Presence Of Laryngopharyngeal Reflux Research Articles

Laryngopharyngeal Reflux in Obstructive Sleep Apnea-Hypopnea Syndrome: An Updated Meta-Analysis.

Laryngopharyngeal reflux (LPR) is a common disorder in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). This meta-analysis was carried out to evaluate the LPR prevalence in individuals with OSAHS and to analyze the correlation of LPR positivity with the clinical features of patients with OSAHS. A detailed review of the English and Chinese literature on the occurrence of LPR in patients with OSAHS was performed by employing online search tools such as PubMed, EMBASE, Web of Science, VIP, CNKI, WanFang, etc. Two researchers analyzed the studies for quality according to the STROBE standard checklist. The acquired data were analyzed using Stata 11.0 and R 3.6.1 software. The effect size was estimated and calculated using weighted mean difference (WMD) and correlation coefficients. Moreover, a combined analysis was performed by employing either a random- or fixed-effects model. Ultimately, 27 studies met our inclusion criteria. Our study revealed that the LPR prevalence in OSAHS patients was 49%. We carried out subgroup analyses as per OSAHS severity, ethnicity, and body mass index (BMI). The results suggested that the probability of LPR in European and American patients with OSAHS was higher, and the prevalence of LPR was higher in obese individuals and patients with severe OSAHS. Moreover, apnea-hypopnea index (AHI) and BMI were higher in LPR-positive OSAHS patients than in LPR-negative OSAHS patients, but no significant variation in age was observed in the two groups. Moreover, the reflux symptom index (RSI) scores and the reflux finding score (RFS) exhibited a positive correlation with AHI. The current literature shows a higher incidence of LPR in individuals with OSAHS (49%). The severity of AHI in individuals with OSAHS is associated with the presence of LPR. Patients with OSAHS accompanied by LPR showed higher BMI and AHI as compared to those patients with LPR-negative OSAHS.

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population-Based Study.

To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study. Cross-sectional study. Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis. 701 were enrolled (54.8% female, 45.2% male; mean age, 50.2± 13.3 years). The mean apnea-hypopnea index score was 17 ± 18.3 events/hr, and the mean RSI score was 7.0 ± 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires. Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep. 3 Laryngoscope, 132:1877-1882, 2022.

Comparison of Proton Pump Inhibitor and Triple Therapy Regimen for Laryngospharyngeal Reflux Disease.

Laryngopharyngeal reflux is retrograde flow of contents of the stomach to the larynx and the pharynx. The study aims to compare two regimens (proton pump inhibitor monotherapy versus triple therapy) on the outcome of Helicobactor pylori positive laryngopharyngeal reflux disease. The presence of laryngopharyngeal reflux was determined by reflux symptom index and reflux finding score. The presence of Helicobactor pylori in the tissue was confirmed by rapid urease test. All urease test negative laryngopharyngeal reflux patients were given a course of proton pump inhibitors and results were evaluated. All urease test positive patients were divided into two groups. One group was given a course of proton pump inhibitors and another group was given a course of triple therapy and the results were compared. A total number of 704 laryngopharyngeal reflux patients were screened for urease test. Among them 138 patients (19.6 %) were urease test negative and were given proton pump inhibitor therapy. Improvement in both reflux finding score (average score 11.75) and reflux symptom index (average score 5.25) score was observed after 3 months with p-value<0.05. In urease test positive patients, improvement in scores was observed in both proton pump inhibitors and triple therapy group, however marked improvement in the clinical features was observed in triple therapy group with p-value<0.05. The study reveals association between laryngopharyngeal reflux and Helicobactor pylori. Proton pump inhibitor therapy is sufficient if no Helicobactor pylori is detected, however incase of presence of Helicobactor pylori, triple therapy gives better results.

