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

Jerome R Lechien,Sven Saussez,Stéphane Hans,Petros D Karkos,Vinciane Muls,Carlos M Chiesa-Estomba,Maria R Barillari

doi:10.3390/jcm9113618

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.

Highlights

Laryngopharyngeal reflux (LPR) is often considered as over- or under-diagnosed
An reflux symptom score (RSS)-12>11 is suggestive of LPR and is a practical clinical tool that may be used in general medicine to monitor the symptom evolution throughout therapeutic course
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Summary

Introduction

LPR is often considered as over- or under-diagnosed. In practice, because the symptoms and findings are both nonspecific [12], the detection of LPR is still complicated. The role of LPR and the gastroduodenal refluxate on the microbiota remains unknown This topic was, studied for GERD, metaplasia and esophageal microbiota [38], providing interesting findings such as the microbiota alteration by long-term proton pump inhibitor therapy [39]. The mean weaknesses of the RSI are the lack of consideration of some prevalent symptoms, such as throat pain, odynophagia, halitosis or regurgitations, and the lack of consideration of the symptom frequency [12] For these reasons, reflux symptom score (RSS), which is a 22-item patient reported outcome questionnaire, was recently developed [49]. RSS-12 consists of a 12-item clinical tool assessing both frequency and severity of the most prevalent LPR-related symptoms as well as their impact on quality of life (Table 1). For patients with digestive complaints, the use of RSS, which include digestive items, makes sense

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