicine, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou City Hospital of Integrated Western and Traditional Chinese Medicine, China
| | - Chuyong Lin
- Department of Rehabilitation Medicine, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou City Hospital of Integrated Western and Traditional Chinese Medicine, China
| | - Jing Ji
- Department of Rehabilitation Medicine, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou City Hospital of Integrated Western and Traditional Chinese Medicine, China.
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Yang CH, Lin WC, Chen WC, Luo SD, Yang MY, Hwang CF, Chen SF. Association of Autonomic Symptom Burden with Sudden Sensorineural Hearing Loss. Otolaryngol Head Neck Surg 2024; 170:862-869. [PMID: 37877235 DOI: 10.1002/ohn.560] [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: 06/12/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To investigate the autonomic symptom burden in patients with sudden sensorineural hearing loss (SSNHL) and its association with the severity and prognosis. STUDY DESIGN Observational prospective study. SETTING Tertiary academic medical center. METHODS Patients diagnosed with SSNHL at a single medical center completed the COMPASS 31 questionnaire, which assesses dysautonomia across 6 domains with 31 questions. A total COMPASS 31 score was calculated by summing the scores from each weighted domain. The treatment outcome was evaluated by the percentage of recovery, calculated as the hearing gain in pure tone average (PTA) after treatment divided by the pretreatment PTA difference between the 2 ears. We defined poor recovery as a percentage of recovery <80%. RESULTS A total of 63 SSNHL patients were included. The mean COMPASS 31 score was 23.4 (SD 14). Patients with poor recovery had significantly higher COMPASS 31 scores than those with good recovery (mean 26.4 [SD 14.4] vs 16.9 [SD 10.4]; 95% confidence interval [CI] 2-17). There was a negative association between COMPASS 31 score and both hearing gain (r = -.323, 95% CI -0.082 to -0.529) and percentage of recovery (r = -.365, 95% CI -0.129 to -0.562). Multivariate analyses of independent factors indicate that patients with higher COMPASS 31 scores had a greater risk for poor recovery (OR 1.06 [95% CI 1.003-1.117]). CONCLUSION This study highlights the association between autonomic symptom burden and poor hearing outcomes in SSNHL patients. The findings underscore the importance of evaluating autonomic function during the treatment of SSNHL.
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Affiliation(s)
- Chao-Hui Yang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Yu Yang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chung-Feng Hwang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Fang Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Lechien JR. Personalized Treatments Based on Laryngopharyngeal Reflux Patient Profiles: A Narrative Review. J Pers Med 2023; 13:1567. [PMID: 38003882 PMCID: PMC10671871 DOI: 10.3390/jpm13111567] [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: 09/23/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To review the current findings of the literature on the existence of several profiles of laryngopharyngeal reflux (LPR) patients and to propose personalized diagnostic and therapeutic approaches. METHODS A state-of-the art review of the literature was conducted using the PubMED, Scopus, and Cochrane Library databases. The information related to epidemiology, demographics, clinical presentations, diagnostic approaches, and therapeutic responses were extracted to identify outcomes that may influence the clinical and therapeutic courses of LPR. RESULTS The clinical presentation and therapeutic courses of LPR may be influenced by gender, age, weight, comorbidities, dietary habits and culture, anxiety, stress, and saliva enzyme profile. The clinical expression of reflux, including laryngopharyngeal, respiratory, nasal, and eye symptoms, and the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring profile of patients are important issues to improve in patient management. The use of more personalized therapeutic strategies appears to be associated with better symptom relief and cures over the long-term. The role of pepsin in LPR physiology is well-established but the lack of information about the role of other gastrointestinal enzymes in the development of LPR-related mucosa inflammation limits the development of future enzyme-based personalized diagnostic and therapeutic approaches. CONCLUSION Laryngopharyngeal reflux is a challenging ear, nose, and throat condition associated with poor therapeutic responses and a long-term burden in Western countries. Artificial intelligence should be used for developing personalized therapeutic strategies based on patient features.
