Mean Reflux Finding Score 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.

Association between laryngopharyngeal reflux and obstructive sleep apnea in adults.

BackgroundObstructive sleep apnea syndrome (OSAS) and laryngopharyngeal reflux (LPR) have been found to coexist in the population. OSAS and LPR also share obesity as an important risk factor. However, the relationship between LPR and OSAS remains unclear. This study aimed to correlate LPR as measured by the Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS) with OSAS.MethodsThis cross-sectional study included sixty-four subjects who underwent anamnesis to complete the RSI and the Epworth Sleeping Scale (ESS). The subjects were then divided into the OSAS and non-OSAS groups based on the Apnea-Hypopnea Index (AHI) obtained through a polysomnography examination. Both groups underwent a flexible fiberoptic nasopharyngolaryngoscopy examination to determine the RFS. LPR was identified based on the RSI and RFS.ResultsThe mean BMI of the OSAS group significantly was higher than the non-OSAS group (p < 0.05). Most of the subjects in the OSAS group exhibited mild-moderate OSAS (AHI 10–29), and severe OSAS occurred in only seven subjects. The mean RSI and RFS values in the OSAS group did not differ significantly from the non-OSAS group (p = 0.34 and p = 0.36, respectively). The proportion of LPR between the mild-moderate OSAS group, the severe OSAS group, and the non-OSAS group did not differ significantly (p = 1.00). RSI and RFS did not significantly correlate with AHI. Based on RSI, the proportion of LPR between the ESS (+) and ESS (-) groups did not significantly differ (adjusted p = 0.062). The proportion of LPR based on RFS was almost equal between the ESS (+) and ESS (-) groups (p = 0.817).ConclusionsThe BMI of the OSAS group was significantly higher than the non-OSAS group. There was no significant difference in RSI and RFS between the OSAS and non-OSAS groups. There was no significant correlation between RSI and AHI, or between RFS and AHI. There was no significant difference in the proportion of RSI between the ESS (+) and the ESS (-) groups.

Changes in laryngopharyngeal reflux after uvulopalatopharyngoplasty for obstructive sleep apnea: An observational study.

PurposeTo estimate laryngopharyngeal reflux (LPR) changes after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) using the reflux symptom index (RSI) and reflux finding score (RFS) questionnaires.MethodsA total of 91 participants were recruited and divided into three groups: control (n = 27), OSA mild to moderate (n = 29), and OSA severe (n = 35) groups according to polysomnography. All participants completed the preoperative RSI, and underwent blinded evaluation on videolaryngoscopy using the RFS questionnaire. Thirty‐four OSA patients who underwent UPPP surgery completed postoperative polysomnography and questionnaires again after a 6‐month follow‐up.ResultsThe RSI score and RFS were higher in patients with OSA than in those without OSA. Patients with severe OSA also had a higher RSI score and RFS than those with mild to moderate OSA. Apnea and hypopnea index degree and percentage of recording time for <90% oxygen saturation showed positive correlation with LPR symptoms. But the lowest blood oxygen saturation during the recording time was negatively correlated with LPR symptoms. The mean RSI score and RFS before UPPP surgery were 15.88 ± 4.85 and 13.18 ± 4.80, after surgery decreasing to 9.53 ± 4.16 and 8.65 ± 4.87, respectively (P <.05). In 25 patients where surgery was successful, RSI scores, RFSs and individual RSI variables decreased after surgery.ConclusionsLPR symptoms are common among OSA patients, and the coexistence of OSA and LPR cannot be ignored. Successful UPPP surgery potentially reduces LPR symptoms and improves laryngoscopic signs by alleviating sleep respiratory disorders. Level of Evidence: 3.

