Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

Abstract

Introduction Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

Chronic Cough as a Symptom of Laryngopharyngeal Reflux—Two Case Reports

“…About 4−10% of patients who complain about laryngeal diseases are diagnosed with LPR [8]. Patients with reflux have the impaired physiological barriers that protect from acid gastric contents (upper and lower sphincter of the oesophagus, oesophageal mucosa, peristalsis, as well as saliva and gravity), acid gastric contents damage epithelium of the larynx and pharynx [9]. It was found that approximately half of patients with recurring laryngitis or voice disorders suffer from LPR.…”

“…A crucial examination in diagnostics of laryngopharyngeal reflux is also laryngoscopy, which shows changes in the larynx such as reddening, oedema or inflammation [7,9]. When the symptoms are intensive and persist for a long time, laryngoscopy is necessary to exclude other laryngeal diseases, including neoplasm [9].…”

“…When the symptoms are intensive and persist for a long time, laryngoscopy is necessary to exclude other laryngeal diseases, including neoplasm [9].…”

“…In spite of high sensitivity, pHmetry is an invasive, expensive and time-consuming examination, therefore, in the opinion of some authors, it is reserved only for patients with ambiguous clinical symptoms or after unsuccessful IPP therapy [9,11,12]. Some scientists believe that diagnosis is possible after taking medical history, the assessment of the patient's symptoms with the RSI scale and when the response to treatment is observed [9].…”

“…Some scientists believe that diagnosis is possible after taking medical history, the assessment of the patient's symptoms with the RSI scale and when the response to treatment is observed [9].…”