The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Lechien, Jérôme R.; Muls, Vinciane; Dapri, Giovanni; Mouawad, F.; Eisendrath, Pierre; Schindler, Antonio; Nacci, Andrea; Barillari, Maria Rosaria; Finck, Camille; Saussez, Sven; Akst, Lee M.; Sataloff, Robert T.

doi:10.1111/coa.13395

Cited by 40 publications

(43 citation statements)

References 81 publications

(141 reference statements)

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“…This therapeutic approach is however associated with an uncertain success rate and, depending of the therapeutic outcomes used, a significant number of patients are found to be resistant to treatment. According to a recent systematic review, the non-response rate would be close to 40% of patients[85]. The critical analysis of the different therapeutic schemes and their related success rate has to consider the respective pharmacological properties of the drugs used.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Treatment of laryngopharyngeal reflux disease: A systematic review

Lechien¹,

Mouawad²,

Barillari³

et al. 2019

WJCC

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“…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. In that way, our study group has recently proposed a clinical algorithm for the management of these patients, 49 but future studies are needed to confirm its reliability.…”

Section: Discussionmentioning

confidence: 99%

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

et al. 2020

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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

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“…The most prevalent symptoms associated with LPR are globus sensation, throat clearing, hoarseness, excess throat mucus or postnasal drip [2,12,40]. These symptoms, which are commonly observed in primary care medicine, are nonspecific and may be associated with active laryngopharyngeal allergy [2], rhinitis [41], chronic rhinosinusitis [42], smoking [43], alcohol abuse [44] and benign laryngopharyngeal infections [45]. In other words, it is difficult to diagnose LPR only based on symptoms [46,47].…”

Section: Symptomsmentioning

confidence: 99%

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

Lechien

Saussez

Muls

et al. 2020

JCM

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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.

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The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Cited by 40 publications

References 81 publications

Treatment of laryngopharyngeal reflux disease: A systematic review

Treatment of laryngopharyngeal reflux disease: A systematic review

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

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

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