The role of magnesium supplement in laryngopharyngeal reflux disease

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Laryngopharyngeal reflux disease (LPRD) is one of the most prevalent upper gastrointestinal disorder encountered in clinical practice and its optimal treatment is not standardized. The role of magnesium in the human body functions is often underestimated. Since magnesium (Mg) plays a major role in the regulation of smooth muscle contractionby relaxing the pyloric sphincter and enhancing gastric emptying, thereby decreasing the pressure on the LES, it was hypothesized that adding magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms. Magnesium has a neutralizing action on the gastric acid and therefore, it may be pertinent to achieve optimal Mg intakes in patients with LPRD.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study done over a period of 1 year conducted in a tertiary care hospital in central India in patients presenting with LPRD of the age group 18-65 years. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study patients were divided into two groups-one treated with esmoprazole 40 mg capsules and alginate syrup and the other with esmoprazole capsules, alginate syrup and magnesium glycinate (250 mg) supplement. Both the groups showed appreciable improvement in their mean reflux symptom index (RSI) and reflux finding score (RFS) at 1 month and 3 months follow-up. Females showed a higher preponderance than males in the disease, symptoms and the mean RSI and RFS score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.&lt;/p&gt;

Low Antioxidant Enzyme Levels and Oxidative Stress in Laryngopharyngeal Reflux (LPR) Patients

ObjectiveLaryngopharyngeal reflux disease (LPR) is a characterized by symptoms different from gastroesophageal reflux disease (GERD). LPR can causes chronic mucosal inflammation which may lead to an increase in cytokine production, and a systemic decrease in antioxidant enzyme levels. Our aim in this study is to evaluate antioxidant enzyme levels in patients with LPR. MethodsReflux Symptom Index (RSI) questionnaire, extraesophageal symptom questionnaire which is included in RSI and Reflux Finding Score (RFS) evaluation with 70° rigid laryngoscope were performed to patients who applied to the otolaryngology clinic with a typical LPR complaint, and 60 patients who had an RSI score above 13 and an RFS score above 7 were included in the study. Thirty people consisting of healthy volunteers were included in the control group. Antioxidant enzyme SOD, GSH-Px and CAT levels were measured in the blood serum of the patients and compared with the control group. Results obtained from biochemical tests were expressed as mean ± SE. Descriptive statistical methods (mean ± standard error) were used for the independent t test for the control and study group. P < 0.05 was considered statistically significant. ResultsIn the LPR group, 28 (46%) were women, 32 (53%) were men, and age range was 21–60, average age was 36.45 ± 1.147.There was no significant difference between LPR and control group in terms of age, gender and Body Mass Index (BMI). In the LPR group, the lowest score for RSI was 14 and the highest score was 39. The average RSI was 23.67. RFS ranges from 8–22. The mean RFS was 13.50. A highly significant statistical correlation was observed between RSI and total RFS (P < 0.001). There was a significant difference between the antioxidant enzyme levels of the control group and the LPR group. Antioxidant enzyme levels of the control group were SOD 274.10 ± 26.836 U / L, GSH-Px 174.20 ± 20.699 µU / mL and CAT 42.2898 ± 20.699 KU / L. Antioxidant enzyme level results of the LPR group were SOD 147 ± 14.022 U / L (P < 0.01), GSH-Px 88.28 ± 9.113 µU / mL (P < 0.01) and CAT 12.67 ± 0.799 KU / L (P < 0.001). The RSI results ranges from 4 to 39 and the RFS from 8 to 22. Antioxidant enzyme levels demonstrated fairly consistent reliability with individual variables from both RFS and RFS. There was also a highly significant statistical correlation between RSI and RFS. ConclusionWe found that the antioxidant enzymes SOD, GPX and catalase enzyme levels were significantly lower in LPR patients. Treatment modalities to reduce oxidative stress (OS) in LPR should be investigated.

Potential Therapeutic Effect of Continuous Positive Airway Pressure on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients

To investigate the potential therapeutic effect of continuous positive airway pressure (CPAP) treatment on laryngopharyngeal reflux in obstructive sleep apnea (OSA) patients, we performed a retrospective analysis of data prospectively collected from patients who underwent CPAP therapy after being diagnosed with moderate to severe OSA between January 2019 and May 2020. Subjects were asked to complete the reflux symptom index (RSI) questionnaire before and after CPAP. Additionally, a laryngoscopic examination was performed to evaluate objective endoscopic findings and determine reflux finding score (RFS). A total of 46 patients were included in the analysis. Overall, significant decreases in mean RSI score (10.85 ± 6.40 vs. 8.80 ± 7.99, p < 0.001) and RFS (7.41 ± 3.32 vs. 4.65 ± 2.12, p < 0.001) were observed after CPAP treatment. Within subdomains of the RSI, throat clearing, postnasal drip, breathing difficulty, troublesome cough, and foreign body sensation were significantly improved by CPAP treatment. All subdomains of RFS, with the exception of posterior commissure hypertrophy and granuloma, showed significant differences after CPAP treatment. There were no differences between subgroups according to body mass index or severity of OSA. CPAP treatment in OSA potentially reduces laryngeal reflux symptoms and improves laryngeal examination findings.

