Management Of Laryngopharyngeal Reflux Research Articles

Study of the empirical role of proton pump inhibitor therapy on laryngopharyngeal reflux

Background: Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist’s office. Study to evaluate the presentation of different signs and symptoms of LPR along with evaluating the role of empiric PPI (proton pump inhibitor) in the management of LPR by observing its effect on RFS and RSI. Methods: A prospective observational study was conducted on 100 cases having different symptoms of LPR. Reflux symptom index (RSI) and Reflux finding score (RFS) were used to diagnose LPR. Patients were put on PPI (Pantoprazole 40 mg OD for 12 weeks) and followed up at 4,8 and 12 weeks and successive RSI and RFS scores were evaluated. The results were compiled and analyzed statistically. Results: Among all symptoms, most common presenting symptom of LPR was foreign body/sensation of something sticking in throat (80%). Upon pharmacological therapy with PPIs (Pantoprazole), the mean RSI score changed from 22.94±5.83 to 11.19±2.97 at 12 weeks of PPI therapy. The mean RFS score changed from 12.93±3.55 to 6.86±2.86 at 12 weeks of PPI therapy. The change in the RFS and RSI score was highly significant (p=0.001). Conclusions: LPR is a common condition presenting in ENT settings, the symptoms and signs of which may be complex. RFS and RSI score are valuable tools for diagnosing LPR. PPIs are proven to be effective therapy for LPR, more studies are encouraged to affirm the efficacy of PPIs over other management options.

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus.

The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. 5 Laryngoscope, 134:1614-1624, 2024.

Gluten Sensitivity Underlying Resistant “Laryngopharyngeal Reflux” Symptoms and Signs

Laryngopharyngeal reflux (LPR) is one of the most common conditions encountered in otolaryngology. Gluten sensitivity may mimic the signs and symptoms of LPR or act as an aggravating cofactor with LPR. Gluten sensitivity and food intolerance also have been implicated as conditions that may be associated specifically with LPR symptoms and signs resistant to traditional medical treatment. Medical management of LPR may be insufficient to control symptoms and laryngeal signs of reflux, constituting resistant LPR. Eliminating gluten from the diet could provide symptomatic relief to patients with gluten sensitivity and LPR that is not controlled adequately by current regimens. The purpose of our study was to investigate the relationship between gluten sensitivity and LPR. We aimed to evaluate reflux finding score (RFS) improvement following elimination of gluten from the diet in patients with resistant LPR who had positive blood tests associated with gluten sensitivity. Symptom improvement was also assessed following dietary gluten elimination. Lastly, we aimed to identify predictors for a positive response to a gluten-free diet. Adult patients who underwent gluten sensitivity testing for treatment-resistant LPR symptoms and/or signs were included. Patients with ≥1 positive test were advised to begin a therapeutic trial of a gluten-free diet. Subjects who chose not to trial a gluten-free diet or tested negative for gluten sensitivity markers served as controls. RFS was the primary outcome measure. One hundred ninety-seven patients were included; 81 trialed a gluten-free diet. Subjects who trialed the gluten-free diet were significantly more likely to demonstrate objective improvement in RFS (77.14% vs 43.88%), and report subjective improvement (55.41% vs 25.77%) than those who did not. RFS had decreased significantly from baseline at 1-3, 3-6, 6-12, and >12-month interval follow-up examinations in subjects who trialed a gluten-free diet. Comparison between subjects who trialed the gluten-free diet, tested positive for a gluten sensitivity marker but did not trial the gluten-free diet, and subjects who were negative for all gluten sensitivity markers revealed that a gluten-free diet was associated with a significantly greater percent improvement in RFS compared to controls at 1-3, 6-12, and >12-months. Gluten sensitivity can mimic or aggravate LPR. A gluten-free diet should be considered for patients with resistant LPR, especially if blood test abnormalities that suggest gluten sensitivity are identified. The diet should be maintained for a minimum of three months to demonstrate objective improvement using RFS.

