Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians

The 2-week wait pathway for suspected head and neck cancers in patients with throat and voice symptoms: referral patterns, common clinical practice and diagnostic efficacy of NICE guidelines

INTRODUCTION

The 2-week wait (2ww) referral pathway has been introduced into UK clinical practice to increase the early detection of cancer and improve survivals. The efficiency of this system for head and neck (H&N) cancers has been questioned over the years because of evidence of low pick-up rates. H&N cancers present with a wide variety of non-specific symptoms, particularly throat and voice symptoms. These symptoms need to be accurately interpreted together with risk factors if they are to be addressed adequately and overload of cancer facilities avoided. One of the most common outcomes of H&N 2ww referrals is laryngopharyngeal reflux (LPR), a common condition that could be diagnosed and managed in the primary care setting with a prescription of proton pump inhibitors (PPI) trials.

METHODS

We retrospectively analysed a cohort of consecutive patients referred on the 2ww pathway for throat and voice symptoms at University College London Hospital H&N cancer clinic during two months in 2019.

RESULTS

A total of 101 patients (43.6% men, mean age 53.3 years) were included. Throat and voice symptoms were described as intermittent in 52.5% and non-lateralised in 88.1%. Diagnosis of LPR was made in 59.4% of the referrals. A PPI trial was prescribed by general practitioners (GPs) in only 7.9% of cases. The cancer pick-up rate in our cohort is 2.9%.

CONCLUSIONS

An improved awareness of the symptoms of LPR could guide GPs to prescribe trials of PPIs in low-risk patients before rushing into a referral on a cancer pathway. This would improve the 2ww process on many levels, reduce the burden on the National Health Service and avoid patients' psychological distress.

Advances in laryngopharyngeal reflux: Etiology, diagnosis, and management

Laryngopharyngeal reflux (LPR) manifests as a variety of nonspecific upper aerodigestive tract symptoms. Rather than a single disorder, LPR may be conceived of as a spectrum of subtypes with varying clinical presentations. LPR signs and symptoms arise from the direct and/or indirect effects of refluxate, physical and molecular injury of the mucosa, and neurologic responses to esophageal events. Specific constituents of refluxate exert distinct mucosal responses and immediate or delayed effects resulting in transient or persistent symptoms and/or laryngeal hypersensitivity. While the complex etiology of LPR presents challenges to its diagnosis and management, tools that aid the identification of LPR subtypes can provide insight into treatment decision-making. Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring provides detailed analysis of reflux events, enabling the development of individualized treatment plans, yet cost and availability limit its widespread use. Alginates offer temporary symptom relief and antireflux surgery may provide benefit when symptoms are recalcitrant to other approaches. Pepsin inhibitors hold promise as a medical therapy when surgery is not an option. Laryngeal hypersensitivity should be considered as part of a comprehensive therapeutic approach. Promising medical and scientific research continues to yield new insights into the complex etiology of LPR and novel strategies for its diagnosis and management.

Laryngopharyngeal Reflux Pathophysiology, Clinical Presentation, and Management: A Narrative Review

Laryngopharyngeal reflux (LPR) is a common and often misinterpreted clinical entity responsible for various symptoms affecting the upper aerodigestive tract. This narrative literature review aims to review the pathophysiology, symptoms, and management of LPR, emphasizing the emerging understanding of gastric content reflux in aerodigestive tissue irritation. Understanding the pathophysiology of LPR will allow general practitioners and specialists to accurately recognize and treat a condition that causes substantial morbidity in the affected patients. Using evidence-based findings from randomized controlled trials, clinical studies, and meta-analyses, the present investigation aims to outline and unify previous research into LPR. A review of anatomical structures, pathogenic mechanisms, endoscopic findings in LPR, and clinical manifestations and treatment options are also discussed. Though controversy around the diagnosis and management of LPR persists, emerging research in cellular damage and diagnostic tools promises to provide increasingly accurate and reliable modalities for characterizing LPR. Hopefully, future research will unify the field and provide overarching guidelines for both primary care and specialists. The present investigation provides an integrated perspective on LPR, a clinically prevalent and complex disease.