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Affiliation(s)
- Jerome R. Lechien
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Baudour, Belgium;
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, (Paris Saclay University), 92150 Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, B1000 Brussels, Belgium
- Research Committee of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), 92150 Paris, France
- Department of Otolaryngology, Elsan Hospital, 92150 Paris, France
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Lechien JR, Bobin F. Variability and accuracy of multiple saliva pepsin measurements in laryngopharyngeal reflux patients. J Otolaryngol Head Neck Surg 2023; 52:66. [PMID: 37794462 PMCID: PMC10548621 DOI: 10.1186/s40463-023-00670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To study the variability and diagnostic value of multiple salivary pepsin measurements in the detection of laryngopharyngeal reflux (LPR). METHODS Patients with LPR symptoms were consecutively recruited from December 2019 to Augustus 2022. Twenty-one asymptomatic individuals completed the study. The diagnostic was confirmed with hypopharyngeal-esophageal impedance-pH monitoring (HEMII-pH). Patients collected three saliva samples during the 24-h testing period. Symptoms and findings were studied with reflux symptom score-12 and reflux sign assessment. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin measurements were calculated considering morning, post-lunch and post-dinner samples. The consistency and relationship between HEMII-pH, pepsin measurements, and clinical features were investigated. RESULTS Morning, post-lunch and post-dinner saliva pepsin concentrations were measured in 42 patients. Pepsin measurements were 64.9%, 59.5%, and 59.0% sensitive for morning, post-lunch and post-dinner collections at cutoff ≥ 16 ng/mL. Considering the highest concentration of the three pepsin saliva collections, the accuracy, sensitivity, specificity and PPV were 70.5%, 73.0%; 66.7% and 78.9%, respectively. Morning pepsin measurements reported higher consistency, sensitivity, and specificity than post-dinner and post-lunch pepsin measurements. CONCLUSION The collection of several saliva pepsin samples improves the detection rate of LPR. In case of high clinical LPR suspicion and negative pepsin test, a HEMII-pH study could provide further diagnostic information.
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Affiliation(s)
- Jerome R Lechien
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, Baudour, Belgium.
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Avenue du Champ de Mars, 6, 7000, 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.
- Polyclinique Elsan de Poitiers, Poitiers, France.
- Research Committee of Young Otolaryngologists of the International Federation of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France.
| | - Francois Bobin
- Polyclinique Elsan de Poitiers, Poitiers, France
- Research Committee of Young Otolaryngologists of the International Federation of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
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Rodriguez A, Steffens Y, Calvo-Henriquez C, Mayo-Yáñez M, Horoi M, Lechien JR. Laryngopharyngeal Reflux Patient Changes during the COVID-19 Quarantine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1475. [PMID: 37629765 PMCID: PMC10456535 DOI: 10.3390/medicina59081475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023]
Abstract
Background and Objective: To examine the effects of the lockdown on diet adherence and stress levels in patients with laryngopharyngeal reflux (LPR). Materials and Methods: Patients with a positive LPR diagnosis at the hypopharyngeal-esophageal impedance-pH monitoring were treated from a pre- to lockdown period with a 3-month high-protein, low-fat, alkaline, plant-based diet, with behavioral changes, and an association of pantoprazole (20 MG/d) and alginate (Gaviscon 3/d). The following patient-reported outcomes questionnaire and findings instrument were used: Reflux Symptom Score-12 (RSS-12) and Reflux Sign Assessment (RSA). At the posttreatment time, patients were invited to evaluate the impact of lockdown on diet adherence and stress management with a predefined grid of foods and beverages and the perceived stress scale (PSS), respectively. Results: Thirty-two patients completed the evaluations. RSS-12 and RSA significantly improved from baseline to 3-month posttreatment. Most patients experienced mild-to-severe stress levels at the end of the lockdown. The level of stress substantially increased in 11 patients (34%) due to the lockdown, while it did not change in 11 patients (44%). In 11 cases (34%), patients reported that the adherence to the anti-reflux diet was better than initially presumed thanks to the lockdown period, while 44% (N = 14) reported that the lockdown did not impact the adherence to a diet. PSS and RSS-12 were significantly correlated at the end of the pandemic (rs = 0.681; p < 0.001). The increase in stress level was positively associated with the lack of adherence to diet (rs = 0.367; p = 0.039). Conclusions: During the lockdown, the diet habits of LPR patients were improved in one-third and unchanged in 44% of cases. The stress level was increased in one-third of patients, which was associated with an increase in symptom scores.