Laryngopharyngeal reflux in children- a current Otolaryngologists perspective

Gastroesophageal reflux disease (GERD) is diagnosed when the reflux of the stomach contents causes complications or troublesome symptoms. This disease can present with esophageal or extraesophageal symptoms. Laryngopharyngeal reflux (LPR) occurs when gastric contents reflux beyond the oesophagus to laryngopharynx, oropharynx or nasopharynx and it can cause symptoms such as: globus, hoarseness, chronic cough, regurgitations, vomiting or failure to thrive in infants. LPR can influence clinical course of many diseases i.a laryngomalacia, subglottic stenosis, chronic hoarseness and/or recurrent respiratory papillomatosis. LPR is also believed to be a factor leading to formation of laryngeal granulomas, ulcerations, Reinkes edema, functional voice disorders, sinusitis, otitis media or even life threatening events in neonates. The main diagnostic methods currently used are laryngoscopy, 24-hours pH-metry and esophageal multichannel intraluminal impedance testing. Treatment consist of lifestyle changes and pharmacologic treatment.The use of antireflux medications is not recommended in patients with extraesophageal symptoms in absence of typical GERD symptoms. Surgical treatment can be considered in children with severe LPR symptoms refractory to pharmacological treatment. Controversies regarding diagnosis and treatment of LPR still exists. Further investigations are needed to establish guidelines for the diagnosis and management of LPR.

Laryngopharyngeal reflux: is laparoscopic fundoplication an effective treatment?

Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case-control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.

Laryngopharyngeal reflux: is laparoscopic fundoplication an effective treatment?

Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case-control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.

Impact of subspecialty training on management of laryngopharyngeal reflux: results of a worldwide survey.

To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees. A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment. Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management. LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.

Management of Laryngopharyngeal Reflux Around the World: An International Study.

To investigate worldwide practices of otolaryngologists in the management of laryngopharyngeal reflux (LPR). An online survey was sent on the management of LPR to members of many otolaryngological societies. The following aspects were evaluated: LPR definition, prevalence, clinical presentation, diagnosis, and treatment. A total of 824 otolaryngologists participated, spread over 65 countries. The symptoms most usually attributed to LPR are cough after lying down/meal, throat clearing and globus sensation while LPR-related findings are arytenoid erythema and posterior commissure hypertrophy. Irrespective to geography, otolaryngologists indicate lack of familiarity with impedance pH monitoring, which they attribute to lack of knowledge in result interpretation. The most common therapeutic regimens significantly vary between world regions, with a higher use of H2 blocker in North America and a lower use of alginate in South America. The duration of treatment also significantly varies between different regions, with West Asia/Africa and East Asia/Oceania otolaryngologists prescribing medication for a shorter period than the others. Only 21.1% of respondents are aware about the existence of nonacid LPR. Overall, only 43.2% of otolaryngologists believe themselves sufficiently knowledgeable about LPR. LPR knowledge and management significantly vary across the world. International guidelines on LPR definition, diagnosis, and treatment are needed to improve knowledge and management around the world. N.A. Laryngoscope, 131:E1589-E1597, 2021.

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

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.

How effective is the control of laryngopharyngeal reflux symptoms by fundoplication? Symptom score analysis

The diagnosis and management of laryngopharyngeal reflux (LPR) symptoms are made difficult by the lack of good standard tests for diagnosis and for assessment of responsiveness to medical therapy. Proximal esophageal 24‑h pH reading may help identify a group of patients likely to benefit from surgery. A consecutive cohort of patients from a prospective populated database were identified. Further review was undertaken by an independent investigator for symptomatic evaluation following fundoplication 24 months after surgery. There were 90 patients (70% female) treated by fundoplication. The 24‑h pH study was successful in 68 patients; abnormal test results were found in 62 patients. Two clinical groups of patients were identified (GORD predominant/LPR predominant) with better control of LPR symptoms in the mixed GOR/LPR cohort but improved overall (p < 0.01). Symptom control was incomplete. In selected patients with elevated proximal pH readings, symptom improvement of LPR can be achieved by fundoplication.