Сapabilitу of 24-hour esophageal pH-impedance monitoring in the diagnosis of GERD-associated laryngeal diseases

Extraesophageal manifestations of gastroesophageal reflux disease (GERD), despite the improvement of methods of diagnosis and treatment of patients with this pathology, still remain an urgent problem of medicine and cause increased attention of clinicians and researchers. In some cases, patients with GERD do not present typical complaints of heartburn, regurgitation; the disease may manifest extraesophageal manifestations, such as chronic cough, hoarseness, reflux laryngitis, and others caused by the presence of laryngopharyngeal reflux (LFR) – inflammation of the mucous membrane of the upper digestive and respiratory tracts with possible morphological changes associated with direct and indirect (reflex) exposure to gastroduodenal reflux. The occurrence of LFR is possible due to a violation of the motor function of the esophagus and insufficiency of the upper esophageal sphincter, as well as a decrease in the tone of the pharyngeal muscles. The most accessible methods of diagnosis of LFR are registration of complaints according to the questionnaire “index of reflux symptoms”, assessment of the clinical and functional state of the larynx using a visually analog “scale of reflux signs”. A positive response to the empirical use of proton pump inhibitors in combination with procinetics and determination of pepsin content in saliva can also be alternative diagnostic methods. To date, 24-hour pH-impedance monitoring is a method that allows the most accurate diagnosis of all types of reflux, regardless of the pH value, to verify high reflux in combination with its physical properties, as well as to estimate the time of chemical and volumetric esophageal clearance. In addition to performing esophagogastroduodenoscopy, the use of this method is indicated in patients with suspected extraesophageal manifestations of GERD. The article presents clinical examples of patients with extraesophageal manifestations of GERD, describes the possibilities of 24-hour pH-impedance monitoring of the esophagus in the diagnosis of LFR and reflux-associated diseases of the larynx.

Association of pepsin and DNA damage in laryngopharyngeal reflux-related vocal fold polyps.

This study aimed to evaluate if laryngopharyngeal reflux (LPR) plays a role as a risk factor for vocal fold polyps (VFPs), and if pepsin is associated with higher oxidative DNA damage of VFPs in the presence of LPR. Thirty patients with VFPs were recruited between 2017 and 2018. Prior to surgery, a laryngoscopy was performed on all subjects to evaluate VFPs. Polyp tissue and saliva samples were obtained scrupulously. Hematoxylin-eosin staining was performed for pathologic analysis. Immunohistochemistry and ELISA were used to detect pepsin in tissue and saliva of VFP patients. 8-OHdG and p-H2AX expression was detected to measure oxidative DNA damage in tissue. DNA damage was investigated in human immortalized laryngeal epithelial cells exposed to pepsin. The pepsin concentration in saliva was significantly higher (t=2.38, P=.024) in the pepsin positive group. There was no significant difference in pepsin expression at different sites and pathological subtypes of VFPs. The levels of 8-OHdG and p-H2AX were significantly higher in the pepsin positive group and positively correlated with the tissue expression of pepsin. The concentration of pepsin in saliva also showed a significant correlation with 8-OHdG levels. Expression of 8-OHdG and p-H2AX, and tail moment of the comet assay were elevated in human immortalized laryngeal epithelial cells following treatment with pepsin. Patients with VFPs have higher levels of oxidative DNA damage in the presence of pepsin reflux. Pepsin may induce DNA damage in laryngeal epithelial cells and participate in the pathogenesis of VFPs.

Screening and diagnosis of laryngopharyngeal reflux in patients with laryngeal cancer stage I-II (T1-2N0M0)

