Treatment of laryngopharyngeal reflux disease: A systematic review

Abstract

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.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…For this reason, various other treatments have been tested for a safer management of GERD or LPR. Alginate compounds have demonstrated, in various studies, an efficacy comparable to PPIs in the management of this disease with a comforting safety profile 705–707 . In particular, magnesium alginates showed interesting results in children with LPR and uncontrolled asthma, with a significant improvement of both reflux and airway related inflammation 708 .…”

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

“…The use of alginate or magaldrate is anecdotal although these drugs decrease acid reflux events during a critical time period corresponding to the first hour after the meals . The majority of authors considered fundoplication for resistant patients . However, many drugs have been studied in recalcitrant GERD but never or less used in LPR.…”

“…For voice professionals as well as patients with muscle tension dysphonia and LPR, the addition of voice therapy could also be considered in the second therapeutic line—understand that this may not impact LPR directly, but that improved vocal hygiene and reduced phonotrauma may lessen laryngeal inflammation through other mechanisms. Fundoplication could be considered for LPR patients who are resistant to all medical treatments or in patients with grade III or IV hiatal hernia according to the Hill classification but physicians would keep in mind that fundoplication may be associated with uncertain efficacy …”

Effects of Antiacid Therapy on Granuloma after Transoral Type IV-VI Cordectomy in Patients with Early-Stage Glottic Cancer

“…Unfortunately, the differences in the two indicators of TG severity between the two groups were not statistically significant, although we believe PPI treatment did alleviate the severity of TG. In this study, postoperative PPI was used for 12 weeks, referring to the antiacid duration 4-24 weeks in a medical routine of vocal process granulation and laryngopharyngeal reflux disease (J. R. Lechien's report in 2019 and Chinse experts consensus on diagnosis and treatment of laryngopharyngeal and reflux disease in 2015) [ 21 ]. The results showed that PPI could shorten the recovery time and potentially prevent severe complications.…”