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

To investigate current practices of laryngologists and non-laryngologists in management of Laryngopharyngeal Reflux (LPR). An online survey was sent to members of otolaryngology societies about LPR, and subgroup analysis was performed between laryngologists and non-laryngologists. This survey was conducted by the LPR Study Group of Young Otolaryngologists of the International Federation of Otolaryngological Societies. A total of 535 otolaryngologists completed the survey. Among them, 127 were laryngologists and 408 were non-laryngologists. Collectively, symptoms most commonly attributed to LPR are cough after lying down/meal, throat clearing, and acid brash; most common findings are thought to be arytenoid erythema and posterior commissure hypertrophy. Respectively, 12.5% and 5% of non-laryngologists and laryngologists believe that ≥50% of LPR patients suffer from heartburn (P = .010). Non-laryngologists are more aware about some extra-laryngeal findings associated with LPR (eg, pharyngeal erythema) than laryngologists. Neither laryngologists nor non-laryngologists associated development of benign lesions of the vocal folds with reflux. The management of LPR substantially differs between groups, with laryngologists indicating increased awareness of (impedance)-pH monitoring as well as the prevalence and treatment of nonacid/mixed LPR. Conversely, non-laryngologists are much more likely to include gastroenterology referral in their management of presumed LPR. Respectively, 44.8% and 27.6% of non-laryngologists and laryngologists believe themselves not sufficiently knowledgeable about LPR. Significant differences exist between laryngologists and non-laryngologists in diagnosis and treatment of LPR. Overall only one-third of responders believe themselves to be sufficiently educated about LPR. 4 Laryngoscope, 130:E539-E547, 2020.

Laryngopharyngeal reflux- diagnosis and management at a tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Laryngopharyngeal reflux (LPR) disease is a clinical entity due to the retrograde flow of gastric contents into the pharynx. It can be considered as an extraesophageal syndrome of gastroesophageal reflux disease (GERD). The objective of the present study is to study the clinical profile of LPR and their response to treatment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 100 consecutive patients attending the outpatient department of ENT, presenting with a clinical profile of LPR were selected in the present study. The patients’ symptoms were evaluated based on the reflux symptom index (RSI) and was followed by an endoscopic examination of larynx and a scoring was made based on reflux finding score (RFS). An RSI score of ≥13 and RFS of &amp;gt;7 were considered for starting patients on LPR treatment. The patients were then put on treatment and followed up for 3 months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study population the most common symptom was foreign body sensation in throat (52%). The most common sign noted on endoscopic examination of larynx was hyperemia/erythema of laryngeal tissue particularly bilateral arytenoids. Majority of our patients responded well to combination of pantoprazole (40 mg) and domperidon (30 mg) for 4 weeks. This was evaluated in terms of reduction in the RSI and RFS scores.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; LPR is more commonly encountered clinical entity and the otorhinolaryngologist should bear it in mind while treating patients for chronic complaints of throat pain, change in voice etc. Appropriate diagnosis and management of LPR can prevent unwarranted use of antibiotics and surgeries in these patients.&lt;/p&gt;

Laryngopharyngeal Reflux: An Update

Otolaryngologists and gastroenterologists seem to differ in their definitions and management of laryngopharyngeal reflux (LPR). In this review article, the author suggests a multidisciplinary approach to LPR diagnosis. Based on the latest findings, the author proposes an algorithm to facilitate the assessment and management of LPR.

Gaviscon® Advance alone versus co-prescription of Gaviscon® Advance and proton pump inhibitors in the treatment of laryngopharyngeal reflux.

Management of laryngopharyngeal reflux (LPR) typically comprises alginates and proton pump inhibitors (PPIs) alone or in combination, yet evidence to support any particular treatment regimen is lacking. We sought to evaluate the efficacy of Gaviscon® Advance alone versus co-prescription with a PPI in treating LPR. One hundred consecutive LPR patients with a reflux symptom index (RSI) score > 10 attending our joint voice clinic (JVC) were studied prospectively. All were treated with Gaviscon® Advance four times daily. If patients had been started on a PPI prior to their JVC attendance, this was optimised to a twice-daily dosing regimen and continued. RSI scores were recorded at first attendance and 3months post-treatment via postal questionnaire. Scores were analysed using t tests and Levene's test for equality of variances. Follow-up RSI scores were returned by 72 patients, 39 of whom were treated with Gaviscon® Advance only (group A) and 33 with Gaviscon® Advance + PPI (group B). Mean pre-treatment RSI scores were similar between groups [group A: 19.2, 95% confidence interval (CI) ± 2.4; group B: 21.3, 95% CI ± 3.2 (p = 0.65)]. No significant differences were observed with respect to 3-month post-treatment RSI scores [group A: 9.9, 95% CI ± 2.8; group B: 12.6, 95% CI ± 4.2 (p = 0.82)] and change in RSI scores [group A: 9.3, 95% CI ± 3.0; group B: 8.7, 95% CI ± 2.9 [p = 0.75]). Gaviscon® Advance alone is effective in treating symptoms of LPR, while co-prescription with a high-dose PPI offers no additional benefit.

