Incidence Of Laryngopharyngeal Reflux Research Articles

Analysis of bile acid in saliva of patients with laryngopharyngeal reflux and non-laryngopharyngeal reflux

ABSTRACT — Background: Laryngopharyngeal reflux (LPR) is the backflow of gastric and or duodenal fluid into the larynx, pharynx, trachea, and bronchi. The prevalence of LPR is difficult to determine due to the limited gold standard and the large variety of LPR symptoms. Damage can occur due to the decrease in pH value and also because of exposure to harmful enzymes in reflux, including bile acid. Purpose : This study was conducted to analyze bile acid levels in the saliva of LPR patient and non LPR subject. Methods: This study is an observational study with a case-control design. The study was conducted in the ORL-HNS Department of Dr. M. Djamil Hospital, Padang, West Sumatra, Indonesia. The total sample size was 44 people. We enrolled 22 healthy subjects as the control group and 22 patients suspected of having LPR. Result: LPR patients are more common in women than in men, with 12 women and 10 men. Bile acid in the LPR group means of is 25.08±7.67µM, meanwhile, in the healthy group, the mean was 18.99±8.26 µM. There is a statistically significant in the incidence of LPR with the bile acids (p = 0.015) based on t- independent test. Conclusion: Our study confirmed that bile acids in saliva play a major role in diagnosing LPR.

Relationship between total free Sugars Consumption and Incidence of Laryngopharyngeal Reflux in Adolescents

Background: Up to date there are still few studies showing the relationship between laryngopharyngeal reflux (LPR) and free sugars consumption in adolescents. We consequently aimed to discover any association of free sugars consumption with LPR in Indonesian adolescents. Methods: This cross-sectional study was conducted on 210 middle school students in Jakarta, Indonesia. Data on age and gender were collected using a questionnaire, while body mass index was determined by anthropometric measurement. Free sugars consumption and LPR were evaluated by means of Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) and Reflux Symptom Index (RSI), respectively. Data were analyzed using Mann-Whitney test at level of significance p <0.05. Results: Median age (min - max) was 16 (15 – 18) years, body mass index 19.8 (15.4 – 27.0) kg/m2, and free sugars consumption 6.7 (1.5 – 70.6) g/day. The prevalence of LPR was 14.3%. There was a statistically significant difference in free sugars consumption of the LPR negative versus the LPR positive groups (p< 0.049). Conclusion: Free sugars consumption was strongly related to laryngopharyngeal reflux incidence. There is a need for a policy on and monitoring of free sugars consumption to decrease its harmful impact on adolescent health. Keywords: free sugars, laryngopharyngeal reflux, adolescents, Indonesia

Laryngopharyngeal Reflux in Sleep-Disordered Breathing Patients.

Our study aims to evaluate the distribution of laryngopharyngeal reflux (LPR) in patients with sleep-disordered breathing (SDB) via the Reflux Symptom Index (RSI) and to describe the sleep architecture in SDB patients with and without LPR. A cross-sectional, descriptive study was conducted. Patients with SDB were identified via the Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire; they were then screened with the RSI and physical examination for LPR. PSG was performed to evaluate obstructive sleep apnea (OSA). Of 45 patients, 15 were scored as having LPR via the RSI. Utilizing the Respiratory Disturbance Index (RDI), patients were further classified into four groups: 9 non-LPR with non-OSA SDB, 21 non-LPR with OSA, 4 LPR with non-OSA SDB, and 11 LPR with OSA. The prevalence of LPR was 30.8% in the non-OSA SDB group and 34.4% in the OSA group. All SDB parameters in both groups were similar. SDB patients with high body mass index tended to have LPR and/or OSA. Average ESS scores in the four groups suggested excessive daytime sleepiness, and patients with LPR had higher ESS scores. Regardless of LPR status, SDB patients had a lower percentage of REM sleep and a higher percentage of light sleep. The incidence of LPR in OSA patients was similar in non-OSA SDB patients. REM sleep percentage decreased in the four groups, with the non-OSA SDB group having the lowest percentage of REM sleep; light sleep percentage increased in the four groups, with the OSA group having the highest percentage of light sleep.

