Laryngopharyngeal reflux and autonomic nerve dysfunction: what about stress?

Lechien, Jérôme R.; Kumar, Radhika; Chiesa‐Estomba, Carlos Miguel

doi:10.1007/s00405-019-05567-6

Cited by 10 publications

(12 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A few data are available in the literature about the resistance to treatment. Pisegna et al reported that the lack of therapeutic compliance is probably one of the most important cause, 45 but many other factors would be involved including autonomic nerve dysfunction, 46,47 or genetic make-up (drug metabolism, sphincter functioning, etc.). 48 This variability between laryngologists and non-laryngologists is in line with the lack of consensus or validated therapeutic algorithm for the management of patients with recalcitrant LPR.…”

Section: Discussionmentioning

confidence: 99%

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objective To investigate current practices of laryngologists and non‐laryngologists in management of Laryngopharyngeal Reflux (LPR). Methods An online survey was sent to members of otolaryngology societies about LPR, and subgroup analysis was performed between laryngologists and non‐laryngologists. This survey was conducted by the LPR Study Group of Young Otolaryngologists of the International Federation of Otolaryngological Societies. Results A total of 535 otolaryngologists completed the survey. Among them, 127 were laryngologists and 408 were non‐laryngologists. Collectively, symptoms most commonly attributed to LPR are cough after lying down/meal, throat clearing, and acid brash; most common findings are thought to be arytenoid erythema and posterior commissure hypertrophy. Respectively, 12.5% and 5% of non‐laryngologists and laryngologists believe that ≥50% of LPR patients suffer from heartburn (P = .010). Non‐laryngologists are more aware about some extra‐laryngeal findings associated with LPR (eg, pharyngeal erythema) than laryngologists. Neither laryngologists nor non‐laryngologists associated development of benign lesions of the vocal folds with reflux. The management of LPR substantially differs between groups, with laryngologists indicating increased awareness of (impedance)‐pH monitoring as well as the prevalence and treatment of nonacid/mixed LPR. Conversely, non‐laryngologists are much more likely to include gastroenterology referral in their management of presumed LPR. Respectively, 44.8% and 27.6% of non‐laryngologists and laryngologists believe themselves not sufficiently knowledgeable about LPR. Conclusions Significant differences exist between laryngologists and non‐laryngologists in diagnosis and treatment of LPR. Overall only one‐third of responders believe themselves to be sufficiently educated about LPR. Level of Evidence 4 Laryngoscope, 130:E539–E547, 2020

show abstract

Section: Discussionmentioning

confidence: 99%

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Over the past few decades, the empirical therapeutic trial based on proton pump inhibitors (PPIs) was proposed as the main cost-effective approach to treat and support the LPR diagnosis [71][72][73][74][75][76][77][78][79][80][81][82][83][84]. Nowadays, this approach is increasingly challenged for many reasons [64,75].…”

Section: Cost-effective Empirical Approachmentioning

confidence: 99%

“…In that way, the physician could have a critical role in strengthening the relevance of diet in both the suspected and confirmed LPR disease. Because LPR is often due to diet habits [80,81] and stress [82], the primary care physician has a key role in alerting the patient about these favoring factors and preventing recurrence or chronicity of the disease. Some scores assessing the refluxogenic potential of diet were developed [83,84] and, through a mobile phone app, could be useful for patients in the choice of their favorite foods.…”

Section: Cost-effective Empirical Approachmentioning

confidence: 99%

“…The awareness of patients regarding the importance of diet is crucial in the short to long-term management of LPR and the role of the primary care physician is crucial. Similar findings have to be considered for the management of stress and anxiety, which both lead to autonomic nerve dysfunction and transient esophageal sphincter relaxation [35,36,82]. A practical algorithm of management of LPR by primary care physician is proposed in Figure 2.…”

Section: Cost-effective Empirical Approachmentioning

confidence: 99%

See 1 more Smart Citation

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

Lechien

Saussez

Muls

et al. 2020

JCM

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Because some LPR-related symptoms could be associated with stress (autonomic nerve dysfunction), 24,25 the stress of patients was assessed at baseline through a visual analog scale (0 = no stress over the last month; 10 = important stress negatively impacting sleep).…”

Section: Evaluation Of Symptoms and Findingsmentioning

confidence: 99%

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

Lechien¹,

Bobin²,

Muls

et al. 2020

The Laryngoscope

Self Cite

View full text Add to dashboard Cite

Objectives/Hypothesis: To assess the evolution of laryngeal and extralaryngeal symptoms and findings of laryngopharyngeal reflux (LPR) throughout a 3-month to 9-month treatment.Study Design: Prospective Controlled Study. Methods: One hundred twenty-seven LPR patients and 123 healthy individuals were enrolled from four European hospitals. Patients were managed with a 3-month personalized treatment considering the LPR characteristics at the impedance-pH monitoring. Regarding the clinical therapeutic response, treatment was adapted for 3 to 6 additional months. Symptoms and findings were assessed throughout the therapeutic course with the Reflux Symptom Score (RSS) and the short version of the Reflux Sign Assessment (sRSA). The relationship between patient and reflux characteristics, symptoms, and findings was assessed.Results: One hundred twenty-one LPR patients completed the study. LPR patients exhibited more laryngeal and extralaryngeal symptoms and findings than healthy individuals. RSS significantly improved from baseline to 6 weeks posttreatment and continued to improve from 3 months to 6 months posttreatment. sRSA significantly improved from baseline to 3 months posttreatment. No further improvement was noted at 6 months posttreatment for pharyngeal and oral findings. Laryngeal findings continued to improve from 3 months to 6 months posttreatment. There was a significant association between patient stress level and RSS (P = .045). At 3 months posttreatment, 28.1% of patients had high or complete response, whereas 47.1% required 6 months or 9 months of treatment. Overall, 24.8% of patients had an LPR chronic course.Conclusions: Laryngeal and extralaryngeal symptoms and findings significantly improved throughout treatment in LPR patients. The improvement of laryngeal findings was slower. Regarding the low prevalence of some digestive or otolaryngological symptoms, a short version of the RSS could be developed.

show abstract

Laryngopharyngeal reflux and autonomic nerve dysfunction: what about stress?

Cited by 10 publications

References 13 publications

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

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

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

Contact Info

Product

Resources

About