Changes of Laryngeal and Extralaryngeal Symptoms and Findings in Laryngopharyngeal Reflux Patients

Lechien, Jérôme R.; Bobin, François; Muls, Vinciane; Mouawad, F.; Dapri, Giovanni; Dequanter, Didier; Horoi, Mihaéla; Thill, Marie Paule; Ruiz, Alexandra Rodriguez; Saussez, Sven

doi:10.1002/lary.28962

Cited by 22 publications

(36 citation statements)

References 41 publications

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“…The most prevalent findings associated with LPR include posterior commissure hypertrophy, arytenoid erythema, oropharyngeal and anterior pilar erythema ( LPR and are easily seen by the primary care physician (Figure 1) [61]. improved through treatment (D).…”

Section: Resultsmentioning

confidence: 99%

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Lechien¹,

Saussez²,

Muls³

et al. 2020

Preprint

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Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

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Section: Resultsmentioning

confidence: 99%

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Lechien¹,

Saussez²,

Muls³

et al. 2020

Preprint

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“…. However, the primary care physician had to keep in mind that some patients have a significant improvement of symptoms but these signs may persist over time [55].…”

Section: Resultsmentioning

confidence: 99%

“…LPR patients have a significantly higher prevalence of anterior pilar erythema, coated tongue, uvula and oropharyngeal posterior wall erythema compared with healthy individuals [ 54 ]. These signs may be easily seen by the primary care physician and may be useful for both the diagnosis and the posttreatment follow-up ( Figure 1 ) [ 55 ]. However, the primary care physician has to keep in mind that the assessment of findings is still subjective supporting that the pre- to posttreatment evaluation needs to be performed by the same physician.…”

Section: Resultsmentioning

confidence: 99%

“…The use of HEMII-pH in patients with moderate-to-severe LPR symptoms is increasingly considered as a cost-effective approach because that allows the prescription of personalized treatment considering the LPR features (acid, weakly acid or alkaline; upright/daytime versus supine/nighttime) [ 64 ]. Such treatment is associated with good outcomes, the possibility to reduce drug doses throughout the treatment and drug weaning at 3 to 9 months [ 55 ]. The pharyngeal event may be detected by oropharyngeal pH study using a unique pH sensor into the pharynx (Restech ® , Respiratory Technology Corp. San Diego, USA).…”

Section: Additional Examinationsmentioning

confidence: 99%

“…Coated tongue ( C ) is found in 49.4% of patients and may significantly improve through treatment ( D ). However, the primary care physician had to keep in mind that some patients have a significant improvement of symptoms but these signs may persist over time [ 55 ].…”

Section: Figurementioning

confidence: 99%

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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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Laryngopharyngeal Reflux Disease is More Severe in Obese Patients: A Prospective Multicenter Study

Lechien

Bobin²,

Muls

et al. 2021

The Laryngoscope

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Objectives/Hypothesis To investigate whether there is an impact of obesity and overweight on the clinical findings and therapeutic responses of patients with laryngopharyngeal reflux (LPR). Study Design Prospective uncontrolled. Methods Patients with LPR‐related symptoms and positive LPR diagnosis at the hypopharyngeal‐esophageal multichannel intraluminal impedance pH‐monitoring (HEMII‐pH) were recruited from December 2017 to December 2020. Patients were treated with a combination of diet, proton pump inhibitors, and alginate for 3 to 6 months. The following outcomes were studied according to the weight of patients: HEMII‐pH, gastrointestinal endoscopy features, symptoms, findings, and therapeutic response. Results A total of 262 patients completed the study, accounting for 134, 85, and 43 patients with normal weight (body mass index [BMI] <25), overweight (BMI = 25–29.99), and obesity (BMI >30). Obese patients reported significant higher prevalence of gastroesophageal reflux disease (GERD), acid LPR, and a more severe LPR disease regarding the number of pharyngeal reflux events, reflux symptom score (RSS), and reflux sign assessment (RSA). RSS and RSA scores significantly improved from baseline to 3‐month posttreatment irrespective of the patient weight group. Symptoms and signs continued to improve from 3 to 6‐month posttreatment only in patients with a normal weight. Conclusion Obesity is associated with a more severe LPR disease and a higher proportion of GERD and acid LPR. Obese LPR patients may require more frequently PPI‐therapy regarding the higher prevalence of GERD. Level of Evidence 3 Laryngoscope, 131:E2742–E2748, 2021

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Changes of Laryngeal and Extralaryngeal Symptoms and Findings in Laryngopharyngeal Reflux Patients

Cited by 22 publications

References 41 publications

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

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

Laryngopharyngeal Reflux Disease is More Severe in Obese Patients: A Prospective Multicenter Study

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