Laryngeal injury following endotracheal intubation: Have you considered reflux?

Laryngotracheal injury is an increasingly common complication of intubation and mechanical ventilation, with an estimated 87% of intubated and ventilated patients developing a laryngotracheal injury often preventing their rehabilitation from acute illness. Laryngotracheal injuries encompass a diverse set of pathologies including inflammation and oedema in addition to vocal cord ulceration and paralysis, granuloma, stenosis, and scarring. The existing literature has identified several factors including intubation duration, endotracheal tube size, type and cuff pressures, and technical factors including the skill and experience of the endoscopist. Despite these associations, a key aspect in the sequelae of laryngotracheal injuries is due to reflux and is not clearly related to iatrogenic and mechanical factors.Laryngopharyngeal reflux is a type of reflux that contaminates the upper aerodigestive tract. The combination of patient positioning and continuous nasogastric tube feeding act to affect the upper aerodigestive tract with acidic and non-acidic refluxate that causes direct and indirect mucosal injury impeding healing.Despite laryngopharyngeal reflux being an established and recognised causative factor of upper aerodigestive tract inflammatory pathology and laryngotracheal injury, it is very understudied in critical care. Further, there is yet to be an agreed pathway to assess, manage and prevent laryngotracheal injury in intubated and ventilated patients. The incidence of laryngopharyngeal reflux in the intubated and mechanically ventilated patient in the intensive care unit is currently unknown. Prospective studies may allow us to understand further potential mechanisms of upper aerodigestive tract injury due to laryngopharyngeal reflux and herald the development of preventative and management strategies of laryngopharyngeal reflux-mediated upper aerodigestive tract injury in critically ill patients.

A Characterization Study of the Patients Visiting Hospital due to Laryngopharyngeal Reflux Suspicion: A Prospective Case-Control Study

Background: This study aimed to explore the characteristics of laryngopharyngeal reflux (LPR) and the association between LPR and allergic rhinitis (AR). Methods: In this prospective case-control study, a total of 102 patients with suspected LPR who visited the Department of Otolaryngology Head and Neck Surgery, Heping Hospital Affiliated to Changzhi Medical College, between June 2019 and June 2021 were consecutively included. They were divided into the LPR-positive group and the LPR-negative group according to 24-h Dx-pH monitoring. The influencing factors of LPR, including the scores for AR (SFAR) and AR prevalence, were compared between the two groups. Results: The total SFAR and scores in items 1, 3, 4, and 5 of the LPR-positive group were significantly higher than those of the LPR-negative group (p < 0.05). The prevalence of AR in the LPR-positive group was 60%, which was significantly higher than that in the LPR-negative group (36.54%) (p < 0.05). After excluding confounding factors, AR was positively correlated with the incidence of LPR, and the incidence of LPR with AR was 2.372 times that of non-AR. Receiver operating characteristic curve results show that AR has the highest predictive value for LPR, and the area of AR under the curve is was 0.617. Conclusions: The SFAR and incidence of AR are high in patients with positive LPR, and AR may be a risk factor for LPR. The results of this study may deepen our understanding of the occurrence of LPR.

Manifestations of ENT Caused By Gastroesophageal Reflux Disease

Abstract Introduction. The presence of gastric reflux in the pharynx and larynx causes reflux laryngopharyngitis. The incidence of laryngopharyngeal reflux has increased dramatically in recent years, but with the introduction of flexible fiber optic esophagoscopy, evidence-based research on gastroesophageal reflux disease has evolved greatly. Laryngoscopy is the main investigation to be performed to establish the diagnosis of reflux. Material and methods. This study is both retrospective and prospective, the first being performed on a group of 175 patients, who presented in the ENT outpatient clinic, within the County Emergency Clinical Hospital “St. Andrew the Apostle” Constanta. The aim of this paper is to evaluate and compare the manifestations of ENT caused by reflux disease but also to establish the correct therapeutic conduct.