Laryngopharyngeal Reflux Among Patients Undergoing Bariatric Surgery.

The effect of altered subsphincteric gastric volume and pressure after bariatric surgery on laryngopharyngeal reflux (LPR) remains largely unknown. This was a cross-sectional pilot study conducted between January 2018 and January 2019 to identify changes in LPR symptoms and signs in bariatric surgery patients presurgery and postsurgery. Thirty-four patients listed for bariatric surgery in a single tertiary referral center were recruited, where 31 (77.4% female, mean age 46.3 ± 8.9 years) fulfilled the eligibility criteria. Of the eligible patients, 54.8% and 45.2% underwent sleeve gastrectomy (SG) and gastric bypass (GB), respectively. LPR symptoms were assessed using the self-reported reflux symptom index (RSI). Video-recorded endolaryngeal signs were scored using the reflux finding score (RFS) by two blinded otolaryngologists. Patients' presurgical and 3-month postsurgical body mass index (BMI), RSI, and RFS were determined. Patients were deemed as having LPR when RSI > 13 or RFS > 7. There was a significant correlation between the postsurgical RSI and RFS changes (Pearson's r = 0.474, p = 0.007). Of the 31 patients, 12.9% (RSI) and 6.4% (RFS) recovered from preexisting LPR, whereas 22.6% (RSI) and 3.2% (RFS) developed new de novo LPR postsurgery. The postsurgical mean RFS change improved significantly in the GB group compared with that of the SG group (p < 0.05). LPR is best assessed clinically using a multimodal approach (RSI and RFS). Bariatric surgery may worsen or lead to de novo LPR. Recognizing the LPR outcomes in these patients is paramount for optimal voice, speech, and swallowing functions.

Laryngopharyngeal Reflux Disease: Outcome of Patients After Treatment in Otolaryngology Clinics.

IntroductionLaryngopharyngeal reflux (LPR) is a different entity from gastroesophageal reflux disease (GERD). Patients with LPR usually present with a variety of symptoms such as hoarseness, voice fatigue, burning sensation in the throat, persistent cough, sore throat, dysphagia, a sensation of a lump in the throat, and chronic throat clearing. The management of LPR is based on medications (proton pump inhibitors) along with lifestyle and dietary modifications. It has been suggested that the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) are useful parameters to assess patients with LPR.The aim of this study is to assess the subjective and objective benefits of RFS and RSI for diagnosing and management of LPR in the tertiary care center and to find the difference in RSI and RSI scoring with respect to gender.MethodsA prospective study was performed and 102 patients were included according to inclusion criteria. RFS and RSI questionnaires were filled on the first visit of patients and then treatment with proton pump inhibitors was started along with lifestyle modification instructions. Questionnaires were filled after four weeks and then 12weeks post-treatment. Repeated measure analysis of variance (ANOVA) was performed to compare the mean RFS and RSI from baseline to the end of treatment. The post hoc analysis was done using the Bonferroni test of multiple comparisons. An independent sample t-test was also used to compare the mean RFS and RSI between genders. P-values less than 0.05 were considered statistically significantResultsRFS and RSI were found to be significantly decreased post-treatment after four weeks and 12 weeks post-treatment (p-value- <0.01). Eight point eight percent (8.8%) side effects were observed in the study, the change in quality of life after a three-month treatment was significantly improved among 62.7% patients, and 75.5% did lifestyle modifications. In the mean comparison of RFS and RSI with respect to gender, it was observed that the mean RFS of females samples after one month and three months of treatment were significantly less as compared to male samples, p<0.01. There was no significant mean difference observed for RSI after one month and three months of treatment with respect to gender (p>0.05).ConclusionRFS and RSI are convenient and helpful for diagnosing LPR, and they can be easily implemented in ear, nose, throat (ENT) clinics for the subjective and objective assessment of LPR. Females showed greater improvement on laryngoscopy findings (RFS scores) post-treatment as compared to males.