Narrative review of relationship between chronic cough and laryngopharyngeal reflux

Gastroesophageal reflux disease (GERD) as a possible cause of chronic cough is known for decades. However, more than 75% of patients with extraoesophageal symptoms do not suffer from typical symptoms of GERD like pyrosis and regurgitations and have negative upper gastrointestinal endoscopy. For such a condition term laryngopharyngeal reflux (LPR) was introduced and is used for more than two decades. Since the comprehensive information on relationship between chronic cough and LPR is missing the aim of this paper is to summarize current knowledge based on review of published information during last 13 years. Laryngopharyngeal reflux is found in 20% of patients with chronic cough. The main and recognized diagnostic method for LPR is 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring, revealing reflux episodes irritating the upper and lower respiratory tract mucosa. The treatment of LPR should be initiated with dietary and lifestyle measures, followed by proton pump inhibitor (PPI) therapy and other measures. Despite progress, more research is needed for accurate diagnosis and targeted therapies. Key areas for exploration include biomarkers for diagnosis, the impact of non-acid reflux on symptom development, and the efficacy of new drugs. Further studies with a focused population, excluding other causes like asthma, and using new diagnostic criteria for LPR are essential. It's crucial to consider LPR as a potential cause of unexplained chronic cough and to approach diagnosis and treatment with a multidisciplinary perspective.

Knowledge, attitudes and practices of patients with chronic pharyngitis toward laryngopharyngeal reflux in Suzhou, China

BACKGROUND

This study aimed to investigate the knowledge, attitudes and practices (KAP) of patients with chronic pharyngitis in Suzhou, China toward laryngopharyngeal reflux (LPR).

METHODS

This cross-sectional study was conducted in patients with chronic pharyngitis in Suzhou, China at the otolaryngology outpatient clinic of the First Affiliated Hospital of Soochow University between November, 2022, and May, 2023. Data was collected through a self-designed online questionnaire encompassing the sociodemographic characteristics and three dimensions of KAP. The questionnaire was administered using SoJump, and data were exported from this platform. Subsequently, statistical analysis, including Structural Equation Modeling, was performed using SPSS 22 software to evaluate the KAP scores.

RESULTS

A total of 487 valid questionnaires were collected, with 275 (56.35%) female patients. The mean score of KAP were 4.76 ± 2.93 (possible range: 0-11), 33.10 ± 4.46 (possible range: 8-40), 31.29 ± 6.04 (possible range: 8-40), respectively. Pearson's correlation analysis showed significant positive correlations between knowledge and attitude dimensions (r = 0.413, P < 0.001), knowledge and practice dimensions (r = 0.355, P < 0.001), and attitude and practice dimensions (r = 0.481, P < 0.001). Structural equation modeling revealed that education exhibited positive effect on knowledge (β = 0.476, P < 0.001) and attitude (β = 0.600, P < 0.001), and having family history of chronic pharyngitis showed positive effect on knowledge (β = 0.580, P = 0.047), experienced with reflux symptoms showed positive effect on knowledge (β = 0.838, P = 0.001) and attitude (β = 0.631, P = 0.085). Moreover, knowledge showed positive effect on attitude (β = 0.555, P < 0.001) and practice (β = 0.351, P < 0.001). Attitude, in turn, showed positive effect on practice (β = 0.511, P < 0.001).

CONCLUSION

Patients with chronic pharyngitis had inadequate knowledge, positive attitudes and suboptimal practices toward LPR. Education, family history of chronic pharyngitis, experienced with reflux symptoms might have effect on their KAP.

The Impact of Nutrition on the Onset, Course of Disease and Quality of Life of Patients with Laryngopharyngeal Reflux

Research background

The role of dietary habits of patients with laryngopharyngeal reflux (LPR) is comparatively underexplored. The aim of the study is to examine dietary habits, onset and course of the disease as well as the quality of life of patients with LPR.

Experimental approach

The results of the modified food frequency questionnaire (FFQ-m) and laryngopharyngeal reflux health-related quality of life (LPR-HRQL) questionnaires were compared between subjects with and without LPR. There were a total of 100 subjects with LPR and 65 subjects in the control group. The group of subjects with LPR was further randomly divided into two subgroups; the first subgroup was treated with esomeprazole at a dose of 20 mg twice daily combined with the instructions for dietary and general lifestyle changes, and the other with pantoprazole at a dose of 20 mg twice daily combined with the instructions for dietary and general lifestyle changes. Participants were instructed to fill out FFQ-m and LPR-HRQL questionnaires immediately after the initial examination and then after control examinations 30 and 60 days after the initial examination.

