Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation

Abstract

One third of adults experience laryngeal symptoms such as throat clearing and chronic cough and 50-80% of adults seeking care of these symptoms are told that laryngopharyngeal reflux (LPR) is the etiology. LPR results from retrograde flow of gastroduodenal contents to the larynx and pharynx; however, treatment of presumed LPR remains challenging with limited evidence-based guidance. This article summarizes the @GIJournal Twitter discussion of Yadlapati et al, “Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation,” originally published in Clinical Gastroenterology and Hepatology. In this study of 302 patients with chronic laryngeal symptoms referred for reflux evaluation, five distinct phenotypic groups were described, and reflux was only present in two of the proposed phenotypes. LPR and GERD with hiatal hernia (group A); mild LPR/GERD (group B); no LPR/no GERD (group C); reflex cough (group D); and mixed/possible obstructive esophagogastric junction (EGJ) (group E). Phenotypic differences can inform targeted clinical trials design and improve outcomes.