Prevalence and Correlation of Laryngopharyngeal Reflux in Females with Vitamin D Deficiency in a Multi-Specialty Polyclinic in New Delhi, India

Background: Laryngopharyngeal Reflux (LPR) is a condition in which gastric content reflux into the larynx and pharynx. It is one of the extraesophageal manifestations of gastroesophageal reflux disease (GERD), involving the laryngeal regio. The laryngopharyngeal epithelium is more susceptible to reflux-related tissue injury than the esophageal epithelium. Objectives: This study aimed to test the hypothesis of whether severe vitamin D deficiency results in increased Laryngopharyngeal reflux (LPR) symptoms in Indian females. The objective was to find out the prevalence of LPR in the severe vitamin D deficient Indian female population. Methods: A descriptive observational study was done at a multispecialty polyclinic in New Delhi, India, over a period of one year. Based on a pilot study, a sample size of 185 individuals was taken. All females referring to the general outpatient department (OPD) with vitamin D levels below 20 ng/ml were included. The frequency of LPR symptoms in the study participants was assessed using the reflux symptom index (RSI) and reflux finding score (RFS) given for all symptomatic patients using a validated scoring system. The data were analyzed descriptively with Microsoft Excel and SPSS version 21 using appropriate tests. Results: In this study, 92% of the subjects aged more than 25 years, and the mean vitamin D level was 9.87 (± 3.425) ng/ml. Moreover, 74% of study participants had severe vitamin D deficiency (≤ 10 ng/ml). The mean RSI for our study participants was 14.54 (± 10.353). Also, the mean RFS was 1.77 (± 3.069). No significant correlation was established between the severity of vitamin D deficiency and RSI as well as RFS. The prevalence of LPR was 43%. Conclusions: Hypovitaminosis D does not have any effect on LPR in the Indian female population.

The Role of Nutritional and Dietary Habits in Etiology in Pediatric Vocal Fold Nodule

In pediatric pediatric vocal fold nodule (VFN) patients, different causes have been suggested in the development of the vocal cord nodule, including laryngopharyngeal reflux (LPR). It is known that the content of consumed foods, obesity, and other dietary behaviors are among the risk factors for the development of reflux. The aim of this study was to evaluate dietary and food consumption habits in pediatric VFN patients. This prospective-controlled study included 50 children with VFNs (age range 5-14 years) and 50 age-matched children without any voice disorders as a control group. BMI values of each participant were evaluated according to age-percentile range. The voice usage habits and personality structure of all the children were questioned. All patients underwent laryngeal examination and voice analysis. The Turkish Pediatric Voice Handicap Index (t-PVHI) and Child Voice Handicap Index-10 (t-CVHI) were completed by patients or their parents. The examination findings of all patients were evaluated with the reflux finding score (RFS), and their complaints were questioned with the reflux symptom index (RSI). In addition, eating and drinking at night, fast eating and excessive food consumption habits and the frequency of consumption of packaged foods defined as junk food, carbonated beverage were questioned. The data obtained were compared statistically between the two groups. There was no significant difference between the study and control groups in terms of age, gender distribution, median BMI value, voice usage habits, and personality structure. In the study group, t-PVHI, t-CVHI, jitter, schimmer values, the mean RFS, and RSI scores were significantly higher than those of the control group. The number of children with high consumption of junk food and carbonated drinks was higher in the study group. There was no significant difference between the two groups in terms of dietary habits. Food consumption habits may play a role in childhood voice problems in this population.

Combination drug therapy for laryngopharyngeal reflex

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; We sought to evaluate the combination of high-dose prebreakfast proton pump inhibitors (PPIs) (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing as a surrogate and rational regimen for LPR.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 subjects that presented to ENT and HNS OPD with symptoms of laryngopharyngeal reflux (LPR) were prospectively evaluated and underwent a comprehensive otolaryngological examination. All subjects were treated sequentially and outcomes recorded using reflux finding score (RFS) and reflux symptom index (RSI). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of the cohort was 35±06.51 (age range, 8-55). Mean RSI of all patients was 24.8 before treatment with combination of PPIs and H2 receptor antagonists. Significant change in RSI were observed after the first 8 weeks of therapy and no further significant changes were observed over the next 16 weeks. Mean RFS of the patients was 12 before starting the treatment and there was a significant response in mean RFS at 16 weeks of therapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A surrogate high-dose prebreakfast PPI (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing regimen is effective in improving RSI and RFS in majority of cases who present with LPR.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Validation of the Brazilian Portuguese Version of the Reflux Finding Score