Results and conclusions

Patients with LPR consume more food with high reflux potential, drink more carbonated drinks and juices and have a worse quality of life than the control group (p<0.001). Taking proton pump inhibitors at a dose of 20 mg twice daily in combination with a change in dietary habits such as substituting acidic, spicy, fermented, sweet, fried foods and other foods with a high reflux potential as well as carbonated drinks and juices with the food with a low reflux potential and water significantly reduced the symptoms of LPR and increased the quality of life of the patients (p<0.001).

Novelty and scientific contribution

This is the first study showing the correlation between dietary habits and the quality of life of patients with LPR. The contribution of this research is an objective assessment of the follow-up of patients with LPR that could be used in their regular assessment.

Prethyroidectomy voice and swallowing disorders and the possible role of laryngopharyngeal reflux disease

OBJECTIVES

The aim of the study was to evaluate voice and swallowing function before thyroid surgery and to explore the possible role of thyroid enlargement and laryngopharyngeal reflux (LPR).

METHODS

We conducted a prospective study of patients who underwent hemi- or total thyroidectomy (n = 118) and compared the results with patients of laparoscopic cholecystectomy (n = 110). All subjects underwent videolaryngostroboscopy, filled in subjective evaluations of voice, swallowing and reflux complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) and perceptual voice evaluation were conducted.

RESULTS

We found no difference in voice quality between study and control group, neither in subjective complaints nor in AVA or perceptual evaluation. We did find indicative signs of minor laryngeal changes in thyroid group. Swallowing Impairment Score (SIS) revealed worse swallowing function in thyroid patients (p = 0.0006). Comparison of Reflux Symptom Index (RSI) scores revealed that thyroid group patients have higher values compared to control group (p = 0.006). Nevertheless, Reflux Finding Score (RFS) showed identical scores in both groups (p = 0.220). In thyroid group there was a strong positive correlation between RSI and SIS (ρ = 0.641), but no correlation between RFS and SIS (ρ = -0.002). In addition, we found a weak positive correlation between thyroid weight and RFS (ρ = 0.379).

CONCLUSIONS

Changes in laryngeal area caused by thyroid disorders do not lead to subjective but indicate slight objective disturbances in voice quality. We detected a decline in swallowing quality within thyroid patients. Higher RSI scores and a positive correlation between RFS and thyroid weight, indicate a possible role of thyroid gland in LPR.

Current Treatment of Laryngopharyngeal Reflux

Objectives: Laryngopharyngeal reflux (LPR) is a complex syndrome characterized by the reflux of gastroduodenal contents into the pharynx or larynx, resulting in a range of symptoms, including chronic cough, throat clearing, pain, dysphagia, hoarseness, and dysphonia. Despite the lack of a gold standard for diagnosis or treatment, various strategies have been proposed to manage LPR. However, the effectiveness of these treatments is compromised by the lack of a uniform treatment protocol, which places a burden on patients, physicians, and the healthcare system. This study aims to systematically review the treatments of LPR and provide updated and useful clinical information to clinical physicians. Methods: The literature with an emphasis on LPR and related keywords is searched and reviewed in PubMed. Results: Treatment of LPR includes health education, lifestyle modification, dietary changes, medications, and surgery, as well as the emergence of a novel treatment method involving external upper esophageal sphincter compression devices. Conclusions: Currently, medication is the main treatment, supplemented with lifestyle and dietary changes, but there is still a lack of effective means for patients with drug-resistant or intolerant LPR. More high-quality and rigorous trials must continue to be conducted to determine the best treatment options and find novel treatments. Taking into account the complexity of LPR, this study proposes a simple algorithm to help clinicians with the initial management of this disease.

Role of Reflux Symptom Index and Reflux Finding Score in Diagnosing Laryngopharyngeal Reflux: A Prospective Study

Laryngopharyngeal Reflux Disease (LPRD) is caused due to reflux of gastric content into the larynx and pharynx. The present study was done to assess the role of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in the treatment outcomes in symptomatic patients with LPRD. This is a prospective analytical study conducted on 200 patients for a period of 2 years, from January 2020 to February 2022. Patients suspected with LPR were evaluated using RSI and RFS, and both pre and post treatment scores were compared to assess the change in scores of RSI and RFS following 8 weeks of treatment with PPI (Proton pump inhibitor). The patients experienced a greater incidence of moderate symptoms in RSI. Wilcoxon signed-rank test showed significant difference between pre and post treatment scores with respect to reflux symptoms and reflux findings (p < 0.05). Implementation of RSI and RFS scoring system helped for early diagnosis of LPR, and a significant difference was seen between pre and post treatment scores in both RSI and RFS.