Topicality: The variety of manifestations of laryngopharyngeal reflux (LPR) in otolaryngological practice has made this problem relevant for the past decades. The development of LPR is associated with impaired function of the upper esophageal sphincter, which allows reflux to enter the larynx, pharynx, nasal cavity and middle ear cavity. In a number of studies, pathological reflux has been identified as one of the factors in the development of cancer of the upper respiratory and digestive tract. Aim of the study: to improve methods fors creening and diagnosis of laryngopharyngeal reflux in patients with laryngeal cancer stage I-II (T1-2N0M0). Materials and methods: The study group included 93 patients with stage I-II laryngeal cancer (T1-2N0M0). The control group was represented by 36 patients with reflux-associated benign neoplasms of the larynx. For preliminary diagnosis and objectification of complaints used the RSI test. To increase the accuracy of interpretation and objectification of laryngoscopic manifestations of LPR, the RFS scale was used. The daily pH-monitoring was carried out using an AG-1pH-M acidogastrograph with an electrode system. The severity of reflux was determined according to DeMeester criteria. According to the results of pH monitoring, clinical groups were formed. Results: When analyzing the results of the examination, the RSI index exceeded “9” in 41 (44.1%) patients. When tested on the RFS scale, the indicator “13 and higher” was recorded in 48 (51.6%) patients. All patients (41) with a positive RSI test received 24-hour pH monitoring. According to 24-hour pH-monitoring, the presence of LPR was verified in 33 (80.1%) patients with a positive RSI test. The study group consisted of 33 (80.1%) patients with squamous cell carcinoma of the larynx T1-2N0M0. After 24-hour pH-monitoring, we obtained the data: mild LPR was observed in 6 (18.2%) patients, moderate severity of LPR in 18 (54.5%) and severe LPR in 9 (27.3%). In patients with laryngeal cancer T1-2N0M0, which is associated with LPR, the DeMeester criterion exceeded 14.72. Conclusions: Comparison of pH-monitoring data and visual-analogue scales reaches 80.1% of compliance in patients with laryngeal cancer T1-2N0M0, which is associated with LPR. According to 24-hour pH-monitoring, the presence of LPR was verified in 33 (35.5%) of the examined patients with squamous cell carcinoma of the larynx. Using the modified The Reflux Symptom Index and The Reflux Finding Score scales is a highly reliable method for screening the diagnosis of laryngopharyngeal reflux in patients with laryngeal cancer.

Impact of Laryngopharyngeal Reflux on Professional Singers

Laryngopharyngeal reflux (LPR) is retrograde flow of gastric content to the larynx and pharynx where these materials come in contact with the upper aerodigestive tract. It is an inflammatory disease associated with voice disorders and lesions in vocal fold. Presence of LPR among professional voice users such as singers can have a dramatic impact on voice quality. Singers are high-risk candidates for LPR because of necessary air support involving higher intra-abdominal pressure, more stress due to professional career, uncomfortable schedules, late meals before going to sleep, and bad food habits such as increased intake of citrus products, fatty, and spicy foods. The objective of this article is to review the current etiopathogenesis, clinical presentations, diagnosis, treatment, and lifestyle modification in cases of singers suffering from LPR and to propose a new patient-related outcome.

Association between salivary secretary function and laryngopharyngeal reflux: a prospective study

This study aimed to demonstrate the prevalence and risk factors of laryngopharyngeal reflux (LPR) in patients with xerostomia and to investigate the association between salivary function and LPR. The prevalence of LPR among patients with xerostomia was analyzed and the clinical and salivary gland function were compared between 2 groups; the non-LPR and the LPR groups. The prevalence of LPR was 82.2% in patients with xerostomia. The presence of LPR was correlated with the unstimulated or stimulated salivary flow rate (SFR). LPR did not correlate with scintigraphy findings except time to the minimum count of the parotid gland. Low stimulated SFR and unstimulated SFR were recognized as independent risk factors of LPR. A significant correlation was observed between the Reflux Symptom Index and the xerostomia symptoms score. Furthermore, RFS also correlated with unstimulated and stimulated SFR. This finding supports that salivary secretory function has an impact on LPR.

PS01.057: THYROIDECTOMY AND LARYNGO-PHARYNGEAL REFLUX: WHAT’S NEW

Abstract Background ‘Local neck symptoms’ may be related to goiter; a persistence of those symptoms after an uncomplicated total thyroidectomy (TT) might be referred to the laryngo-pharyngeal reflux (LPR). Our previous study found a correlation between goiter and LPR in selected patients with local neck symptoms; the purpose of our current study is to investigate the presence of a laringopharyngitis in patients with goiter, before and after TT, even in the absence of local neck symptoms, assessing whether the presence of LPR may play a role at the outset of the symptomatology. Methods Two groups of patients were considered and they differred for the presence or absence of local neck symptoms: group A (25 patients) and group B (40 patients). The clinical evaluation was standardized using the reflux symptom index. The patients were subjected to videolaringoscopy (VLS) and to esophageal videoflurography (VFGE) before and three months after surgery. Results Before surgery all the patients in group A showed a normal vocal chord motility and laryngitis findings at the VLS. The VFGE was positive to abnormal swallowing in 86% of patients. The laryngitis findings at VLS, were found in 38% of cases in group B. At VFGE 96% of the patients were positive to the test. The symptoms reported in the pre-operative were unchanged after surgery in group A. In group B 63% of patients remained positive; at VFGE 73% had a clear pathological condition. Conclusion In 2010 ‘Amelita’ study concluded that LPR should be taken into account as a possible movens of post-thyroidectomy clinical picture, both in the diagnosis and in the therapeutic management of those patients who complained about local neck symptoms, since the only TT hadn’t been effective. The collected data of the current study are consistent with those of the previous study: symptoms persisted or increased in laryngopharingeal reflux-positive patients, while in the control group the symptoms were absent or the new appearance symptomatic pictures were moderate. It is a shared view that we shouldn’t wait for the overt clinical picture, but prevent it. It is essential to identify, through a careful pre-operative evaluation, patients positive to LPR. Disclosure All authors have declared no conflicts of interest.