Laryngopharyngeal reflux (LPR) poses a diagnostic challenge. Clinical diagnosis, based on suggestive symptoms and laryngoscopic signs of inflammation, should be acceptable, as long as diligent differential diagnosis is sought. In order to minimize subjectivity, a number of diagnostic instruments have been proposed, being the most common the Reflux Symptom Index and the Reflux Finding Score (RFS). The latter has been translated into several languages including Portuguese, but it still has not been properly validated in this language. To validate the Brazilian Portuguese version of the RFS. For validity and internal consistency, 172 adults were studied (106 with LPR and 66 healthy controls). Flexible transnasal laryngoscopy images were randomly examined twice by each of the two experienced otolaryngologists with a 72-hour interval. Strict exclusion criteria were applied to avoid other possible known causes of chronic laryngitis. For assessment of reproducibility and temporal stability, a random sample of 108 subjects (53 patients and 55 controls) were tested and retested. A statistically significant difference was observed in the mean RFS between patients with LPR (10.26±3.58) and controls (5.52±1.34) (P < 0.001). The interclass correlation coefficient comparing test and retest for both raters was high (R1=0.956; R2= 0.948). The Brazilian Portuguese version of the RFS proved to be a reliable and reproducible instrument for the diagnosis of LPR with a sensitivity of 82.08%, a specificity of 93.94%, a positive predictive value of 95.60%, and a negative predictive value was 76.54%.

Comparison of Reflux Symptom Index (RSI) with Reflux Finding Score (RFS) and Its Effectiveness in Diagnosis of Laryngopharyngeal Reflux Disease (LPRD).

LPRD is a common condition in patients attending ENT OPDs. Although esophageal manometry and 24h pH monitoring is considered the gold standard for diagnosis, it is an expensive and time consuming investigation. Newer clinical scales have been developed for diagnosing LPR such as RSI, RFS, Carlsson-Dent, ReQuest, GerdQ, etc. The objective of the study is to compare RSI with RFS and to establish its effectiveness in diagnosing LPRD among OPD patients. It's a descriptive cross-sectional study. ENT outpatients with features of LPRD were asked to fill RSI proforma (score ≥ 13 abnormal), after which they were subjected to indirect laryngoscopy to obtain the RFS (score ≥ 7 diagnostic of LPRD). RSI was compared with RFS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of RSI were noted. Of 165 patients, 53.9% were females. Mean RSI scores in males and females were 11.9 and 11.5 and mean RFS scores were 6.4 and 5.7 respectively. RSI had 79.1% sensitivity and 83.7% specificity in diagnosing LPRD with PPV 76.8%, NPV 85.4% and accuracy 81.8% (Chi square value 64.5, p ≤ 0.01). There was substantial agreement between RSI and RFS (Cohen's kappa: 0.625, p ≤ 0.0001). RSI is a simple tool to diagnose LPRD which doesn't mandate invasive procedures such as endoscopy or esophageal manometry. Hence it can be used effectively to diagnose LPRD in ENT outpatients and start the treatment at the earliest.

Signs and symptoms of laryngopharyngeal reflux and its relation to complaints and vocal quality.

To verify the association between laryngopharyngeal reflux (LPR) with age, gender, vocal deviation and voice complaints. The study included patients between 18 and 70 years old, referred to the Otorhinolaryngology service for complaints of voice or reflux, of both sexes. Endolaryngeal findings were classified using the Reflux Finding Score (RFS) scale. The presence or absence of vocal and reflux complaints was verified and correlated with the RFS classification. On the same date, they were submitted to sustained vowel voice recording and chained speech. The auditory-perceptual assessment was performed by a speech therapist, classifying the general degree of vocal deviation based on the GRBASI scale. Ninety-seven patients were evaluated, with a mean age of 42. 6 years, 62. 3% female, and mean RFS scores of 6. 26 points. Among the patients, 48 subjects had vocal complaints, 34 women with a mean age of 44. 9 years and an average RFS score of 6. 94 points. The other 49 individuals had no vocal complaints, and of these 27 were women, with a mean age of 41. 2 years and a mean RFS score of 5. 5 points. The variables "reflux complaint", "vocal complaint" and age were the ones that most correlated with the RFS scale scores. There is a relationship among reflux complaints, laryngeal findings and vocal complaint.