Assessment of the Current Knowledge and Practice of General Practitioners Towards Laryngopharyngeal Reflux in Saudi Arabia

Background General practitioners (GPs) have a significant role in the diagnosis of patients with laryngopharyngeal reflux (LPR). Some published data revealed a lack of knowledge among GPs about the disease, consequently, this lack of knowledge impacted their performance. This survey aims to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia. Methodology This survey study was conducted to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia using an online questionnaire. The questionnaire was distributed and collected from the five regions in Saudi Arabia, which are The Central Region (Riyadh, Qassim), Eastern Region (Dammam, Al-Kharj, Al-Ahasa), Western Region (Makkah, Madinah, Jeddah), Southern Region (Asir, Najran, Jizan), and Northern Region (Tabuk, Jouf, Hail). Results In the current study, we collected data from 387 general practitioners, 61.8% of whom were aged between 21-30 years old, and 57.4% of the participants were males. Moreover, 40.6% of the participants thought that both LPR and gastroesophageal reflux disease (GERD) share pathophysiology, however, they are two different diseases considering their clinical presentation. Moreover, it was found that heartburn was the most known symptom of LPR among the participants (Mean score 2.14 (SD=1.31), where a lower score indicated more relation). Considering the treatment of LPR, 40.6% and 40.3% of the participants reported using proton pump inhibitors once or twice daily respectively. In contrast, antihistamine/H2 blockers, alginate, and magaldrate were used to a lesser extent as reported by 27.1%, 21.7%, and 12.1%. Conclusion The current study showed limited knowledge among general practitioners considering LPR with a higher rate of referring patients to other departments depending on symptoms which may increase the pressure on other departments of mild cases.

[Current possibilities and challenges in the treatment of laryngopharyngeal reflux]

Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with a variety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.

Laryngopharyngeal reflux as a potential cause of Eustachian tube dysfunction in patients with otitis media with effusion

OBJECTIVE

To explore the association between laryngopharyngeal reflux disease (LPRD)-related symptoms and the Eustachian tube (ET) function in adult patients with otitis media with effusion (OME).

MATERIALS AND METHODS

A total of 105 adult patients with OME were retrospectively studied. All these patients had undergone tubomanometry (TMM) test for the affected ears before treatments. The LPRD-related symptoms were all assessed by the Reflux Symptom Index (RSI) scale.

RESULTS

Among the 105 included patients, the numbers of subjects with only one and both two ears affected were 65 (57.1%) and 40 (42.9%), respectively. Therefore, a total of 145 affected ears were studied. For these affected ears, a linear regression analysis that included sex, age, BMI, smoking history, drinking history, RSI value, and the condition of the contralateral ear suggested that only RSI value was significantly associated with TMM value (P < 0.001), with the correlation coefficient of -0.112. Among the 9 symptoms in RSI scale, affected ears with the following symptoms (vs. affected ears without) showed significantly lower TMM values: excess throat mucus or postnasal drip, difficulty swallowing food, liquids, or pills, and sensations of something stuck in your throat or a lump in your throat (all P < 0.05).

CONCLUSION

LPRD may disrupt ET function in adult OME patients. A higher RSI score is independently predictive for a bad ET patency in such patients and is indicative for an additional anti-reflux therapy.

Resource utilization and variation among practitioners for evaluating voice hoarseness secondary to suspected reflux disease: A retrospective chart review

