Laryngopharyngeal Reflux: Trends in Diagnostic Interpretation Criteria

Abstract

Laryngopharyngeal reflux (LPR) is becoming recognized as a clinical entity with a variety of presentations distinct from those of gastroesophreflux disease (GERD). However, much uncertainty remains as to what is considered pathologic versus physiologic reflux. The aim of the study was to determine the normal range of pharyngeal reflux (PR) occurring in healthy adults based on pH-monitoring parameters utilized in the DeMeester scoring system for GERD. We have reviewed the current pool of prospective literature examining ambulatory dual-channel pH-monitoring study data derived from hypopharyngeal proximal probes in normal adults. From our review we have identified trends in several monitoring parameters based on the DeMeester scoring system for GERD. Our discussion recognizes and accepts the limitations imposed by small sample sizes and the number of healthy individuals that would be required to determine the general adult physiologic range of PR. We also explore the possible need for separate normal PR reference intervals based on age or gender disparities. Additional discussion and the summary address future directions for LPR research notably, (1) identification of the most appropriate research paradigm for LPR (i.e., pH 4 vs. 5), (2) establishing reproducibility for the appropriate LPR research paradigm, and (3) complementary modalities to ambulatory dual-channel pH monitoring for the study of acid and nonacid bolus movement within the esophagus

Laryngopharyngeal reflux in patients with reflux esophagitis

“…The role of GERD in causing extraesophageal symptoms is also increasingly being recognized [4] . Chronic laryngeal signs and symptoms associated with GERD are often referred to as reflux laryngitis or laryngopharyngeal reflux (LPR) [5] . But, not all episodes of GERD are associated with LPR and not all patients with LPR have typical features of GERD [6] .…”

Normal values in ambulatory oesophageal pH monitoring at two levels in Spain

“…For the study of patients with extra-oesophageal syndromes, different placements of the pH electrode have been employed: upper oesophagus (11,19,20), UOS (6,9), trachea (21,22), pharynx (5.11,23,24), oropharynx (25) or simultaneously in the upper oesophagus and pharynx (26), considering that for an improved assessment, the proximal pH electrode should be placed as close as possible to the organ in question (larynx or pharynx) (9,24). To date no comparisons have been established in this respect in normal subjects (11,23,24) but in those with laryngitis (27).…”

“…To date no comparisons have been established in this respect in normal subjects (11,23,24) but in those with laryngitis (27). The use of probes with two electrodes 15 cm apart allows individual adjustment of the proximal electrode using the distal electrode only for identifying the pseudoreflux events (9).…”

“…the relatively large volume of the hypopharynx (9,24,26,28). Although some authors reported that artefacts at this level are usually of short duration and their exclusion has little effect on overall outcome (5), manual review is encouraged.…”

Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

“…En general se considera como patológica, la exposición de la mucosa laríngea a un pH <4, sin embargo, existe controversia al respecto. No existe consenso claro respecto a cuántos eventos con 26,33 . La patogenia del RFL incluye eventos de reflujo no ácido.…”