Prevalence of Laryngopharyngeal Reflux in Patients with Gastroesophageal Reflux Disease Undergoing Upper Esophagogastroduodenoscopy

Introduction: Gastroesophageal reflux disease (GERD) has been defined as the retrograde flow of gastric contents into the esophagus. Laryngopharyngeal reflux (LPR) is one of the manifestations of GERD which can be diagnosed clinically by Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The aim of this study was to find the prevalence of laryngopharyngeal reflux in patients with GERD undergoing upper esophagogastroduodenoscopy. Methods: This was a prospective cross sectional study and all the patients visiting author’s institute with GERD undergoing upper esophagogastroduodenoscopy were included. All the relevant data on history, examination, RSI scores, RFS scores and upper esophagogastroduodenoscopy findings were recorded in the standard proforma and data were analysed. Results: A total of 205 patients with GERD and undergoing upper esophagogastroduodenoscopy were included whose mean age was 46.1 years. The female to male ratio was 1.3:1. The most common presenting symptoms in our study was hoarseness (97%) followed by coughing (90.7%). The mean RSI score was 11.6. The symptom prevalence of LPR was 23.4%. The prevalence in between age groups and gender was not significantly different. The mean RFS score was 9.5. The prevalence of LPR by RFS assessment was 64.4%, which is significantly more than the prevalence assessed by RSI (23.4%). Conclusion: The prevalence of LPR in patients with GERD by RSI was less than the prevalence by RFS. So both the tools need to be used simultaneously to make the diagnosis and not recommendable to use independently.

Prevalence of Laryngopharyngeal Reflux in Patients with Gastroesophageal Reflux Disease Undergoing Upper Esophagogastroduodenoscopy

Introduction Gastroesophageal reflux disease (GERD) has been defined as the retrograde flow of gastric contents into the esophagus. Laryngopharyngeal reflux (LPR) is one of the manifestations of GERD which can be diagnosed clinically by Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The aim of this study was to find the prevalence of laryngopharyngeal reflux in patients with GERD undergoing upper esophagogastroduodenoscopy.&#x0D; MethodsThis was a prospective cross sectional study and all the patients visiting author’s institute with GERD undergoing upper esophagogastroduodenoscopy were included. All the relevant data on history, examination, RSI scores, RFS scores and upper esophagogastroduodenoscopy findings were recorded in the standard proforma and data were analysed.&#x0D; ResultsA total of 205 patients with GERD and undergoing upper esophagogastroduodenoscopy were included whose mean age was 46.1 years. The female to male ratio was 1.3:1. The most common presenting symptoms in our study was hoarseness (97%) followed by coughing (90.7%). The mean RSI score was 11.6. The symptom prevalence of LPR was 23.4%. The prevalence in between age groups and gender was not significantly different. The mean RFS score was 9.5. The prevalence of LPR by RFS assessment was 64.4%, which is significantly more than the prevalence assessed by RSI (23.4%).&#x0D; ConclusionThe prevalence of LPR in patients with GERD by RSI was less than the prevalence by RFS. So both the tools need to be used simultaneously to make the diagnosis and not recommendable to use independently.

Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease.

The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy (LTH) and its inflammation, adopting Narrow Band Imaging (NBI) technology. We enrolled, as cases, patients with clinical diagnosis of laryngopharyngeal reflux disease (LPRD), a Reflux Symptom Index (RSI) ≥ 13, and a Reflux Finding Score (RFS) ≥ 7. Controls were enrolled among patients who underwent the same transnasal endoscopy, equipped with NBI, with a RSI < 13 and a RFS < 7. Nasopharynx, Lingual Tonsils (LT), Hypopharynx and Larynx were evaluated by two experienced otolaryngologists, who calculated the Reflux Finding Scale (RFS) score and focused their attention on the base of the tongue, observing its surface with NBI technology. 82 patients with diagnosis of laryngopharyngeal reflux were enrolled as cases. Mean RFS was 11.7 (SD = 2.9). As controls, we enrolled 80 patients. Mean RFS was 2.7 (SD = 1.63). We found that RFS positivity was associated with a significant increase in LT dimension (2.5 vs 1.1, p < 0.001), with a higher LT crypt inflammation grading (1.8 vs 0.09, p < 0.001) and with a higher Roman Cobblestone pattern grading (1.48 vs 0.11, p < 0.001). A significant correlation between the crypt inflammation and the hyperemia subscore of RFS was present (r = 0.696, p < 0.0001), while it was not possible to find a correlation between crypt inflammation and either diffuse laryngeal edema (r = 0.166, p = 0.135) and posterior commissure hypertrophy (r = 0.089, p = 0.427). NBI allowed us to identify endoscopically the presence of enlarged lingual tonsil, crypt inflammation and superficial mucosal changes, in patients affected by LPRD. 2 (prospective, case-control study).