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Affiliation(s)
- Alexandra Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (A.R.); (Y.S.); (M.H.)
| | - Younes Steffens
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (A.R.); (Y.S.); (M.H.)
| | - Christian Calvo-Henriquez
- Department of Otolaryngology-Head and Neck Surgery, Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain;
| | - Mihaela Horoi
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (A.R.); (Y.S.); (M.H.)
| | - Jerome R. Lechien
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (A.R.); (Y.S.); (M.H.)
- Department of Otolaryngology, Elsan Hospital, 86000 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, 75000 Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
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Lechien JR, Cheikh-Youssef R, Maniaci A, Mayo-Yanez M, Iannella G, Vaira LA. Transcutaneous electrical acupoint stimulation, autonomic nerve dysfunction and laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2023; 280:2059-2060. [PMID: 36357611 DOI: 10.1007/s00405-022-07740-w] [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: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Jerome R Lechien
- Department of Laryngology and Broncho-esophagology, EpiCURA Hospital, University of Mons, Mons, Belgium.
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France.
- Polyclinic of Poitiers, Poitiers, France.
| | | | - Antonino Maniaci
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Miguel Mayo-Yanez
- Otorhinolaryngology, Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Giannicola Iannella
- Department of Otolaryngology-Head Neck Surgery, Sapienza University of Rome, Rome, Italy
| | - Luigi A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Lechien JR, Baudouin R, Hans S, Akst LM. History of Otolaryngology: Globus Pharyngeus as "Globus Hystericus". Otolaryngol Head Neck Surg 2023; 168:889-892. [PMID: 35380891 DOI: 10.1177/01945998221093517] [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: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 11/15/2022]
Abstract
Globus pharyngeus is the uncomfortable sensation of a "lump in the throat," and at present it has many recognized pathophysiologic causes. However, until relatively recently, this condition was often labeled "globus hystericus" and was thought to be a manifestation of hysteria or anxiety. In this commentary, we briefly review the history surrounding the initial treatment of globus pharyngeus sensation as a hysterical condition rooted in anxiety/psychological causes; then, we briefly review the emerging evidence that roots globus pharyngeus sensation within a constellation of pathophysiologies that are related to pharyngoesophageal inflammation and irritation rather than psychological disorders.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, 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 Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, 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
| | - Robin Baudouin
- 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
| | - Stéphane Hans
- 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
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Hospital, The Johns Hopkins University, Baltimore, Massachusetts, USA
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Roles of Heart Rate Variability in Assessing Autonomic Nervous System in Functional Gastrointestinal Disorders: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13020293. [PMID: 36673103 PMCID: PMC9857852 DOI: 10.3390/diagnostics13020293] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Functional gastrointestinal disorders (FGID) and gastroesophageal reflux (GERD) disease affect a large global population and incur substantial health care costs. Impairment in gut-brain communication is one of the main causes of these disorders. The central nervous system (CNS) provides its inputs to the enteric nervous system (ENS) by modulating the autonomic nervous system (ANS) to control the gastrointestinal functions. Therefore, GERD and FGID's might be associated with autonomic dysfunction, which can be identified via heart rate variability (HRV). FGIDs may be treated by restoring the autonomic dysfunction via neuromodulation. This article reviews the roles of HRV in the assessment of autonomic function and dysfunction in (i) gastroesophageal reflux (GERD), and the following FGIDs: (ii) functional dyspepsia (FD) and gastroparesis, (iii) irritable bowel syndrome (IBS) and (iv) constipation. The roles of HRV in the assessment of autonomic responses to various interventions were also reviewed. We used PUBMED, Web of Science, Elsevier/Science direct and Scopus to search the eligible studies for each disorder, which also included the keyword 'heart rate variability'. The retrieved studies were screened and filtered to identify the most suitable studies using HRV parameters to associate the autonomic function with any of the above disorders. Studies involving both human and animal models were included. Based on analyses of HRV, GERD as well as the FGIDs were found to be associated with decreased parasympathetic activity and increased sympathetic nervous system activity with the autonomic balance shifted towards the sympathetic nervous system. In addition, the HRV methods were also reported to be able to assess the autonomic responses to various interventions (mostly neuromodulation), typically the enhancement of parasympathetic activity. In summary, GERD and FGIDs are associated with impaired autonomic dysfunction, mainly due to suppressed vagal and overactive sympathetic tone, which can be assessed noninvasively using HRV.
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Lechien JR, Saussez S, Mayo-Yanez M, Iannella G, Vaira LA. Reflux symptoms may develop in cases of throat mucosa injury, stress and related-autonomic nerve dysfunction. Am J Otolaryngol 2022; 44:103687. [DOI: 10.1016/j.amjoto.2022.103687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
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Abdul-Razakq H, Emmanuel A, Brugaletta C, Sweis R, Perring S. An investigation into the effect of nasogastric intubation on markers of autonomic nervous function. Neurogastroenterol Motil 2022; 34:e14214. [PMID: 34337828 DOI: 10.1111/nmo.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nasogastric (NG) intubation for esophageal manometry can be traumatic and may be associated with a temporary reduction/absence in esophageal peristalsis. This study explored the prevalence and effect on esophageal motor function. We also hypothesized that baseline anxiety as well as markers of autonomic nerve function were correlated to attenuated esophageal peristalsis. METHODS Twenty-seven patients with esophageal symptoms referred for esophageal manometry investigation (mean age 56.8 ± 16.7 years, range 23-85 years) reported baseline anxiety score (Likert scale) preintubation. Patients had continuous heart rate and blood pressure measured prior to intubation and until 10 min after catheter withdrawal. Quality of motility was assessed for each 5 ml water swallow using standard Chicago Classification metrics. KEY RESULTS Nasogastric-intubation elicited a significant increase in heart rate (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) blood pressure, which was in part anticipatory. The median time taken for patients' first hypotensive peristalsis (Distal Contractile Integral; DCI ≥100 mmHg s cm) was 130 s (Interquartile range; 47-242 s) and for their first normal peristalsis (DCI ≥450 mm Hg s cm) was 150 s (IQR 61-320 s), with improvement and consistent stabilization in DCI there onward. This corresponded closely to the time for initial recovery of heart rate and systolic and diastolic blood pressure postintubation. CONCLUSIONS AND INFERENCES Nasogastric intubation resulted in heightened sympathetic responses and/or dampened parasympathetic responses, and an associated temporary reduction or absence in esophageal peristalsis.