Laryngopharyngeal Reflux: Current Concepts on Etiology and Pathophysiology and Its Role in Dysphagia

Laryngopharyngeal reflux (LPR) is one of the most commonly encountered chronic inflammatory conditions of the larynx. The lack of a unifying consensus regarding diagnosis and management makes it difficult to relate laryngeal disorders and dysphagia to this disease entity, particularly for an otolaryngologist. This article reviews diagnosis and management of LPR from an otolaryngological and gastroenterological perspective by reconciling current trends in the literature. More sophisticated testing via multichannel pH probes as well as the implementation of pepsin assays has potential in diagnosing LPR. This will hopefully more clearly delineate this disease entity, in the setting of dysphagia. Dysphagia and LPR both have significant overlap with numerous disease entities. Though there is little literature to address outcomes in treatment and management of dysphagia in the setting of LPR, few studies show that managing LPR-related dysphagia may improve with surgical intervention if there is no improvement with conservative management.

A clinical study of symptomatic profile and response in objective and subjective parameters to proton pump inhibitor in laryngopharyngeal reflux

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study was conducted to identify the various clinical presentations and findings in cases of LPR and also to study the role of proton pump inhibitor in the management of laryngopharyngeal reflux by observing the effect of proton pump inhibitor on reflux finding score (RFI) and reflux symptom index (RSI).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective, interventional, cohort study of 50 diagnosed cases of LPR with RSI &amp;gt;13 and RFS &amp;gt;7 (based on fibreoptic laryngoscopic findings) at the time of initial presentation was done. They were treated with a 6 month course of oral cap omeprazole (20 mg twice daily 30 minutes before meals) and followed up at 0, 4, 8 and 24 weeks for any improvement in RSI and RFS scores. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Most frequent symptoms detected in the cases were frequent clearing of throat, dry cough and sensation of lump in the throat all of which showed significant improvement at follow up at 4 weeks. Most common finding on fibreoptic laryngoscopy was erythema and diffuse laryngeal oedema, both of which showed significant improvement on follow up.There was also a significant change in RSI and RFS after receiving Omeprazole at 4 weeks, 8 weeks and at 24 weeks duration (p &amp;lt;0.0001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study dealt mainly with study of combination of clinical features that LPR presents time line of improvement of these features with capsule omeprazole. It is proposed that a presumptive diagnosis of LPR can be made based on the criteria of RSI and patients be given an empirical therapeutic trial including behavioral and dietary recommendations and 6 months of twice-daily proton-pump inhibitor therapy for an excellent clinical response.&lt;/p&gt;

How to Approach Laryngopharyngeal Reflux: An Otolaryngology Perspective.

In the otolaryngology practice, there is a rising concern with the current diagnosis and management of laryngopharyngeal reflux (LPR). The implication of LPR in many common head and neck symptoms, along with the rising cost of empiric therapy and no overall improvement in patient symptoms, has established a need to review what are indeed laryngopharyngeal complaints secondary to reflux and what are not. This article reviews the otolaryngologist's approach to LPR, the various ways diagnosis is made, and the guidelines that inform the current trends in otolaryngology management of LPR. The goal of this article is to recognize that reflux can be the cause of a variety of laryngopharyngeal complaints seen within an otolaryngology practice, but when empiric therapy does not improve symptoms, consideration should be given to other non-reflux causes.

A meta-analysis for the role of proton pump inhibitor therapy in patients with laryngopharyngeal reflux.