Case-control survey on relationship between laryngopharyngeal reflux and vocal fold polyps

Objective: To investigate whether laryngopharyngeal reflux(LPR) is an independent risk factor for vocal fold polyps and to analyze the potential mechanism. Methods: Case control survey was designed. Subjects who came to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from September 2018 to December 2019, including 152 cases with vocal fold polyps and 176 cases with normal vocal folds, were selected. All the subjects filled in a questionnaire and were assessed by the reflux symptom index (RSI) and the reflux finding score (RFS) scale. RSI>13 and(or) RFS>7 were classified as LPR. Chi-square test, univariate and multivariate unconditional logistic regression models were used for statistical analysis. Results: The incidence of LPR and throat clearing in vocal fold polyps group (47.37%, 73.68%) was significantly higher than that in control group (27.27%, 59.09%), with statistically significant difference (P<0.001, P=0.005, respectively). The incidence of troublesome cough, indigestion or stomach acid coming up was no difference between the two groups(P=0.672, P=0.099). Multivariate unconditional logistic regression analysis showed that LPR (OR=1.815, 95%CI:1.061-3.103), occupational exposure(OR=2.655, 95%CI:1.397-5.042), spicy food(OR=1.958, 95%CI:1.142-3.355) were risk factors for vocal fold polyps. Conclusion: LPR, occupational exposure, spicy food are independent risk factors for vocal fold polyps. Frequent throat clearing caused by LPR may be the main cause of vocal ford polyps. In order to prevent vocal fold polyps, we need to take action to treat laryngopharyngeal reflux disease actively.

Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test.

Background: To investigate the presence of laryngopharyngeal reflux in patients with obstructive sleep apnea (OSA) employing the salivary pepsin concentration method. To compare the results of pepsin concentration with the severity of the pathology. Methods: Seventy-five OSA patients (44 males, 31 females) were enrolled in the study. For each patient, the AHI (apnea–hypopnea index) and the BMI (body mass index) were initially evaluated. All the patients enrolled were assessed using the reflux symptom index (RSI) and the reflux finding score (RFS) in order to perform a clinical diagnosis of laryngopharyngeal reflux. In all patients a salivary sample was taken to estimate the presence of pepsin and its concentration. Results: The incidence of LPR (laryngopharyngeal reflux) in OSA patients, evaluated using the salivary pepsin concentration test (PEP-test), was found to be 32% of cases. Linear regression testing did not show any correlation between AHI and pepsin concentration in salivary samples (p = 0.1). Conclusion: A high number of patients with OSA seem to show positivity for salivary pepsin, correlated to an LPR. There does not appear to be a correlation between the severity of apnea and the grade of salivary pepsin reflux. On the other hand, direct correlation between BMI and the value of pepsin in salivary specimens was observed.

Observational study on patients with laryngeal cancer and/or vocal leukoplakia concurrent with laryngopharyngeal reflux

Objective: To observe the incidence and to determine the significance of laryngopharyngeal reflux (LPR) in laryngeal cancer and vocal leukoplakia. Methods: The patients who had been diagnosed as laryngeal cancer or vocal leukoplakia between January 2014 and June 2017 were included in this study. All of them received 24-hour multichannel intraluminal impedance-pH monitoring. The prevalence of LPR and numerous parameters from the 24-hour pH monitoring in laryngeal cancer patient and vocal leukoplakia patient groups were analyzed. The chi-square test was used for counting data, t test and Mann-Whitney U were used for measuring data. Results: In the 91 laryngeal cancer patients, the prevalence of pathologic LPR was 28.6%(26/91), the median number[P(25), P(75), P(95)]of acid reflux events was 0[0, 3, 5], time of acid exposure was 0[0, 14, 234]s, number of weakly acidic reflux events was 3[0, 6, 11]. In the 54 vocal leukoplakia patients, the prevalence of pathologic LPR was 29.6%(16/54), the number of acid reflux events was 0[0, 3, 4], time of acid exposure was 0[0, 13, 118]s, number of weakly acidic reflux events was 1.5[0, 5, 9]. The incidence of LPR did not vary in the laryngeal cancer patient and vocal leukoplakia patient groups, but were both higher than healthy Chinese volunteers according to a report in the other literature. Furthermore, all the three patients with no history of tobacco or alcohol existed acid or weakly acidic reflux episodes. Conclusions: Laryngopharyngeal reflux might play a role as an etiologic factor in laryngeal cancer and vocal leukoplakia.