The purpose of this study was to assess the variation in resource utilization for the diagnosis and treatment of dysphonia or hoarseness in patients with suspected laryngopharyngeal reflux (LPRD) and/or gastroesophageal reflux (GERD). Secondary data was collected from a single-institution database of charts from patients evaluated between October 1, 2011 and March 31, 2020. This study was conducted as a retrospective chart review. Key outcome variables included demographic data, initial specialty visit, date of first symptom evaluation to final follow-up visit, additional procedural evaluation, and final diagnosis as attributed by the diagnosing physician. Inclusion criteria included patients ≥18 older referred to providers for suspected LPRD/GERD with a primary complaint of voice changes or hoarseness and appeared for follow-up. A total of 134 subjects were included for analysis. Data analysis included descriptive and univariate analysis, chi-square test of independence, independent means t test, and 1-way analysis of variance. Most patients (88) received some form of procedural evaluation in addition to clinical evaluation. The most frequent was videostroboscopy (59). Patients who first visited a gastroenterologist were more likely to undergo esophageal pH-monitoring (n = 14, P < .001) and manometry (n = 10, P < .001). Patients referred to speech-language pathology were very likely to undergo videostroboscopic evaluation (n = 7, P < .001). The prevailing final diagnosis as attributed by the diagnosing physician was confirmed to be of non-reflux etiology (49) or due to GERD alone (34). LPRD only was the least frequent diagnosis (10). Our results demonstrate that there is significant variation in the number and type of diagnostic tests based on the type of practitioner initially seen by the patient. Additionally, of patients thought to have voice change or hoarseness because of LPRD and/or GERD, more than a third had a non-reflux cause of their symptoms. Further research should identify beneficial patterns in resource utilization and further diagnostic utility of diagnostic procedures for more accurate diagnosis.

Do Otolaryngologists Over- or Underestimate Laryngopharyngeal Reflux Symptoms and Findings in Clinical Practice? A Comparison Study between the True Prevalence and the Otolaryngologist-Estimated Prevalence of Symptoms and Findings

Purpose: To investigate the prevalence of symptoms and signs of laryngopharyngeal reflux (LPR) and to compare them with the otolaryngologist-estimated prevalence of the most common LPR-related symptoms and signs. Methods: The prevalence of LPR symptoms and signs was determined through the clinical data of 403 patients with a positive LPR diagnosis on hypopharyngeal−esophageal multichannel intraluminal impedance pH monitoring. The otolaryngologist-estimated prevalence was assessed through an international survey investigating the thoughts of 824 otolaryngologists toward LPR symptom and sign prevalence. The determination of potential over- or underestimation of LPR symptoms and findings was investigated through a data comparison between the ‘true’ prevalence and the ‘estimated prevalence’ of symptoms and findings by otolaryngologists. Results: The prevalence of breathing difficulties, coated tongue, and ventricular band inflammation was adequately evaluated by otolaryngologists. The prevalence of hoarseness, throat pain, odynophagia, dysphagia, throat clearing, globus sensation, excess throat mucus, tongue burning, heartburn, regurgitations, halitosis, cough after eating or lying down, and troublesome cough was overestimated by otolaryngologists (p < 0.01), while the prevalence of chest pain was underestimated as an LPR symptom. Most laryngeal signs, e.g., arytenoid/laryngeal erythema, inter-arytenoid granulation, posterior commissure hypertrophy, retrocricoid edema/erythema, and endolaryngeal sticky mucus, were overestimated (p < 0.01). The occurrence of anterior pillar erythema and tongue tonsil hypertrophy was underestimated by participants. Conclusion: Most laryngopharyngeal reflux symptoms and laryngeal signs were overestimated by otolaryngologists, while some non-laryngeal findings were underestimated. Future studies are needed to better understand the reasons for this phenomenon and to improve the awareness of otolaryngologists toward the most and least prevalent reflux symptoms and signs.

Sensitivity, Specificity, and Predictive Values of Laryngopharyngeal Reflux Symptoms and Signs in Clinical Practice

OBJECTIVE

To investigate the sensitivity (SE), specificity (SP), and positive and negative predictive value (PPV and NPV) of symptoms and signs of laryngopharyngeal reflux (LPR).

STUDY DESIGN

Prospective controlled.

SETTING

University medical center.

METHODS

Patients presenting with LPR symptoms and signs were consecutively included after diagnosis confirmation through 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring. Healthy individuals were recruited to compose a control group. Symptoms and signs were evaluated with the reflux symptom score and reflux sign assessment. The SE, SP, PPV, and NPV of symptoms and signs were assessed.