We aimed to systematically review the randomized controlled trials (RCTs) regarding the therapeutic efficiency of proton pump inhibitor (PPI) therapy for laryngopharyngeal reflux (LPR). Randomized and placebo-controlled trials regarding the therapeutic efficacy of PPIs on LPR patients were systematically searched from MEDLINE, Cochrane Library, and EMBASE. Data were extracted from eligible studies meeting the inclusion criteria. Heterogeneity among these eligible studies was evaluated by the Q-statistic and I 2 test, based on which a fixed- or random-effects model was performed to pooled relative risks (RRs) for the response rate and standardized mean differences (SMDs) for reflux symptom index (RSI) and the reflux finding score (RFS). Potential publication bias was evaluated by trim and fill method. Totally, 13 RCTs including 831 LPR patients were eligible for this meta-analysis. Pooled results demonstrated that the total RSI significantly improved for patients who received PPI therapy by comparing with those receiving placebo (SMD=3.65; 95% CI 1.56-5.75), though no significant difference was found in response rate (RR=0.04, 95% CI -0.06 to 0.14) and RFS (SMD=0.91; 95% CI -0.53 to 2.35) between these two groups of patients. No publication bias was found among eligible studies. PPI treatment could significantly improve reflux symptoms in LPR patients and, therefore, should be taken into consideration for LPR management with other strategies, such as lifestyle modification.

Hypopharyngeal pepsin and Sep70 as diagnostic markers of laryngopharyngeal reflux: preliminary study.

The management of laryngopharyngeal reflux (LPR) has been challenging. Hypopharyngeal multichannel intraluminal impedance (HMII) has shown to increase the sensitivity in diagnosing LPR. The objective of this study is to investigate the potential use of pepsin and Sep70 as diagnostic tools for detection of LPR in combination with HMII. Tissue samples of hypopharynx, distal esophagus, and gastric cardia were collected from patients with LPR symptoms regardless of gastroesophageal reflux (GERD) diagnosis and underwent HMII to detect LPR and high esophageal reflux (HER: reflux 2 cm distal to upper esophageal sphincter) events. Patients were classified into two groups based on the presence of abnormal proximal exposure (APE), which was defined as LPR ≥1/day and/or HER ≥5/day: (1) positive-APE and (2) negative-APE. Patients with typical GERD symptoms without LPR symptoms who did not undergo HMII were used as a "control" GERD group. Protein was isolated from tissue samples and Western blot analysis of pepsin and Sep70 was performed. Pepsinogen was used as a control to differentiate pepsin from pepsinogen. Relative quantitation was performed using Image Studio Lite Software with normalization against the internal actin of each blot. From October 2012 to September 2013, 55 patients underwent HMII. Of 55, 20 patients underwent biopsies from hypopharynx (17 positive-APE and 3 negative-APE). Ten patients with typical GERD symptoms were identified from tissue bank as a "control" GERD group. Pepsin was detected in distal esophagus and hypopharynx in all groups without significant difference among groups. However, Sep70 in distal esophagus and hypopharynx was significantly depleted in the positive-APE group compared to the other groups (p = 0.032 and 0.002, respectively). Depletion of Sep70 with the presence of pepsin in the hypopharynx may indicate cellular injury in laryngopharynx due to constant proximal reflux. However, the normative data for these markers have to be validated.

Prokinetic agents and laryngopharyngeal reflux disease: Prokinetic agents and laryngopharyngeal reflux disease: a systematic review.

Our objective was to systematically identify and evaluate prospective studies providing evidence for and against the use of prokinetic agents in the treatment of laryngopharyngeal reflux (LPR) disease. Our data sources were PubMed, Embase, BIOSIS, and Web of Science databases. A systematic literature review was conducted to identify studies prospectively evaluating the effectiveness of prokinetic agents in the treatment of LPR. Data from eligible studies were independently extracted from each study by two authors. The primary outcome of interest was the improvement of LPR symptoms among study participants. Secondary outcomes included resolution of LPR physical signs and the development of side effects from therapy. Among 724 unique articles identified, four studies met inclusion criteria. These four investigations provided mixed evidence about the effectiveness of prokinetic agents in the treatment of LPR. The studies included in the review were deemed to be at high risk of bias. Three of the four investigations demonstrated a statistically significant difference in patient symptoms that favored the use of prokinetics in the management of LPR. The investigations were mixed in their report of improvement in physical examination findings among patients receiving and those not receiving prokinetic medical therapy. No significant adverse effects were described in any of these trials. Prokinetic agents may be a viable treatment option for LPR. The current body of literature is inadequate to make a recommendation for their use in this disease process. Further research should be conducted to assess the use of prokinetic medications in the management of LPR.