Correlation between chronic rhinosinusitis and laryngopharyngeal reflux

Background: Chronic rhinosinusitis (CRS) is a major Ear, Nose and Throat disease and there are higher numbers of refractory cases poorly responding to medical and surgical treatment. Laryngopharyngeal reflux (LPR) is said to be the important cause for same. Aims and Objectives: This study aims to study the incidence of LPR in patients of refractory CRS. This study also aims to study the impact of proton pump inhibitors (PPI) (effective treatment of LPR) given as adjuvant therapy along with functional endoscopic sinus surgery (FESS) in patients with refractory CRS. Materials and Methods: A total of 40 patients of refractory CRS taken up for the study were evaluated for signs and symptoms of LPR. They were then divided into two groups of 20 each - study group and control group. All the patients in both groups were evaluated for signs and symptoms of CRS. All these patients underwent FESS. Post-surgery patients in the study group were given intranasal steroids (INS) along with PPI (tablet pantoprazole) whereas in control group were put on INS without PPI. The patients were followed monthly for 3 months for improvement in signs and symptoms of CRS and patient’s relief and comfortability levels. Results: 45% of patients of refractory CRS had LPR with the posterior larynx being mainly involved. The major signs and symptoms of CRS were nasal obstruction, nasal discharge, and nasal polyps. There was more improvement in nasal obstruction, nasal discharge, and post-nasal discharge in patients of study group with PPI as compared to control group without PPI. There was better relief of symptoms in patients given PPI as compared to control group and this improvement was more marked at 3rd post-operative visit after 3 months. Conclusion: There is a strong association between refractory CRS and LPR. PPI are an effective drug for refractory CRS when given as adjuvant therapy along with FESS.

Toward an Improved Understanding of Isolated Upright Reflux: Positional Effects on the Lower Esophageal Sphincter in Patients with Symptoms of Gastroesophageal Reflux

The purpose of this study was to assess the effect of body position on lower esophageal sphincter (LES) structure and function. Symptomatic patients underwent high-resolution manometry in the supine and upright positions followed by pH testing. Regardless of whether there was a positive DeMeester score, isolated upright reflux patterns were considered present when the supine fraction of time pH <4 = 0%. Predominant-upright and predominant-supine bipositional reflux (SBR) patterns were considered present when the supine fraction of time was <upright fraction of time pH <4 and the supine fraction was >upright fraction of time pH <4, respectively. Of 128 patients, 35 isolated upright, 55 predominant-upright bipositional, and 27 SBR patients were identified. When supine, LES pressure/length was higher in upright compared to bipositional reflux patients. When upright, there was no difference in LES pressure/length between groups. The LES in isolated upright reflux patients became defective when moved from supine to upright position compared to bipositional patients, where the LES was defective regardless of position. Although the incidence of laryngopharyngeal reflux (LPR) events was comparable between groups, isolated upright patients commonly had a normal DeMeester score. Position impacts LES competency in those with upright reflux and would not be detected with supine manometry. Upright reflux can be associated with GERD and LPR despite negative pH testing.

