Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review

Abstract

Objective To review the current literature about the epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux (LPR). Data Sources PubMed, Cochrane Library, and Scopus. Methods A comprehensive review of the literature on LPR epidemiology, clinical presentation, diagnosis, and treatment was conducted. Using the PRISMA statement, 3 authors selected relevant publications to provide a critical analysis of the literature. Conclusions The important heterogeneity across studies in LPR diagnosis continues to make it difficult to summarize a single body of thought. Controversies persist concerning epidemiology, clinical presentation, diagnosis, and treatment. No recent epidemiologic study exists regarding prevalence and incidence with the use of objective diagnostic tools. There is no survey that evaluates the prevalence of symptoms and signs on a large number of patients with confirmed LPR. Regarding diagnosis, an increasing number of authors used multichannel intraluminal impedance–pH monitoring, although there is no consensus regarding standardization of the diagnostic criteria. The efficiency of proton pump inhibitor (PPI) therapy remains poorly demonstrated and misevaluated by incomplete clinical tools that do not take into consideration many symptoms and extralaryngeal findings. Despite the recent advances in knowledge about nonacid LPR, treatment protocols based on PPIs do not seem to have evolved. Implications for Practice The development of multichannel intraluminal impedance–pH monitoring and pepsin and bile salt detection should be considered for the establishment of a multiparameter diagnostic approach. LPR treatment should evolve to a more personalized regimen, including diet, PPIs, alginate, and magaldrate according to individual patient characteristics. Multicenter international studies with a standardized protocol could improve scientific knowledge about LPR.

Validity and reliability of the reflux symptom score

“…A well‐defined rating system for frequency is important because the rating of symptoms with a classic visual analog scale remains subjective and may depend on many sociocultural factors . According to a recent analysis of LPR symptoms and outcomes, the subjectivity in symptom rating as well as the lack of consideration of many common symptoms in some PRO questionnaires could partly explain the inconsistencies between studies about the superiority of PPI over placebo in LPR disease . The development of the RSS incorporated these two important points to obtain a reliable clinical PRO questionnaire.…”

“…The therapeutic algorithm was based on recent recommendations of our LPR Study Group. 4 According to the MII-pH data and the reflux profile (acid, nonacid, mixed), patients were treated with a personalized treatment scheme including diet, behavioral changes, and use of PPIs (pantoprazole, 20 mg twice daily) AE alginate (Gaviscon Advance; Reckitt Benckiser, Slough, UK) AE magaldrate (Riopan; Takeda, Zaventem, Belgium). Each The questionnaire is subdivided into three parts according to the complaints: ear, nose and throat (part 1, 9 items), digestive (part 2, 9 items), and respiratory (part 3, 4 items) symptoms.…”

“…LPR‐related symptoms are found in approximately 10% of outpatients visiting ear, nose, and throat (ENT) departments and up to 75% of patients with refractory ENT symptoms . The majority of symptoms are nonspecific, including globus sensation, cough, throat clearing, hoarseness, and throat pain . In addition, fiberoptic examination usually identifies nonspecific laryngeal and extralaryngeal findings; the most common are posterior commissure hypertrophy, laryngeal and pharyngeal erythema, and retrocricoid hypertrophy .…”

“…2,3 The majority of symptoms are nonspecific, including globus sensation, cough, throat clearing, hoarseness, and throat pain. 4,5 In addition, fiberoptic examination usually identifies nonspecific laryngeal and extralaryngeal findings; the most common are posterior commissure hypertrophy, laryngeal and pharyngeal erythema, and retrocricoid hypertrophy. [5][6][7] The nonspecificity of both symptoms and findings makes the clinical diagnosis uncertain, and follow-up can be difficult.…”

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

“…The U.S. version of RSS is described in Figure . According to the MII‐pH reflux characteristics (acid, nonacid, mixed), patients were treated with personalized treatment scheme including diet and behavioral changes associated with pantoprazole (20 mg twice daily) ± alginate (twice or thrice daily) …”