Characteristics of Laryngopharyngeal Reflux in Patients of Different Genders and Ages

Li, Zhi; Zhang, Chun; Wang, Xiaoyu; Zhang, Jinhong; Liu, Lianlian; Wang, Jiasen; Zhao, Jing; Zou, Shizhen; Ma, Xin; Li, Jinrang

doi:10.1016/j.jvoice.2022.11.035

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…Currently, most experts agree with the advantage using HEMII-pH for detecting LPR, as recent studies found that LPR patients more frequently experience weakly acidic or nonacid pharyngeal reflux events. 41,75 Moreover, only a portion of proximal esophageal reflux events reach the pharynx, 76 while some patients may have a high proportion of gastroesophageal reflux events reaching the proximal esophagus or pharynx despite a low distal reflux burden, 5 therefore, making the traditional MII-pH less reliable than HEMII-pH in identifying LPR. In a recent systematic review of normative data for HEMII-pH, authors concluded that the 95th percentile thresholds were 10-73 events for proximal esophageal events, and 0-10 events for hypopharyngeal reflux events using HEMII-pH.…”

Section: Esophageal Manometry (Statement 21)mentioning

confidence: 99%

“…The reflux monitoring technologies have evolved throughout the past 3 decades. Currently, most experts agree with the advantage of using HEMII‐pH for detecting LPR, as recent studies found that LPR patients more frequently experience weakly acidic or nonacid pharyngeal reflux events 41,75 . Moreover, only a portion of proximal esophageal reflux events reach the pharynx, 76 while some patients may have a high proportion of gastroesophageal reflux events reaching the proximal esophagus or pharynx despite a low distal reflux burden, 5 therefore, making the traditional MII‐pH less reliable than HEMII‐pH in identifying LPR.…”

Section: Additional Examinationsmentioning

confidence: 99%

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The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Lechien,

Vaezi,

Chan

et al. 2023

The Laryngoscope

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ObjectiveThe objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR.MethodsForty‐eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician.ResultsAfter the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non‐specific laryngeal and extra‐laryngeal symptoms and signs that can be evaluated with validated patient‐reported outcome questionnaires and clinical instruments. The hypopharyngeal–esophageal multichannel intraluminal impedance–pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h.ConclusionA global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR.Level of Evidence5 Laryngoscope, 2023

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Section: Esophageal Manometry (Statement 21)mentioning

confidence: 99%

Section: Additional Examinationsmentioning

confidence: 99%

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Lechien,

Vaezi,

Chan

et al. 2023

The Laryngoscope

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“…As of 2023, LPR remains a controversial and challenging condition, affecting 10% to 30% of outpatients consulting otolaryngology offices [1]. An increasing number of studies suggested the existence of several LPR profiles [11][12][13][14][15], which should be considered for more personalized diagnostic and therapeutic approaches.…”

Section: Introductionmentioning

confidence: 99%

Personalized Treatments Based on Laryngopharyngeal Reflux Patient Profiles: A Narrative Review

Lechien

2023

JPM

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Objective: To review the current findings of the literature on the existence of several profiles of laryngopharyngeal reflux (LPR) patients and to propose personalized diagnostic and therapeutic approaches. Methods: A state-of-the art review of the literature was conducted using the PubMED, Scopus, and Cochrane Library databases. The information related to epidemiology, demographics, clinical presentations, diagnostic approaches, and therapeutic responses were extracted to identify outcomes that may influence the clinical and therapeutic courses of LPR. Results: The clinical presentation and therapeutic courses of LPR may be influenced by gender, age, weight, comorbidities, dietary habits and culture, anxiety, stress, and saliva enzyme profile. The clinical expression of reflux, including laryngopharyngeal, respiratory, nasal, and eye symptoms, and the hypopharyngeal–esophageal multichannel intraluminal impedance-pH monitoring profile of patients are important issues to improve in patient management. The use of more personalized therapeutic strategies appears to be associated with better symptom relief and cures over the long-term. The role of pepsin in LPR physiology is well-established but the lack of information about the role of other gastrointestinal enzymes in the development of LPR-related mucosa inflammation limits the development of future enzyme-based personalized diagnostic and therapeutic approaches. Conclusion: Laryngopharyngeal reflux is a challenging ear, nose, and throat condition associated with poor therapeutic responses and a long-term burden in Western countries. Artificial intelligence should be used for developing personalized therapeutic strategies based on patient features.

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“…4 Liu et al retrospectively analyzed a large sample of elderly LPR patients (>60 years) and showed that their reflux finding score (RFS) was significantly higher than younger patients. 5 Lee et al reported significantly fewer responders to proton pump inhibitors (PPIs) therapy, interpreted as those whose RSI score improved by more than 50%, in >60-year-old LPR patients than in the younger group (57% vs 86%). 6 RSI/RFS scales used in these studies are subjective, notwithstanding, it indicates the influence of age in reflux patterns on the secondary side.…”

mentioning

confidence: 99%

“…A prospective multicenter study conducted by Lechien et al found significantly lower reflux symptom index (RSI) scores in elderly patients (≥60 years) than in the younger group 4 . Liu et al retrospectively analyzed a large sample of elderly LPR patients (>60 years) and showed that their reflux finding score (RFS) was significantly higher than younger patients 5 . Lee et al reported significantly fewer responders to proton pump inhibitors (PPIs) therapy, interpreted as those whose RSI score improved by more than 50%, in >60‐year‐old LPR patients than in the younger group (57% vs 86%) 6 .…”

mentioning

confidence: 99%

The Time‑Point Distribution Characteristics of Laryngopharyngeal Reflux in Elderly Patients

Liu,

Zhang,

Liu

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo identify the characteristics of the time‐point distribution of the occurrence of hypopharyngeal‐proximal reflux episodes (HREs) in elderly and younger patients with laryngopharyngeal reflux (LPR).Study DesignRetrospective cohort study.SettingAnalysis of data from patients with LPR‐related symptoms and 24‑hour hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH (24‐hour HEMII‑pH) monitoring from February 2017 to September 2022 at Sixth Medical Center of PLA General Hospital.MethodsPatients were divided into 2 age groups: the elderly group (>60 years) and the younger group (≤60 years). The time series of HREs and meals within 24 hours were analyzed based on HEMII‑pH.ResultsA total of 305 patients were included (126 elderly patients). In younger patients, except for nonacid‐gas HREs, the incidence of the remaining types of HREs tended to increase within 2 hours after meals, especially after dinner. The incidence of all types of HREs pre‐ and postmeal was not significantly different in the elderly group (χ2 = 0.080, P = .777). The incidence of nighttime HREs in elderly patients was statistically higher than in younger patients (6.23% vs 3.96%, P = .030), particularly acid‐/nonacid‐liquid HREs.ConclusionHREs tend to increase within 2 hours after meals in younger LPR patients, except for nonacid‐gas HREs. In elderly LPR patients, the incidence of all types of HREs pre‐ and postmeal were not significantly different, and nighttime fluid HREs was more prone to occur than in younger patients.

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Characteristics of Laryngopharyngeal Reflux in Patients of Different Genders and Ages

Cited by 6 publications

References 34 publications

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Personalized Treatments Based on Laryngopharyngeal Reflux Patient Profiles: A Narrative Review

The Time‑Point Distribution Characteristics of Laryngopharyngeal Reflux in Elderly Patients

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