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Affiliation(s)
- Humayra Abdul-Razakq
- GI Physiology Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Concetta Brugaletta
- GI Physiology Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rami Sweis
- GI Physiology Unit, University College London Hospitals NHS Foundation Trust, London, UK
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Huang F, Liao Q, Gan X, Wen W. Correlation Between Refractory Laryngopharyngeal Reflux Disease and Symptoms of Anxiety and Depression. Neuropsychiatr Dis Treat 2022; 18:925-932. [PMID: 35502360 PMCID: PMC9056093 DOI: 10.2147/ndt.s349933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The occurrence, development, and prognosis of refractory laryngopharyngeal reflux disease (LPRD) may be related to anxiety and depression. Our study aims to investigate anxiety and depressive symptoms in LPRD and clarify the correlations among them. PATIENTS AND METHODS Twenty-eight patients were diagnosed with LPRD and subsequently referred to the Department of Mental Health for treatment. The patients were divided into the Self-rating Anxiety Scale (SAS)/Self-rating Depression Scale (SDS) positive group (+) and the SAS/SDS negative group (-). All patients were treated (oral administration) with a standard dose of proton pump inhibitor (PPI, omeprazole 20 mg bid) plus one tablet of Deanxit (flupentixol-melitracen) after breakfast. Treatment efficacy was evaluated after one month of drug treatment. The therapeutic effect of PPI treatment alone was compared with that treated with PPI + Deanxit. RESULTS Among 28 patients with refractory LPRD, the main reflux symptoms and signs were specific. There were differences in gender distribution and age distribution among the 28 patients with refractory LPRD, and there were 17 patients (60.7%) in the SAS/SDS (+) group and 11 patients in the SAS/SDS (-) group (39.3%). Regarding efficacy evaluation after one month of PPI + Deanxit treatment, the differences in indices before and after treatment were statistically significant (all p<0.05). CONCLUSION Anxiety and depressive symptoms influence the occurrence, development, and treatment efficacy of refractory LPRD. Attention to and targeted treatment of anxiety and depressive symptoms can help improve the treatment outcomes of patients with refractory LPRD.
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Affiliation(s)
- Fengling Huang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530000, People's Republic of China
| | - Qiu Liao
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530000, People's Republic of China
| | - Xingkun Gan
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530000, People's Republic of China
| | - Wensheng Wen
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530000, People's Republic of China
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Lechien JR, Barillari MR, De Marrez LG, Hans S. Dysphonia in COVID-19 patients: Direct or indirect symptom? Am J Otolaryngol 2022; 43:103246. [PMID: 34555788 PMCID: PMC8450233 DOI: 10.1016/j.amjoto.2021.103246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/05/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jerome R Lechien
- Elsan Group, Paris, France; Department of Otorhinolaryngology-Head & Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Belgium.
| | - Maria R Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy
| | - Lisa G De Marrez
- Department of Otorhinolaryngology-Head & Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
| | - Stephane Hans
- Department of Otorhinolaryngology-Head & Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
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Silvestro M, Dovetto FM, Corvino V, Apisa P, Malesci R, Tessitore A, Milizia P, Tedeschi G, Marciano E, Russo A. Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis. Headache 2021; 61:1452-1459. [PMID: 34618362 PMCID: PMC9293350 DOI: 10.1111/head.14222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 01/22/2023]
Abstract
Background People with cluster headache (CH) are frequently burdened by misdiagnosis or diagnostic delay. The peculiar somatic and behavioral changes characterizing patients with CH are not useful to improve diagnostic accuracy. In our clinical experience, we noticed a typical voice quality with low and croaking tone in patients with CH. In this cross‐sectional study, we evaluated, by digital voice analysis, whether it is possible to identify typical voice quality characterizing patients with CH compared with healthy controls (HCs). Furthermore, to investigate whether putative differences in voice characteristics could be underpinned by constitutional aspects or pathological processes of vocal cords, subjects underwent a videolaryngostroboscopy. Smoking habits and alcohol consumption were specifically investigated. Methods After conducting digital recording of the voices from both patients with CH and HCs in a soundproof insulated cabin in the laboratory of the Audiology Department, a set of voice parameters was analyzed. We included the measures of fundamental frequency, calculations of jitter and shimmer, and noise‐to‐harmonics ratios as well as quantities related to the spectral tilt (i.e., H1–H2, H1–A1, H1–A2, and H1–A3) in 20 patients with CH and in 13 HCs. A videolaryngostroboscopy was performed in all subjects. Results Patients with CH, explored during the cluster bout period, showed significantly lower second harmonic (H1–H2) values compared with HCs (−6.9 ± 7.6 vs. 2.1 ± 6.7, p = 0.002), usually characterizing the so‐called creaky voice. By using a laryngoscopy investigation, a significantly higher prevalence of mild to moderate vocal cord edema and laryngopharyngeal reflux signs were found in patients with CH (100% of patients with CH vs. 15% of HC, p < 0.001). Conclusion Creaky phonation is a “physiological mode of laryngeal operation” usually underpinned by shortened and thickened vocal folds. Creaky voice phonation can be due to a vocal fold's reduced capability to become slack or flaccid secondary to vocal cord edema underpinned by laryngopharyngeal reflux affecting the phonatory mechanisms in patients with CH. The laryngopharyngeal reflux may represent a dysautonomic sign related to the increased parasympathetic tone during in‐bout period, reinforcing the hypothesis of an extracranial autonomic dysfunction as part of CH clinical picture.