Study on the correlation between adenoid hypertrophy and laryngopharyngeal reflux in children

Objective:To discuss the correlation between adenoid hypertrophy and laryngopharyngeal reflux in children, and to determine the accuracy of reflux symptom index(RSI) and reflux finding score(RFS) in predicting adenoid hypertrophy and laryngopharyngeal reflux(LPR). Method:Assessment of RSI and RFS was performed in 71 children with adenoid hypertrophy who underwent surgery.The adenoid biopsy specimens were examined by pepsin immunohistochemical staining. According to the positive results of pepsin staining to evaluate the sensitivity and specificity of RSI and RFS to predict LPR. Result:Among the 71 children with adenoid hypertrophy, RSI was greater than 13 points in 4 cases (5.63%), RFS was greater than 7 points in 26 cases (36.62%), and 1(1.41%) was positive in both scores. Pepsin expression was detected in 52 cases of adenoid hypertrophy tissues, with a total positive rate of 73.24% (52/71),most were strong positive（15/71,21.13%）and positive（23/71,32.39%）. The higher the adenoid hypertrophy grade, the higher the expression level of pepsin (r=0.476, P<0.01).Define the positive rate of pepsin as the gold standard for the diagnosis of LPR, the sensitivity and specificity of RSI and RFS were 5.77%,34.62% and 94.74%,57.89% respectively. Pepsin staining intensity was positively correlated with troublesome or annoying cough（r=0.356, P=0.002）and was negatively correlated with ventricular obliteration（r=－0.212，P=0.038）. Conclusion:There is a correlation between adenoid hypertrophy and LPR in children，LPR plays an important role in the development of adenoid and the role and mechanism of pepsin in adenoid hypertrophy needs further studyAs the low sensitivity of RSI and RFS, it is not suitable for the screening of adenoid hypertrophy in children with LPR. Children with adenoid hypertrophy cough for a long time and the laryngoscopy shows the ventricular obliteration, the presence of LPR should be warned.

Relationship between Depression and Laryngopharyngeal Reflux.

This study investigated the relationship between depression, somatization, anxiety, personality, and laryngopharyngeal reflux (LPR). We prospectively analyzed 231 patients with symptoms with LPR using the laryngopharyngeal reflux symptom index and the reflux finding score. Seventy nine (34.2%) patients were diagnosed with LPR. A significant correlation was detected between the presence of LPR and total scores on the Patient Health Questionnaire-9 (5.6±5.3 vs. 4.0±4.6, p=0.017) and the 7-item Generalized Anxiety Disorder Scale (4.3±4.9 vs. 3.0±4.5, p=0.041). LPR was significantly more frequent in those with depression than in those without (45.6% vs. 27.0%, p=0.004). A multivariate analysis confirmed a significant association between the presence of LPR and depression (odds ratio, 1.068; 95% confidence interval, 1.011–1.128; p=0.019). Our preliminary results suggest that patients with LPR may need to be carefully evaluated for depression.

