Risk factors for laryngopharyngeal reflux

Abstract

The aim of this study was to evaluate the demographic and clinicopathologic characteristics of gastroesophageal reflux disease (GERD) with and without laryngopharyngeal reflux (LPR) to determine the risk factors for the occurrence of LPR in patients with GERD. This is a retrospective study of GERD patients with and without LPR. From the outpatient computer program of our hospital we randomly enrolled 45 GERD patients with LPR into the first group and another 45 GERD patients without LPR to the second group. Medical records of the patients in both groups were examined. All patients underwent upper gastrointestinal system endoscopy. LPR was confirmed by laryngoscopy, and LPR-related laryngoscopy scoring. Non-erosive GERD (NERD), erosive GERD (ERD) and Barrett's esophagus (BE) were diagnosed by endoscopy and histopathology. Various clinical parameters including status of Helicobacter pylori (H. pylori) infection, topography of gastritis were analyzed. For therapy, lansoprazole in a dosage of 30 mg BID for at least 8 weeks were given to all patients in both groups. GERD patients with and without LPR were compared according to demographic, clinic, endoscopic and histopathological parameters. The results revealed that patients with LPR were younger than the patients without LPR (38.7 ± 10.2 years and 43.8 ± 11.5 years; p = 0.08); however, there was no statistical significance. Patients without LPR showed no gender predilection (55% male) while LPR patients showed male preponderance (71% male). In LPR group, 11 patients (24%) had NERD, while 28 (62%) and 6 (13%) patients had ERD and BE, respectively. Twenty-seven (60%) patients without LPR were diagnosed as NERD, 15 patients (33%) without LPR had ERD and only 3 patients (6.6%) showed the histological findings of BE. The patients in LPR group had higher body mass index. Hiatal hernia was more frequent in the patients with LPR (53%) than in the patients without LPR (24%) (p = 0.005). LPR patients had longer duration of reflux symptoms than the patients without LPR (p = 0.04). H. pylori status was not different in both groups but the patients without LPR had more corpus gastritis than the patients with LPR. Eight weeks of lansoprazole treatment was successful in 71% of patients with LPR, and 86% of patients without LPR. We concluded that male gender, hiatal hernia, longer duration of symptoms, high BMI, having ERD and BE seems as risk factors for the occurrence of LPR in patients with GERD. H. pylori status did not have any effect on the development of LPR. Corpus dominant gastritis may have a protective role against the development of LPR. Proton pump inhibitor therapy is less effective in patients with LPR.

Higher levels of total pepsin and bile acids in the saliva as a possible risk factor for early laryngeal cancer

“…It is also known that alcohol intake increases the distal oesophagus exposure to acid reflux 17. High body mass index (BMI) and longer duration of re-flux symptoms are also risk factors for the occurrence of LPR 19. BMI data were not obtained from our participants, therefore we cannot discuss the role of BMI in the aetiology of LPR in our study.…”

Do body mass index and fat volume influence vocal quality, phonatory range, and aerodynamics in females?

“…The three weight groups also differed significantly in the RSI data, with the OB subjects scoring highest and the UW subjects lowest on laryngeal-pharyngeal reflux symptoms. Elevated RSI values in OB subjects is not uncommon in comparsion to lower weight groups (23) . However, like the age factor, the impact of these RSI findings on the experimental and voice-related data, was likely negligible because all RSI data were below the clinically significant threshold of RSI=13, that is, one of this study's inclusion criteria (10) .…”

Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

“…Additionally, the prevalence of GERD is 68% in patients with hiatal hernia[24,25]. Recent studies have shown that LPR is found in 70% of patients with GERD, 53% patients with GERD and LPR have hiatal hernia, and approximately 50% of patients with GERD and hernia have common symptoms of LPR[4,26]. In our study, we found that 67.7%-74.2% of patients with LPR and type I hiatal hernia had typical GERD symptoms, similar to a pervious study[26].…”

“…All of these clinical presentations of LPR are considered as extraesophageal symptoms for distinguishing typical symptoms of GERD, such as heartburn and regurgitation. The incidence rate of reflux-induced laryngitis ranges from 18%-80%[3,4]. The association between GERD and hiatal hernia has been well confirmed, including sliding hernia (type I), paraesophageal hernia (type II), and mixed hernia (types III and IV)[5].…”

“…The association between GERD and hiatal hernia has been well confirmed, including sliding hernia (type I), paraesophageal hernia (type II), and mixed hernia (types III and IV)[5]. Recently, evidence has suggested that hiatal hernia is one of the major risk factors for the occurrence of LPR in patients with GERD[4]. The management strategies for LPR, GERD, and type I hiatal hernia are similar, which involve controlling the occurrence of reflux and reducing reflux-induced symptoms.…”