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Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca M Dovetto
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Virginia Corvino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Pasqualina Apisa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Rita Malesci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Tessitore
- Headache Center, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Milizia
- Department of Asia, Africa and the Mediterranean, University of Naples l'Orientale, Naples, Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elio Marciano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Russo
- Headache Center, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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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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15
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Verhasselt M, Rodriguez A, Dequanter D, Lechien JR. Chronic Course, Weaning, and Awareness of Patients With Reflux Toward Proton Pump Inhibitor Therapy. J Voice 2021:S0892-1997(21)00098-9. [PMID: 33795183 DOI: 10.1016/j.jvoice.2021.03.002] [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: 11/14/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the feasibility of middle-term proton pump inhibitor (PPI) weaning in patients with laryngopharyngeal reflux (LPR) and evaluate patient awareness of PPI adverse events. METHODS We conducted a cross-sectional study of 100 LPR patients treated with an association of diet, PPIs, and alginate. Patients were followed from September 2016 to May 2020. At the end of the initial 3-to-6 months therapeutic period, LPR patients were weaned from PPIs and instructed to respect diet and stress management over the long-term. The 3-year symptom recurrence rate, PPI use, and patient awareness of PPI adverse events were assessed. RESULTS Sixty-seven patients completed the evaluation. Twenty-seven patients (40.3%) reported a chronic course of LPR-symptoms, requiring chronic or occasional PPI use. LPR symptom recurrence occurred 1-to-2 or 3-to-5 times yearly in 8.9% and 20.9% of patients, respectively. Recurrences were managed by short-term diet, alginate, or PPI intake. The remaining patients (29.9%) did not report middle-term LPR recurrence. The 3-year weaning rate of occasional or chronic use of PPIs was 64.2%. Among participants, 26.8% were aware of PPI-related adverse events, most frequently through physicians (33%), online sources (17%), and friends or family (17%). Nonresponder patients were significantly more aware of PPI adverse events than responders (P = 0.029). PPI-attributed adverse events occurred in 29.8% of patients. CONCLUSION Sixty-four percent of LPR patients treated with PPIs were weaned at 3-year posttreatment time. Different forms of LPR may exist regarding symptom relief, recurrences, and chronic course.
