Trends in laryngopharyngeal reflux: a British ENT survey

Abstract

There is a lot of scepticism surrounding laryngopharyngeal reflux (LPR). Symptoms such as globus pharyngeus, constant throat clearing, chronic cough, idiopathic hoarseness, catarrh and choking episodes may be reflux-related. The aim of this survey was to highlight current treatment trends in LPR. Questionnaires were emailed to 260 members of the British Academy of Otolaryngology-Head and Neck surgery (BAO-HNS). Survey recipients were asked about type, duration and dose of antireflux treatment and length of follow-up appointments, if any. Finally, they were asked about awareness of any reflux symptom and reflux sign questionnaires. Survey response rate was 60%. The vast majority of the otolaryngologists surveyed believe in laryngopharyngeal reflux (90%) and more than 50% prescribe proton pump inhibitors (PPIs). The preferred duration of treatment is 2 months (37%). Only a minority will prescribe PPIs for 6 months or more. Most otolaryngologists will give the standard GORD dose (70%) (once daily) and only a few (20%) will prescribe more aggressive and prolonged doses. The commonest symptoms for which proton pump inhibitors are prescribed are globus (73%), followed by choking episodes (66%) and chronic cough (62%). If LPR is suspected, most of the otolaryngologists will follow-up the patients (61%) and approximately one third (31%) will discharge them back to the general practitioners. Only eight-percent 8% will refer to gastroenterologists. The three commonest laryngoscopic signs that makes them suspect LPR are erythema of the arytenoids (86%) or the vocal cords (57%) and granulomas (42%). The majority of the otolaryngologists (94%) do not use popular questionnaires such as the RFS or RSI. Despite the controversy surrounding laryngopharyngeal reflux, our results suggest that the majority of the otolaryngologists surveyed believe in LPR and attempt to treat it. Interesting findings are: the duration of treatment, the doses used, the length of follow-ups or the lack of, and the fact that the majority does not request any specific diagnostic tests. "symptoms and signs" questionnaires are rarely used.

Prospective, observational study using rabeprazole in 455 patients with laryngopharyngeal reflux disease

“…Proton pump inhibitors (PPIs) play an important role in medical treatment of LPRD, and prescriptions for PPIs have increased over tenfold since 1990 [2,9]. Many otolaryngologists believe that LPRD is a genuine condition and attempt to treat with empirical PPI [10]. Although one of generally recommended treatment regimen has been proton pump inhibitors (PPIs), some published therapeutic trials of PPI in laryngitis were uncontrolled [9,11].…”

Review: Current Trends in the Diagnosis and Management of Globus Pharyngeus

“…Interestingly, in the recent survey of ENT consultant in the UK, 94% did not use popular scoring scales such as the reflux symptom index or the reflux finding score [29]. This finding raises questions regarding the application of these scoring scales in clinical practice.…”

“…A survey of general practitioners in 2005 showed the vast majority were unaware of laryngopharyngeal reflux (LPR) and its association with globus pharyngeus [28]. Conversely, in a recent survey of ENT consultants in the UK, 90% believed in laryngopharyngeal reflux and greater than 50% prescribed proton pump inhibitors (PPI's) for the treatment of this [29]. The regimen used varied within this survey, with most prescribing once daily PPI.…”

Role of flexible transnasal esophagoscopy and patient education in the management of globus pharyngeus

“…18 Globus is considered a symptom of laryngopharyngeal reflux and is part of the Reflux Symptom Index described by Belafsky et al 19 There is no standard protocol for managing this condition; and no controlled studies have evaluated the use of PPIs specifically for globus pharyngeus, although it is the primary symptom for which PPIs are prescribed. 20 Any improvement that does occur in laryngopharyngeal symptoms after acid-suppression therapy has been shown to be slower than that in esophageal symptoms. 20 Furthermore, several reports have asserted that most pharyngeal symptoms benefit very little from treatment with PPIs, probably because of the multifactorial etiology involved.…”

“…20 Any improvement that does occur in laryngopharyngeal symptoms after acid-suppression therapy has been shown to be slower than that in esophageal symptoms. 20 Furthermore, several reports have asserted that most pharyngeal symptoms benefit very little from treatment with PPIs, probably because of the multifactorial etiology involved. 21e23 A review of the literature concluded that randomized, controlled trials showed no significant improvement in the symptoms of laryngopharyngeal reflux after treatment with PPIs.…”