RESULTS

The study included 403 patients with LPR and 144 healthy individuals. Throat clearing, globus sensation, heartburn, and excess throat mucus were symptoms with the highest SE (67.5%-69.7%), SP (12.5%-20.8%), and NPV (48.3%-49.2%). The combination of throat clearing, heartburn, globus sensation, and excess throat mucus led to a high SE (96.0%) and NPV (85.2%). Anterior pillar erythema, tongue tonsil hypertrophy, and posterior commissure hypertrophy resulted in the highest SE (75.5%-83.5%). The highest SP was found for uvula erythema/edema, epiglottis erythema, and interarytenoid granulatory tissue (97.1%-97.2%). The association of nonendoscopic signs (anterior pillar erythema, uvula erythema/edema, and coated tongue) had an SE and SP of 80.1% and 47.2%, respectively. The association of throat clearing, heartburn, globus, anterior pillar erythema, and uvula erythema/edema had the highest SE (98.8%), SP (33.3%), PPV (94.3%), and NPV (70.6%).

CONCLUSION

LPR symptoms and signs reported low SP and NPV. The SE, SP, PPV, and NPV may be maximized with the association of throat clearing, heartburn, globus sensation, anterior pillar erythema, and uvula erythema/edema.

Prevalence of Laryngopharyngeal Symptoms in Patients With Gastroesophageal Reflux Disease Refractory to Medical Therapy Undergoing Esophagogastroduodenoscopy

OBJECTIVE

Casting more information on the link between GERD and LPR by investigating the prevalence of laryngopharyngeal symptoms in patients with severe GERD refractory to medical treatment.

DESIGN

Prospective Study METHODS: Fifty patients with typical GERD symptoms presenting for EGD were recruited. All patients filled the GERD-Health-Related Quality of Life (HRQL) questionnaire and were screened for LPR using the Reflux Symptom Score questionnaire. All patients were also evaluated for the presence of hiatal hernia, esophagitis, inlet patch, gastritis (erosive vs. non erosive), polyps, intestinal metaplasia and or Helicobacter pylori infection. Laryngeal images were taken during EGD and evaluated using the Reflux Sign Assessment (RSA).

RESULTS

A total of 50 patients were recruited for this study. The prevalence of heartburn was the highest (90%). The mean score of GERD-HRQL was 30.76±15.09. The mean RSS score was 70.96±46.08. Laryngeal examination was documented in 49 patients. the most common finding was edema (34.7%) followed by redness (28.6%). The mean RSA score for the total group was 21.15±8.04. There was a strong correlation between RSS score and GERD-HQRL score. There was no significant correlation between the RSS and any of the EGD findings (P > 0.05). There was no significant correlation between RSA and GERD-HRQL scores or any of the EGD findings (P > 0.05). However, there was a significant correlation between total RSA and RSS scores (rho=0.287, P = 0.04).

CONCLUSION

The suggested high prevalence of LPRD should alarm the treating physician to the need for a thorough otolaryngologic examination in patients presenting with severe GERD, particularly those in whom the LPR symptoms may be masked by the typical symptoms of GERD.

Awareness about laryngopharyngeal reflux disease among Chinese otolaryngologists: a nationwide survey

OBJECTIVES

This study aimed to investigate the status of the current knowledge about laryngopharyngeal reflux disease (LPRD) among Chinese otolaryngologists.

DESIGN

Multi-centre cross-sectional survey.

SETTING

220 medical centres in different regions of China.

PARTICIPANTS

A total of 2254 otolaryngologists from 220 medical centres in China who were successfully on-site surveyed between November 2019 and December 2020.

MAIN OUTCOME MEASURES

Awareness about LPRD included knowledge about risk factors, symptoms, laryngoscope signs, related diseases, current diagnostic methods and treatments.

RESULTS

The percentage of participants who had heard of LPRD was 96.4%, with academic conferences as the most common source of information (73.3%). The most commonly known risk factor, symptom, laryngoscope sign, related disease, diagnostic method and treatment were alcohol consumption (44.0%), pharyngeal foreign body sensation (66.9%), hyperaemia (52.4%), pharyngolaryngitis (54.8%), pH monitoring (47.6%) and medication (82.1%), respectively. Only 28.3% of all participants knew that 24 h pH or multichannel intraluminal impedance pH monitoring was the most accurate diagnostic test. As many as 73.1% of all participants knew that proton pump inhibitors were the first-line treatment drugs. An analysis of the overall status of awareness using a scoring system suggested that otolaryngologists were better aware owing to more access, working at 3A hospitals, and postgraduate or above educational background (all p<0.05).