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Affiliation(s)
- Marie Verhasselt
- Department of Otolaryngology-Head & Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alejandra Rodriguez
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
| | - Didier Dequanter
- Department of Human Anatomy and Experimental Oncology, University of Mons, Mons, Belgium
| | - Jerome R Lechien
- Department of Otolaryngology-Head & Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
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Lechien JR, De Vos N, Everard A, Saussez S. Laryngopharyngeal reflux: The microbiota theory. Med Hypotheses 2020; 146:110460. [PMID: 33359943 DOI: 10.1016/j.mehy.2020.110460] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023]
Abstract
Laryngopharyngeal reflux (LPR) is a prevalent disease associated with non-specific symptoms and findings. Many gray areas persist in the pathogenesis of LPR, the diagnosis and the treatment. Symptoms are poorly correlated with fiberoptic signs or hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring findings. The therapeutic response remains uncertain with some resistant patients to medical or surgical treatment. The development of LPR-symptoms and findings may be related to the refluxate of a myriad of gastroduodenal enzymes, which may modify the laryngopharyngeal and oral microbiome leading to mucosa maintenance and recovery impairments. The diet of patient is important because it may impact the microbiome composition and some foods are known to increase the number of hypopharyngeal reflux events. The number of hypopharyngeal reflux events may be increased by autonomic nerve dysfunction that may have an important role in the persistence of LPR-symptoms.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, 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 Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
| | - Nathalie De Vos
- Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Amandine Everard
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, WELBIO, Walloon Excellence in Life Sciences and BIOtechnology, UCLouvain, Université Catholique de Louvain, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, 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
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Lechien JR, Saussez S, Muls V, Barillari MR, Chiesa-Estomba CM, Hans S, Karkos PD. Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians. J Clin Med 2020; 9:E3618. [PMID: 33182684 PMCID: PMC7697179 DOI: 10.3390/jcm9113618] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
Laryngopharyngeal reflux (LPR) is a common disease in the general population with acute or chronic symptoms. LPR is often misdiagnosed in primary care because of the lack of typical gastroesophageal reflux disease (GERD) symptoms and findings on endoscopy. Depending on the physician's specialty and experience, LPR may be over- or under-diagnosed. Management of LPR is potentially entirely feasible in primary care as long as General Practitioners (GPs) are aware of certain "red flags" that will prompt referral to a Gastroenterologist or an Otolaryngologist. The use of patient-reported outcome questionnaires and the consideration of some easy ways to diagnose LPR without special instrumentation oropharyngeal findings may help the GP to diagnose and often manage LPR. In this review, we provide a practical algorithm for LPR management for GPs and other specialists that cannot perform fiberoptic examination. In this algorithm, physicians have to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and "red flags". They may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the symptom severity. Proton pump inhibitors and alginates remain a popular choice in order to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.
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Affiliation(s)
- Jerome R. Lechien
- Department of Human Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 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), 92150 Paris, France;
- Department of Otolaryngology-Head & Neck Surgery, Ambroise Paré Hospital, APHP, Paris Saclay University, 92150 Paris, France
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, 1000 Brussels, Belgium
- Department of Otolaryngology-Head & Neck Surgery, CHU Ambroise Paré, 92150 Paris, France
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Mons, Belgium;
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, 1000 Brussels, Belgium
- Department of Otolaryngology-Head & Neck Surgery, CHU Ambroise Paré, 92150 Paris, France
| | - Vinciane Muls
- Division of Gastroenterology and Endoscopy, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Maria R. Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, 34103 Naples, Italy;
| | - Carlos M. Chiesa-Estomba
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, 00685 San Sebastian, Spain;
| | - Stéphane Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France;
- Department of Otolaryngology-Head & Neck Surgery, Ambroise Paré Hospital, APHP, Paris Saclay University, 92150 Paris, France
- Department of Otolaryngology-Head & Neck Surgery, CHU Ambroise Paré, 92150 Paris, France
| | - Petros D. Karkos
- Department of Otorhinolaryngology and Head and Neck Surgery, AHEPA University Hospital, Thessaloniki Medical School, 54621 Thessaloniki, Greece;
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Association between laryngopharyngeal reflux disease and autonomic nerve dysfunction. Eur Arch Otorhinolaryngol 2019; 276:2283-2287. [PMID: 31177327 DOI: 10.1007/s00405-019-05482-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess autonomic nerve function in patients with laryngopharyngeal reflux disease (LPRD) and determine the correlation between LPRD and autonomic nerve dysfunction. METHODS Patients with suspected LPRD who visited our outpatient department were assessed using the reflux symptom index (RSI) and reflux finding score (RFS) scales. Eighty-one suspected LPRD patients with RSI > 13 and RFS > 7 were examined using 5-min short-range heart rate variability, and all were given proton pump inhibitor diagnostic treatment. RESULTS The root mean square of successive R-R intervals, high-frequency (HF) power, standardized HF, and HF % were significantly lower in the case group than in the control group (p < 0.05); however, the low frequency (LF)/HF ratio was significantly higher in the case group (p < 0.05). There were no significant differences in the standard deviation of the average normal-to-normal interval, total power, LF power, and LF % between the two groups (p > 0.05). RSI, RFS, and disease duration were negatively correlated with HF power (r = - 0.89, -0.77, and -0.315, respectively; p < 0.05). The LF/HF ratio and disease duration were positively correlated (r = 0.315, p < 0.05). CONCLUSIONS Autonomic nerve dysfunction was observed in our patients with LPRD. LPRD severity was significantly correlated with autonomic nerve dysfunction and negatively correlated with vagal nerve function.