Study of Laryngopharyngeal Reflux Using pH-Metering in Immediate Post-op of Laryngectomized Patients

ObjectiveLittle is known about incidence of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) in the early postoperatory period of laryngectomy. To evaluate the effect and characteristics of the LPR and GER in laryngectomized patients, by means of double pH-metry during the 48hours after surgery. Material and methodIn 50 patients, 48-hour double-probe pH monitoring was performed in postoperative period following laryngectomy, after a intraoperative placement. Descriptive analysis of 4 variables of pH to level of the sensor proximal, and definition of the presence of esofagic reflux and LPR. ResultsThe incidence of LPR in the postoperative of laryngectomy ranges between 30% and 40%. A esofagic reflux has been observed in 40%. ConclusionsA high incidence of LPR and GER in the postoperative immediate of laryngectomized patients was found.

Is laryngopharyngeal reflux an important risk factor in the development of laryngeal carcinoma?

Laryngopharyngeal reflux (LPR) as a causative irritating factor in the development of laryngeal carcinoma has been suggested. However, the association between LPR and laryngeal carcinoma remains unclear. The aim of this study was to compare the prevalence and severity of reflux between patients with laryngeal carcinoma and clinical LPR. The intention was to find out if a correlation exists between the laryngeal findings and the level of acid reflux. The study population consisted of 29 patients with laryngeal cancer (group I), 33 LPR patients with normal laryngeal findings (group II) and 70 LPR patients with related laryngeal pathology (group III). The results of 24-h, double-channel ambulatory esophageal pH monitoring were analyzed comparing the three groups. The occurrence and severity of abnormal acid reflux at the upper and lower esophageal segments were evaluated. The incidence of LPR or gastroesophageal reflux (GER) did not vary in any of the three groups (LPR was present in 62, 42 and 56% of the patients, while GER was present in 45, 24 and 37% of the patients, respectively). Patients with LPR or GER from the three groups did not differ significantly in terms of the number of acid reflux episodes and percentage of times when the pH was <4. Our data do not support the hypothesis that LPR can be an independent risk factor in the development of larynx cancers. However, the data also do not thoroughly exclude the possibility. The reason why LPR leads to variable pathologies in the larynx may be uncovered by studies probing the differences between patients via detailed examinations of the local anti-reflux barriers such as epithelial morphology and functions.

Gastroesophageal reflux disease: symptoms versus pH monitoring results.

The reason why some patients with gastroesophageal reflux disease (GERD) have symptoms of upper aerodigestive system irritation, while others mainly have gastroenterologic symptoms, is not well established. This retrospective case series study was designed to examine the existence of a correlation between symptoms and reflux characteristics, based on data obtained from esophageal pH monitoring. The study population consisted of 139 patients; 97 patients presented with laryngopharyngeal symptoms of GERD, including unexplained hoarseness, throat clearing, chronic cough, laryngospasm, globus, throat pain, and 42 patients presented with gastroenterologic symptoms, including heartburn and regurgitation. The results of 24-hour, double-channel ambulatory esophageal pH monitoring were analyzed comparing 2 symptom groups. The incidence of abnormal acid reflux at the upper and lower esophageal segments and the effects of upright and supine positions on reflux parameters were evaluated. The incidence of laryngopharyngeal reflux was significantly higher in the laryngopharyngeal symptom group than in the other (52% versus 38%). The patients with laryngopharyngeal reflux from both groups showed no significant differences in terms of number of acid reflux episodes, percentage of times pH was 4, and esophageal acid clearance. Upright and supine parameters did not show significant differences between the patient groups. Upright acid reflux episodes were, however, common in both groups at the lower esophageal and laryngopharyngeal segments. Recent studies suggesting that otolaryngologic patients commonly show upright, daytime reflux with normal esophageal clearance and that typical GERD patients commonly have supine, nocturnal reflux with prolonged esophageal clearance are not supported by this study. This study indicates that acid reflux parameters and positional changes are not sufficient to explain why patients with GERD experience different symptoms. The regional symptoms of GERD may be attributed to the impairment of epithelial resistance, motor activity, and buffering systems for the esophageal antireflux barrier.