CONCLUSION

Although the majority of Chinese otolaryngologists had heard of LPRD, their overall awareness about the disease was not encouraging. More efforts are needed to increase the knowledge about LPRD among this group of physicians.

TRIAL REGISTRATION NUMBER

ChiCTR1900025581.

Effects of acids, pepsin, bile acids, and trypsin on laryngopharyngeal reflux diseases: physiopathology and therapeutic targets

PURPOSE

Laryngopharyngeal reflux disease (LPRD) is a general term for the reflux of gastroduodenal contents into the laryngopharynx, oropharynx and even the nasopharynx, causing a series of symptoms and signs. Currently, little is known regarding the physiopathology of LPRD, and proton pump inhibitors (PPIs) are the drugs of choice for treatment. Although acid reflux plays a critical role in LPRD, PPIs fail to relieve symptoms in up to 40% of patients with LPRD. The influence of other reflux substances on LPRD, including pepsin, bile acid, and trypsin, has received increasing attention. Clarification of the substances involved in LPRD is the basis for LPRD treatment.

METHODS

A review of the effects of acids, pepsin, bile acids, and trypsin on laryngopharyngeal reflux diseases was conducted in PubMed.

RESULTS

Different reflux substances have different effects on LPRD, which will cause various symptoms, inflammatory diseases and neoplastic diseases of the laryngopharynx. For LPRD caused by different reflux substances, 24-h multichannel intraluminal impedance combined with pH-metry (MII-pH), salivary pepsin, bile acid and other tests should be established so that different drugs and treatment courses can be used to provide patients with more personalized treatment plans.

CONCLUSION

This article summarizes the research progress of different reflux substances on the pathogenesis, detection index and treatment of LPRD and lays a theoretical foundation to develop target drugs and clinical diagnosis and treatment.

The Association between Free Sugars Consumption and Laryngopharyngeal Reflux: A Cross-Sectional Study among Chinese Adolescents

There is a lack of evidence to show prevalence of laryngopharyngeal reflux (LPR) and the association between LPR and dietary factors. Adolescents consume the most amount of free sugars among the Chinese population. We conducted this study to investigate the prevalence of LPR in Chinese adolescents and explore the association between free sugars consumption and LPR. A cross-sectional study was conducted on 1517 middle school students in Hunan, China. An online questionnaire was applied to collect data on the condition of LPR, consumption of free sugars and other self-reported covariates. Height, weight and waist circumference were collected by anthropometric measurements. Logistic regression was applied to assess the association between LPR and free sugars consumption. The mean and standard deviation of free sugars consumption was 53.14 ± 44.75 (g/d). The prevalence of LPR was 8.11%. A positive association was observed between LPR and higher free sugars consumption after adjusted multiple covariates, with adjusted odds ratio (95% confident interval) of 1.656 (1.125–2.438). The prevalence of LPR among Chinese adolescents was high. Further analytic studies with strict design are required to test the association between LPR and free sugar consumption. Systematic strategies and policies should to be developed to reduce the intake of free sugars in order to prevent LPR.

Consensus statements and recommendations on the management of mild-to-moderate gastroesophageal reflux disease in the Southeast Asian region

This paper reports the proceedings from the first consensus meeting on the management of mild-to-moderate gastroesophageal reflux disease (GERD) in the Southeast Asian (SEA) region. Seventeen statements were drawn up by a steering committee that focused on epidemiology, mechanism of action, diagnostic investigations, and treatment. Voting on the recommendations used the Delphi method with two rounds of voting among the 10 panel members. The consensus panel agreed that GERD is mostly a mild disease in the SEA region with predominantly non-erosive reflux disease (NERD). Complicated GERD and Barrett's esophagus are infrequently seen. The panel recommended endoscopy in patients with alarm or refractory symptoms but cautioned that the incidence of gastric cancer is higher in SEA. pH and impedance measurements were not recommended for routine assessment. The acid pocket is recognized as an important pathogenic factor in GERD. Lifestyle measures such as weight reduction, avoidance of smoking, reduction of alcohol intake, and elevation of the head of the bed were recommended but strict avoidance of specific foods or drinks was not. Alginates was recommended as the first-line treatment for patients with mild-to-moderate GERD while recognizing that proton-pump inhibitors (PPIs) remained the mainstay of treatment of GERD. The use of alginates was also recommended as adjunctive therapy when GERD symptoms were only partially responsive to PPIs.