Awareness of European Otolaryngologists and General Practitioners Toward Laryngopharyngeal Reflux

Lechien, Jérôme R.; Mouawad, F.; Mortuaire, G.; Remacle, Marc; Bobin, François; Huet, Kathy; Nacci, Andrea; Barillari, Maria Rosaria; Crevier‐Buchman, Lise; Hans, Stéphane; Finck, Camille; Akst, Lee M.; Karkos, Petros D.

doi:10.1177/0003489419858090

Cited by 33 publications

(33 citation statements)

References 37 publications

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“…In a recent study, significant differences in awareness and practices regarding LPR were observed between European otolaryngologists and general practitioners (GPs). Of particular note, only 10.1% of GPs and 27.4% of otolaryngologists believed that they were adequately knowledgeable and skilled regarding LPR [15]. This is the first study designed to investigate current practices and opinions of Asian otolaryngologists regarding LPR.…”

Section: Discussionmentioning

confidence: 94%

“…In a recent systematic review, the most prevalent LPR symptoms were found to be globus sensation, throat clearing, hoarseness, excess throat mucus, and postnasal drip [9], while more than 70% of the Asian otolaryngologists surveyed in this study considered coughing after lying down or after eating, throat clearing, globus sensation, and chronic cough to be LPR-related symptoms. Interestingly, the opinions of Asian and European otolaryngologists about LPR-related symptoms differ [15]. Stomach acid coming up, cough, hoarseness, and throat pain were considered to be the symptoms most closely related to LPR by European otolaryngologists.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison to a previous study about the awareness of European otolaryngologists and GPs of LPR [15], the main strength of this study is it analyzed the opinions and awareness of only otolaryngologists in the Asian region. Furthermore, many Asian otolaryngologists (146 subjects) completed the survey, thereby allowing a comparison of otolaryngologists' practices with respect to LPR between Western and Eastern Asia.…”

Section: Discussionmentioning

confidence: 99%

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Management of Laryngopharyngeal Reflux in Asia

Kim¹,

Lechien²,

Ayad³

et al. 2020

Clin Exp Otorhinolaryngol

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Objectives. This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR).Methods. An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.Results. Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, <i>P</i>=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, <i>P</i>=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR.Conclusion. Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Laryngopharyngeal Reflux in Asia

Kim¹,

Lechien²,

Ayad³

et al. 2020

Clin Exp Otorhinolaryngol

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“…However, only a few studies investigated the potential differences between these two types of LPR patients. This lack of interest is probably related to the low use of pH monitoring or MII‐pH in otolaryngology, which are indispensable to make the GERD diagnosis. Moreover, the recent development of MII‐pH in gastroenterology led to the identification of three LPR subtypes, acid, nonacid, and mixed LPR, regarding the proportion of proximal acid or nonacid reflux episodes.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal reflux in laryngopharyngeal reflux patients: Clinical features and therapeutic response

Lechien¹,

Bobin²,

Muls

et al. 2019

The Laryngoscope

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Objective To investigate the clinical features and the therapeutic response of laryngopharyngeal reflux (LPR) patients with or without gastroesophageal reflux disease (GERD). Methods Patients with LPR symptoms were enrolled from three European Hospitals. The diagnosis of LPR and GERD was made through impedance‐pH monitoring (MII‐pH). A gastrointestinal endoscopy was realized in patients with digestive complaints or ≥60 years old. The 3‐ to 6‐month treatment was based on the association of diet, pantoprazole, alginate, and magaldrate regarding the MII‐pH characteristics. Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were used to evaluate the clinical evolution throughout treatment. The gastrointestinal endoscopy findings, clinical features, and therapeutic response were compared between patients with LPR and GERD (LPR/GERD) and patients with LPR. Results One hundred and eleven LPR patients were included, 54 being LPR/GERD. LPR/GERD patients had a higher number of proximal reflux episodes compared with LPR patients. The prevalence of esophagitis, hernia hiatal, and lower esophageal sphincter insufficiency did not differ between groups. The presence of GERD was strongly associated with acid LPR. Patients without GERD had a higher proportion of nonacid and mixed LPR compared with LPR/GERD patients. The pre‐ to posttreatment evolutions of RSS and RSA were quite similar in both groups, with the exception of the 3‐ to 6‐month improvement of digestive symptoms, which was better in LPR/GERD group. The therapeutic success rates were 79.6% and 77.2% in GERD/LPR and LPR group, respectively. Conclusion GERD is predictive of acid LPR. The clinical evolution and the therapeutic response rates were quite similar in both groups. Level of Evidence 4 Laryngoscope, 130: E479–E489, 2020

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“…Several studies demonstrated that LPR is not an extension of the lower esophageal refluxate into the upper aerodigestive tract. The Montreal criteria defined GERD as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications such as esophagitis [19,20]. The diagnosis may be investigated with pH study that, according to Johnson et DeMeester, has to report a length of time >4.0% of the 24-h recording spent below pH 4.0 or a DeMeester score >14.72 [21].…”

Section: Lpr Is Not Gerd and Gerd Is Not Lprmentioning

confidence: 99%

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

Lechien

Saussez

Muls

et al. 2020

JCM

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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.

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Awareness of European Otolaryngologists and General Practitioners Toward Laryngopharyngeal Reflux

Cited by 33 publications

References 37 publications

Management of Laryngopharyngeal Reflux in Asia

Management of Laryngopharyngeal Reflux in Asia

Gastroesophageal reflux in laryngopharyngeal reflux patients: Clinical features and therapeutic response

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

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