Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux

Agrawal, Neelima; Yadlapati, Rena; Shabeeb, Nadine; Price, Caroline P.E.; Lidder, Alcina K.; Smith, Stephanie Shintani; Bové, Michiel; Pandolfino, John E.; Tan, Brandon

doi:10.1093/dote/doy072

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…These results support the further consideration of oral and pharyngeal findings in the clinical evaluation of LPR patients at baseline (clinical diagnosis) and throughout treatment. Similar conclusions have been made in the study by Agrawal et al, who, however, did not formally investigate the evolution of extralaryngeal findings throughout treatment 34 . Moreover, the improvement of findings seems to vary with regard to the anatomical area and probably the histological pattern of mucosa.…”

Section: Discussionsupporting

confidence: 71%

“…Similar conclusions have been made in the study by Agrawal et al, who, however, did not formally investigate the evolution of extralaryngeal findings throughout treatment. 34 Moreover, the improvement of findings seems to vary with regard to the anatomical area and probably the histological pattern of mucosa. Laryngeal findings improve more slowly than extralaryngeal findings, which have been underexplored in LPR.…”

Section: Discussionmentioning

confidence: 99%

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

Lechien¹,

Bobin²,

Muls

et al. 2020

The Laryngoscope

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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.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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

Lechien¹,

Bobin²,

Muls

et al. 2020

The Laryngoscope

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“…The search identified 1355 relevant papers, of which 76 studies met the inclusion criteria, accounting for 6457 patients. A total of 64 studies consisted of empirical therapeutic trials (Table 1)[8-72], and 12 were studies where authors formally identified LPRD with pH-monitoring ( n = 10) or MII-pH ( n = 2) (Table 2)[40,56,60,73-83].…”

Section: Resultsmentioning

confidence: 99%

Treatment of laryngopharyngeal reflux disease: A systematic review

Lechien¹,

Mouawad²,

Barillari³

et al. 2019

WJCC

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BACKGROUNGFor a long time, laryngopharyngeal reflux disease (LPRD) has been treated by proton pump inhibitors (PPIs) with an uncertain success rate.AIMTo shed light the current therapeutic strategies used for LPRD in order to analysis the rationale in the LPRD treatment.METHODSThree authors conducted a PubMed search to identify papers published between January 1990 and February 2019 about the treatment of LPRD. Clinical prospective or retrospective studies had to explore the impact of medical treatment(s) on the clinical presentation of suspected or confirmed LPRD. The criteria for considering studies for the review were based on the population, intervention, comparison, and outcome framework.RESULTSThe search identified 1355 relevant papers, of which 76 studies met the inclusion criteria, accounting for 6457 patients. A total of 64 studies consisted of empirical therapeutic trials and 12 were studies where authors formally identified LPRD with pH-monitoring or multichannel intraluminal impedance-pH monitoring (MII-pH). The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk. The most used PPIs were omeprazole, esomeprazole, rabeprazole, lansoprazole and pantoprazole with a success rate ranging from 18% to 87%. Other composite treatments have been prescribed including PPIs, alginate, prokinetics, and H2 Receptor antagonists.CONCLUSIONRegarding the development of MII-pH and the identification of LPRD subtypes (acid, nonacid, mixed), future studies are needed to improve the LPRD treatment considering all subtypes of reflux.

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“…Another study focused on the correlation results of laryngopharyngeal pH testing and clinical findings during laryngoscopy. A significant correlation could not be found, however again only a small number of patients ( n = 33) was included in the study and trends approaching statistical significance were noted[ 27 ]. In addition, Yadlapati et al [ 28 ] investigated the correlation between laryngopharyngeal pH testing and PPI response and found no significant correlation.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal function testing model using a new laryngopharyngeal pH probe (Restech) in patients after Ivor-Lewis esophagectomy

Babic¹,

Müller²,

Gebauer³

et al. 2021

WJGO

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BACKGROUND There is no established correlation between 24-h esophageal pH-metry (Eso-pH) and the new laryngopharyngeal pH-monitoring system (Restech) as only small case series exist. Eso-pH was not designed to detect laryngopharyngeal reflux (LPR) and Restech may detect LPR better. We have previously published a dataset using the two techniques in a large patient collective with gastroesophageal reflux disease. Anatomically, patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists. AIM To use a human reflux model to examine our previously published correlation in these patients. METHODS Patients after Ivor Lewis esophagectomy underwent our routine follow-up program with surveillance endoscopies, computed tomography scans and further exams following surgery. Only patients with a complete check-up program and reflux symptoms were offered inclusion into this prospective study and evaluated using Restech and simultaneous Eso-pH. Subsequently, the relationship between the two techniques was evaluated RESULTS A total of 43 patients from May 2016 - November 2018 were included. All patients presented with mainly typical reflux symptoms such as heartburn (74%), regurgitation (84%), chest pain (58%), and dysphagia (47%). Extraesophageal symptoms such as cough, hoarseness, asthma symptoms, and globus sensation were also present. Esophageal 24-hour pH-metry was abnormal in 88% of patients with a mean DeMeester Score of 229.45 [range 26.4-319.5]. Restech evaluation was abnormal in 61% of cases in this highly selective patient cohort. All patients with abnormal supine LPR were also abnormal for supine esophageal reflux measured by conventional Eso-pH. CONCLUSION Patients following esophagectomy and reconstruction with gastric interposition can ideally serve as a human reflux model. Interestingly, laryngopharyngeal reflux phases occur mainly in the upright position. In this human volume-reflux model, results of simultaneous esophageal and laryngopharyngeal (Restech) pH-metry showed 100% correlation as being explicable by one of our reflux scenarios.

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Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux

Cited by 16 publications

References 25 publications

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

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

Treatment of laryngopharyngeal reflux disease: A systematic review

Gastrointestinal function testing model using a new laryngopharyngeal pH probe (Restech) in patients after Ivor-Lewis esophagectomy

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