Reliability and Validity of the Turkish Reflux Symptom Index

To validate and assess reliability of the Turkish Reflux Symptom Index (T-RSI). Cross-sectional case-control study. A Turkish version of the original American English RSI was developed. One hundred thirty-two patients with a Reflux Finding Score (RFS) > 7, and 162 healthy controls (HC) with RFS ≤7 were included in the study. To assess reliability, the T-RSI was scored twice, within a 7-14 day window. For construct validity, the scores obtained in the study group were compared to the scores from the HC group. A correlation between RSI and RFS was assessed to determine content validity. Finally, sensitivity and specificity of the index was calculated using a receiver operating characteristic curve analysis. The T-RSI showed excellent internal consistency (Cronbach`s α = 0.912). Item-total correlation coefficients ranged between 0.572 and 0.773. The Pearson product-moment correlation test indicated that the T-RSI is a reliable tool (r = 0.931, n = 107, P < 0.001). There were significant difference between the study group and the HC group for the mean RSI scores (18.15 ± 7.31 and 7.88 ± 5.32, P < 0.001 respectively). The mean RFS score in the patients was 12.57 and the correlation between RFS score and RSI score was high (r = 0.704). According to the receiver operating characteristic curve analysis the area under curve of the T-RSI was 0.892. The optimal cut-off value was 12.5 with a sensitivity of 82.6% and a specificity of 84.6%. The T-RSI is an easily administered, reliable, and valid instrument for assessing symptoms thought to be related to laryngopharyngeal reflux. A score of T-RSI greater than 12.5 is similar to an RSI score of >13 considered symptomatic for laryngopharyngeal reflux.

Characterisation of Laryngo-pharyngeal Reflux Disease in Old and Ageing Patients

ObjectivesTo characterise laryngo-pharyngeal reflux (LPR) in patients over 60 years of age. MethodsRetrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered “gold-standard” in LPR diagnosis).Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥7. ResultsThe patients’ mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS. ConclusionsIn ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.

CONTINUOUS VERSUS ON-DEMAND PROTON PUMP INHIBITOR TREATMENT FOR LARYNGOPHARYNGEAL REFLUX: A RANDOMIZED CLINICAL TRIAL

Objective: This study aimed to compare continuous and pro re nata (PRN) proton pump inhibitor (PPI) treatments for laryngopharyngeal reflux (LPR).&#x0D; Methods: This randomized clinical trial included 52 LPR patients with lingual tonsil hypertrophy (LTH). Those patients who showed LPR improvement with an initial PPI trial were randomly divided into continuous and PRN PPI treatment groups. The Reflux Symptom Index (RSI) score, Reflux Finding Score (RFS), and LTH grade were used to assess the treatment results.&#x0D; Results: The PPI treatment (30 mg of lansoprazole twice daily) for 6 mo resulted in a significantly decreasing RSI score (p&lt;0.001). The PPI treatments for the first 8 w and the second 8 w also showed significant LPR improvement. However, there was no significant improvement after the third 8 w (p&gt;0.05). After 6 mo, the PPI treatment also resulted in a continuous decrease in the RFS (p&lt;0.001). There were no significant differences in the mean RSI scores (p=0.518) and mean RFSs (p=0.393) between the continuous and PRN PPI groups. In the grade II LTH cases, there was a significant improvement after 6 mo of PPI treatment (p&lt;0.001), although there was no improvement after the first 2 mo in the treatment group. For the grade III LTH cases, there was no significant improvement after the first 2 mo and 6 mo of the PPI treatment.&#x0D; Conclusion: Six months of PPI treatment improved the RSI score, RFS, and LTH grade, although there was no difference between the continuous and PRN PPI treatment groups.