Laryngopharyngeal reflux: an overview on the disease and diagnostic approach

Background Laryngopharyngeal reflux (LPR) can be defined as chronic symptoms or laryngeal mucosal damage caused by the abnormal reflux of gastric contents into the upper airway. LPR plays an important role in up to 50% of laryngeal complaints that present in the otolaryngeal clinic, and the symptomatology of LPR has more different presentation. LPR is suspected in the presence of symptoms of hoarseness, dysphagia, cough, globus, excessive mucus, throat pain, throat clearing, and laryngospasm. Diagnosis of LPR is confirmed using the following: reflux symptom index (RSI), laryngoscopic examination [reflux finding score (RFS)], and esophagogastroduodenoscopy. Patients and methods A cross-sectional study was conducted on 60 patients with typical gastroesophageal reflux disease (GERD) symptoms and laryngeal complaints; these studied patients were recruited from patients who attended the outpatient clinic of Tropical Medicine and Gastroenterology, and Phoniatric Unit, Assiut University Hospital. The symptom questionnaire and the classification proposed by Belafsky and his colleagues (RSI) are used and upper endoscopy is performed for the diagnosis of GERD patients. Nasofibrolaryngoscopy for all these patients was performed to compare the results (RFS). Psychiatric assessment was performed by a psychiatric specialist using symptoms checklist revised 90. Patients with a score more than 60 will be re-evaluated using the following questionnaires: Hamilton checklist of symptoms of depressive illness and Hamilton rating scale for anxiety. Results All studied patients showed positive RSI (100%) and diagnostic endoscopy showed GERD in 58 (96.7%) patients, and 32 (53.3%) of them were found to have a positive finding in laryngoscopy; the findings were as follows: vascular congestion and vocal cord hyperemia in 32 (100%) patients, vocal cord edema in 26 (81%), phonatory gap in 13 (40%), subglottic edema in 12 (37%), vocal cord swelling in 10 (31.25%), and contact granuloma in eight (25%). A positive significant correlation was detected between phonasthenia symptoms, mostly lump sensation, hoarseness, throat clearing, and dry mouth (symptoms), and laryngeal finding (RFS), except for difficulty in swallowing saliva. There is a strong association between psychological symptoms and the presence of LPR; the most commonly detected manifestation was anxiety, and there was a positive significant correlation with anxiety and a negative significant correlation between depression and reflux symptoms. Conclusion RSI and RFS could be useful for the diagnosis and evaluation of LPR in patients with GERD complaining of laryngeal symptoms. Psychological intervention can improve the general well-being and quality of life of patients with gastrointestinal symptoms.

The Association of Reflux and Lingual Tonsil Hypertrophy: A Systematic Review

Objectives: Evaluate the association between lingual tonsil hypertrophy (LTH), gastroesophageal reflux disease (GERD), and laryngopharyngeal reflux (LPR). Methods: A systematic literature search was performed using MEDLINE and the Cochrane Library databases through July 2013 to identify original research articles examining the effects of GERD or LPR on LTH in both adults and children. Only original research articles in English were retrieved using the keywords “reflux and lingual tonsil,” “reflux and base of tongue hypertrophy,” “laryngopharyngeal reflux and lingual tonsil,” “LPR and lingual tonsil,” and extraesophageal reflux and lingual tonsil.” Results: Out of 33 studies that matched the search criteria, 5 studies in adults and 3 studies in children met the inclusion criteria. In adults, one study noted a significantly increased prevalence of LTH in patients with signs and/or symptoms of LPR (62.4%) versus patients without signs and/or symptoms of LPR (29.3%). Four studies noted an increase in the severity of LTH in the presence of signs or symptoms of LPR. In the pediatric population, all 3 studies noted a positive association between the presence of LPR and GERD and the presence of LTH (30%-70%). Conclusions: The results of this systematic review suggest an association between LTH and reflux in both adults and children. This study is limited by heterogeneity in methodology and definitions of LTH and reflux between included studies. Further investigation is needed to characterize the clinical entity of LTH as well as the nature of the relationship between LTH and reflux disease.

Laryngopharyngeal Reflux and Post‐Intubation Dyshponia

BACKGROUND Post intubation dysphonia is a well documented phenomenon. Presence of laryngopharyngeal reflux (LPR) may exacerbate this condition. However, there is a dearth of information identifying LPR as a risk factor for post intubation dysphonia. Other known risk factors include duration of intubation, endotracheal intubation, and ease of intubation. The purpose of this study was to determine the relationship of LPR to postintubation dysphonia. Our hypothesis was that patients with LPR are predisposed to dysphonia following endotracheal intubation.

