Model to Select On-Therapy vs Off-Therapy Tests for Patients With Refractory Esophageal or Extraesophageal Symptoms

Patel, Dhyanesh A.; Sharda, Rohit; Choksi, Yash A.; Slaughter, James C.; Higginbotham, Tina; Garrett, C. Gaelyn; Francis, David O.; Ravi, Karthik; Hasak, Stephen; Katzka, David A.; Gyawali, C. Prakash; Vaezi, Michael F.

doi:10.1053/j.gastro.2018.08.038

Cited by 27 publications

(19 citation statements)

References 24 publications

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“…Nizatidine also increases basal lower oesophageal sphincter pressure, reduces post‐prandial TLOSRs and reduces the rate of acid reflux during TLOSRs in healthy subjects . Patients with erosive reflux oesophagitis, heartburn, asthma or significant hiatus hernias (>2 cm), factors known to be associated with increased oesophageal acid exposure, may still benefit from taking PPIs. However, patients with DGE without these risk factors often fare better on nizatidine.…”

Section: Discussionmentioning

confidence: 99%

Observational cohort study: Getting to the bottom of laryngopharyngeal reflux—It’s a motility disorder and not just about the acid

et al. 2019

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Summary Background Laryngopharyngeal reflux (LPR) has been linked with irritable bowel syndrome (IBS). Functional colonic, upper gastrointestinal (GI) and LPR symptoms often coexist and all improve with osmotic laxative therapy. Reflux scintigraphy demonstrates direct contamination of the airway by refluxate. Aims Evaluate the clinical utility of reflux scintigraphy in managing LPR. Assess the effect of osmotic laxatives combined with acid suppression on both functional GI and LPR symptoms. Methods Forty consecutive patients referred over 6 months with functional colonic symptoms and significant LPR with a reflux symptom index (RSI)> 13 were followed prospectively. All patients underwent pre‐treatment reflux scintigraphy and gastroscopy with assessment of their reflux finding score (RFS). RSI and RFS were reassessed at ENT follow‐up at a median of 5 months. Functional GI symptoms and RSI were reassessed at a median of 17 months. Results Thirty‐nine of 40 (97.5%) demonstrated reflux into their oropharynx on reflux scintigraphy. The majority had minimal typical reflux symptoms (55%) and their LPR was refractory to acid suppression alone (62.5%). Short‐term combination therapy reduced both the RSI (22.6‐17.2, P < .01) and RFS (12.3‐7.7, P < .01). Longer term treatment reduced the RSI further (22.6‐9.2, P < .01) correlating strongly with improvement in functional GI symptoms. Conclusions LPR occurs frequently amongst IBS patients without typical reflux symptoms. Reflux scintigraphy is useful to both diagnose and optimise treatment of LPR. Reducing colonic distension with osmotic laxatives improves both functional GI and LPR symptoms.

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Section: Discussionmentioning

confidence: 99%

Observational cohort study: Getting to the bottom of laryngopharyngeal reflux—It’s a motility disorder and not just about the acid

et al. 2019

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“…The development of a future clinical model to estimate the pretest probability of abnormal pH among patients who failed PPI therapy could improve the diagnosis approach. 153…”

Section: Implications For Practicementioning

confidence: 99%

“…The development of a future clinical model to estimate the pretest probability of abnormal pH among patients who failed PPI therapy could improve the diagnosis approach. 153 According to the LPR profile and the clinical manifestation, a personalized treatment can be proposed. Diet and lifestyle changes should be considered as the first step of treatment and could be sufficient to treat mild LPR.…”

Section: Implications For Practicementioning

confidence: 99%

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

Lechien¹,

Akst

Hamdan

et al. 2019

Otolaryngol.--head neck surg.

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254

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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.

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“…Symptoms of GERD vary widely; esophageal symptoms such as heartburn and regurgitation are the most characteristic features, while gastrointestinal symptoms such as dyspepsia, epigastric pain, and somatoform disorder may also occur [3031323334353637383940414243]. Extraesophageal symptoms include cough, hoarseness, globus, and shortness of breath, and they may be associated with reflux cough syndrome, reflux laryngitis syndrome, reflux asthma syndrome, and reflux dental erosion syndrome [28444546474849505152].…”

Section: Resultsmentioning

confidence: 99%

Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018

et al. 2018

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The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea, and physicians, including surgeons, have been focusing on its treatment. Indeed, in Korea, medical treatment using a proton pump inhibitor is the mainstream treatment for GERD, while awareness of surgical treatment is limited. Accordingly, to promote the understanding of surgical treatment for GERD, the Korean Anti-Reflux Surgery Study Group published the Evidence-Based Practice Guideline for the Surgical Treatment of GERD. The guideline consists of 2 sections: fundamental information such as the definition, symptoms, and diagnostic tools of GERD and a recommendation statement about its surgical treatment. The recommendations presented 5 debates regarding fundoplication: 1) comparison of the effectiveness of medical and surgical treatments, 2) effectiveness of surgical treatment in cases of refractory GERD, 3) effectiveness of surgical treatment of extraesophageal symptoms, 4) comparison of effectiveness between total and partial fundoplication, and 5) effectiveness of fundoplication in cases of hiatal hernia. The present guideline is the first to demonstrate the efficacy of the surgical treatment GERD in Korea.

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Model to Select On-Therapy vs Off-Therapy Tests for Patients With Refractory Esophageal or Extraesophageal Symptoms

Cited by 27 publications

References 24 publications

Observational cohort study: Getting to the bottom of laryngopharyngeal reflux—It’s a motility disorder and not just about the acid

Observational cohort study: Getting to the bottom of laryngopharyngeal reflux—It’s a motility disorder and not just about the acid

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

Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018

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