How I Approach Laryngopharyngoesophageal Reflux (LPR)

Stabenau, Kaleigh A; Johnston, Nikki

doi:10.1007/s11894-021-00823-4

Cited by 3 publications

(3 citation statements)

References 67 publications

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“…The most common among gastrointestinal diagnoses, GERD affects nearly a third of the population of Western countries and the prevalence is increasing 1–3 . While heartburn is the typical indicator symptom, laryngopharyngeal manifestations also occur in up to 40% of patients 4,5 . GERD symptoms and sequelae cause considerable morbidity including significant reductions in quality of life, overall work productivity, and activity impairment and contribute to substantial medication use and costs 2 .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] While heartburn is the typical indicator symptom, laryngopharyngeal manifestations also occur in up to 40% of patients. 4,5 GERD symptoms and sequelae cause considerable morbidity including significant reductions in quality of life, overall work productivity, and activity impairment and contribute to substantial medication use and costs. 2 GERD accounts for $15-20 billion annual direct and indirect costs in the United States (US) alone with >$12 billion spent on acidsuppressing drugs each year.…”

Section: Introductionmentioning

confidence: 99%

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Alginates for Protection Against Pepsin‐Acid Induced Aerodigestive Epithelial Barrier Disruption

et al. 2022

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Objective Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are chronic conditions caused by backflow of gastric and duodenal contents into the esophagus and proximal aerodigestive tract, respectively. Mucosal barrier dysfunction resultant from the synergistic actions of chemical injury and the mucosal inflammatory response during reflux contributes to symptom perception. Alginates effectively treat symptoms of mild to moderate GERD and have recently shown benefit for LPR. In addition to forming a “raft” over gastric contents to reduce acidic reflux episodes, alginates have been found to bind the esophageal mucosa thereby preserving functional barrier integrity measured by transepithelial electrical resistance. The aim of this study was to further examine the topical protective capacity of alginate‐based Gaviscon Advance (GA) and Double Action (GDA) against pepsin‐acid mediated aerodigestive epithelial barrier dysfunction in vitro. Study Design Translational. Methods Immortalized human esophageal and vocal cord epithelial cells cultured in transwells were pretreated with liquid formula GA, GDA, matched viscous placebo solution, or saline (control), then treated for 1 h with saline, acid (pH 3–6) or pepsin (0.1–1 mg/ml) at pH 3–6. Endpoint measure was taken of horseradish peroxidase (HRP) allowed to diffuse across monolayers for 2 h. Results Pepsin (0.1‐1 mg/ml) at pH 3‐6 increased HRP flux through cultures pretreated with saline or placebo (p < 0.05); acid alone did not. GA and GDA prevented barrier dysfunction. Conclusions GA and GDA preserved epithelial barrier function during pepsin‐acid insult better than placebo suggesting that protection was due to alginate. These data support topical protection as a therapeutic approach to GERD and LPR. Laryngoscope, 132:2327–2334, 2022

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Alginates for Protection Against Pepsin‐Acid Induced Aerodigestive Epithelial Barrier Disruption

et al. 2022

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“…Only soft palate erythema had a statistically significant higher incidence in subgroup A PEP + compared to subgroup A PEP −. Therefore, pepsin does not appear to be directly correlated with dental erosion, despite the important role it plays in the pathophysiology of mucosal damage [ 21 ]. Conversely, salivary changes related to LPR could be associated with dental erosions and caries.…”

Section: Discussionmentioning

confidence: 99%

Dental Disorders and Salivary Changes in Patients with Laryngopharyngeal Reflux

Casciaro¹,

Gelardi

Giancaspro

et al. 2022

Diagnostics

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Background: Laryngopharyngeal reflux (LPR) is a common inflammatory condition of the upper aerodigestive tract tissues related to the effects of gastroduodenal content reflux, characterized by a wide variety of clinical manifestations. The aim of our study was to evaluate the possible association between dental disorders and LRP, focusing on the role of salivary changes. Methods: Patient’s dental status was evaluated according to Schiff Index Sensitivity Scale (SISS), Basic Erosive Wear Examination (BEWE) and Decayed, Missing, and Filled Teeth (DMFT) scores. Reflux-associated symptoms were assessed according to Reflux symptom index (RSI). A qualitative and quantitative examination of saliva was performed. Results: Patients suffering from LPR had a higher incidence of dental disorders, regardless the presence of salivary pepsin, and thus, statistically significant higher scores of RSI (p = 0.0001), SISS (p = 0.001), BEWE (p < 0.001) and VAS (p < 0.001). Moreover, they had lower salivary flow compared with healthy patients. Conclusions: The finding of demineralization and dental caries on intraoral evaluation must raise the suspicion of LRP. Reflux treatments should also be aimed at correcting salivary alterations, in order to preserve the buffering capacity and salivary pH, thus preventing mucosal and dental damage.

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