Upper esophageal pH monitoring: Transnasal placement of the Bravo wireless capsule system

Laryngopharyngeal reflux (LPR) is a common entity and is known to be associated with many common aerodigestive disorders. The diagnosis of LPR based on symptoms or laryngeal findings alone is unreliable. Upper esophageal pH monitoring enables the otolaryngologist to objectively confirm the presence of LPR and to gauge the response and effectiveness of medical therapy. In this article, we present the technique for transnasal placement of a wireless pH monitoring capsule for the diagnosis of LPR. This technique can be performed by otolaryngologists in the office. It is safe and can be done under local anesthesia, in conjunction with transnasal esophagoscopy. The main advantage is that, unlike single- or double-probe pH monitoring devices, wireless capsule monitoring does not interfere with patients’ daily activities and diet, giving a more accurate measurement of reflux episodes in the upper esophagus. The technique has a low potential for complications, and monitoring can be performed for 24- and 48-hour periods.

Laser Eustachian Tuboplasty: Two‐Year Results

Laser eustachian tuboplasty (LETP) combined with appropriate medical management will eliminate the chronic presence of middle ear effusions in selected patients. The study population consisted of 13 adults with otitis media with effusion (OME). Patients underwent slow-motion video endoscopy to identify the location and extent of surgical resection. A diode or argon laser was used to vaporize areas of hypertrophic mucosa and submucosa along the cartilaginous eustachian tube. Patients were evaluated at 6, 12, and 24 months. Successful outcome was defined as absence of OME. Patients with evidence of reflux disease or allergic rhinitis were treated with medical therapy before surgery and throughout the follow-up period as indicated. LETP combined with medical management eliminated OME in 36% (4 of 11) of patients at 6 months, 40% (4 of 10) at 1 year, and 38% (3 of 8) at 2 years. Failure of LETP correlated with presence of laryngopharyngeal reflux (P = .01) or allergic disease (P = .05) for the results at 1 year but not at 2 years. LETP combined with appropriate medical management may be an effective treatment in select patients with chronic persistent eustachian tube dysfunction. A controlled trial with a larger number of subjects will be necessary to determine the efficacy of LETP and identify those factors predictive of successful outcome.

Heterotopic gastric mucosa in the cervical esophagus: Could this play a role in the pathogenesis of laryngopharyngeal reflux in a subgroup of patients with posterior laryngitis?

Objective. Acid secretion produced by a heterotopic gastric mucosal patch (HGMP) in the proximal esophagus, instead of gastric acid, may be responsible for laryngopharyngeal reflux (LPR), passing the upper esophageal sphincter. The aim of this study was to investigate the prevalence of HGMP in the proximal esophagus in patients with posterior laryngitis indicating the presence of LPR in comparison with a control group and to elucidate the possible role of this lesion in the pathogenesis of LPR. Material and methods. A total of 36 consecutive patients with posterior laryngitis diagnosed on laryngoscopic examination were enrolled in the study. Esophagoscopy and ambulatory 24-h intra-esophageal dual-probe pH monitoring were performed in all patients. During endoscopy, special attention was paid to the proximal part of the esophagus, and the proximal electrode for pH monitoring was placed in this region under endoscopic view. The control group comprised 660 consecutive patients who had undergone upper gastrointestinal endoscopy for the usual indications. When HGMP was found, biopsies were taken for histological confirmation. Results. HGMP was detected in 5 out of 36 patients. One out of five patients with patches was excluded from the study because the histopathology of this patient's patch revealed antral-type mucosa, which is not capable of acid secretion. Thus a total of 35 patients were included in the study, yielding a HGMP prevalence of 11.4% (4/35). Compared with the prevalence of the control group (1.6%), a significant difference was observed (p<0.005). pH monitoring showed that 45.4% of the patients had abnormal proximal acid reflux. All of four HGMP (+) patients with posterior laryngitis revealed significantly higher abnormal proximal reflux compared to the patients without patches (p<0.05). Conclusions. This first preliminary study may suggest that HGMP in the cervical esophagus could play a role in the pathogenesis of LPR, at least in a minor group of patients with posterior laryngitis, depending on its capability to produce acid in situ, although isolated proximal reflux could not be demonstrated. This finding may need to be supported by further studies with larger patient populations and using acid stimulation tests.