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Nowak JK, Łaźniak A, Lisowska A, Kycler Z, Bobkowski W, Walkowiak J. Gastroesophageal reflux is not associated with short-term variability of parasympathetic activity in children. Adv Med Sci 2017; 62:103-109. [PMID: 28235713 DOI: 10.1016/j.advms.2016.11.012] [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: 07/26/2016] [Revised: 10/04/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE A lower parasympathetic activity was described in patients with the gastroesophageal reflux disease. We aimed to determine whether gastroesophageal reflux (GER) episodes are associated with a short-term parasympathetic tone variability in children. METHODS In order to address this question we performed simultaneous 24-h esophageal multichannel intraluminal impedance-pH and electrocardiographic monitoring in 16 children (age range 6-18 years), including 8 with asthma and 2 with gastroesophageal reflux disease. After describing duration, height, and acidity of 483 GER episodes we also measured parasympathetic-related heart rate variability parameters in 4 time periods: preceding, containing, following GER, and in-between GERs (control). High frequency (HF) power and root-mean square differences of successive R-R intervals (r-MSSD) were assessed in 2.5-min and 1-min periods, respectively. RESULTS We did not identify the searched short-term parasympathetic tone changes. CONCLUSIONS In conclusion, GER episodes and their characteristics were not associated with short-term variability of parasympathetic activity in children.
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Qu Y, Ye JY, Han DM, Zheng L, Cao X, Zhang YH, Ding X. Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease. Chin Med J (Engl) 2016; 128:2162-7. [PMID: 26265608 PMCID: PMC4717981 DOI: 10.4103/0366-6999.162506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea/hypopnea syndrome (OSAHS) and laryngopharyngeal reflux (LPR) disease have a high comorbidity rate, but the potential causal relation between the two diseases remains unclear. Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions. METHODS Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography. High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility. RESULTS There were 13 OSAHS patients (36.1%) without LPR (OSAHS group) and 23 (63.9%) with both OSAHS and LPR (OSAHS and LPR group). Significant differences were found in the onset velocity of liquid swallows (OVL, P = 0.029) and the percent relaxation of the lower esophageal sphincter (LES) during viscous swallows (P = 0.049) between the OSAHS and control groups. The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time (P = 0.016, R = -0.507), and OVL was found to be negatively correlated with recumbent distal acid percent time (P = 0.006, R = -0.557) in the OSAHS and LPR group. CONCLUSIONS OSAHS patients experience esophageal functional changes, and linear correlations were found between the changed esophageal functional parameters and reflux indicators, which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.
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Affiliation(s)
| | | | - De-Min Han
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Increased sympathetic drive during the onset of hypertension in conscious Cyp1a1-Ren2 rats. Pflugers Arch 2013; 466:459-66. [DOI: 10.1007/s00424-013-1338-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/06/2013] [Accepted: 08/14/2013] [Indexed: 12/21/2022]
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