Alkaline, protein, low‐fat and low‐acid diet in laryngopharyngeal reflux disease: Our experience on 65 patients

Lechien, Jérôme R.; Huet, Kathy; Khalifé, Mohamad; Marrez, Lisa G. De; Finck, Camille; Harmegnies, Bernard; Saussez, Sven

doi:10.1111/coa.13269

Cited by 42 publications

(41 citation statements)

References 11 publications

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“…In conclusion, although there are many published studies about LPR, only a few authors have addressed non‐responder patients with confirmed or suspected diagnostic. Provided that LPR diagnosis is accurate and treatment appropriate, there are still myriad potential issues that might lead LPR patients to be truly resistant to treatment—for instance, cofactors might include hiatal hernia, oesophageal sphincter insufficiency, diet, non‐acid/mixed LPR, heterotopic gastric mucosa such as inlet patch, oesophageal visceral hypersensitivity, vagally mediated laryngeal reflexes, etc). Although there are only a few studies that have been done, these factors should be considered in future studies to improve knowledge about resistance to treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Lechien

Muls

Dapri

et al. 2019

Clinical Otolaryngology

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Objective: To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. Methods:A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated.Results: Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did | 785 LECHIEN Et aL

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Section: Discussionmentioning

confidence: 99%

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

Lechien

Muls

Dapri

et al. 2019

Clinical Otolaryngology

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“…According to the MII‐pH data and the reflux profile (acid, nonacid, mixed), patients were treated with a personalized treatment scheme including diet, behavioral changes, and use of PPIs (pantoprazole, 20 mg twice daily) ± alginate (Gaviscon Advance; Reckitt Benckiser, Slough, UK) ± magaldrate (Riopan; Takeda, Zaventem, Belgium). Each patient received a validated grid with diet recommendations and behavior changes, which took into account the patient's personalized habits . The therapeutic effectiveness was assessed for each patient by the RSS after 6 and 12 weeks of treatment.…”

Section: Methodsmentioning

confidence: 99%

“…patient received a validated grid with diet recommendations and behavior changes, which took into account the patient's personalized habits. 19 The therapeutic effectiveness was assessed for each patient by the RSS after 6 and 12 weeks of treatment.…”

Section: Subjects and Settingmentioning

confidence: 99%

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Validity and reliability of the reflux symptom score

Lechien¹,

Bobin²,

et al. 2019

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Objectives/Hypothesis To develop and validate the Reflux Symptom Score (RSS), a self‐administered patient‐reported outcome questionnaire for patients with laryngopharyngeal reflux (LPR). Study Design Prospective controlled study. Methods A total of 113 patients with LPR were enrolled and treated with diet and 3 months of pantoprazole, alginate, and/or magaldrate depending on the LPR characteristics (acid, nonacid, or mixed). Eighty asymptomatic individuals completed the study. Patients and controls completed the RSS twice within a 7‐day period to assess test‐retest reliability. Internal consistency was measured using Cronbach's α for the RSS items in patients and controls. Validity was assessed by comparing the baseline RSS with the Reflux Symptom Index (RSI) and Voice Handicap Index (VHI). Seventy‐seven patients completed the RSS at baseline and after 6 and 12 weeks of treatment to assess responsiveness to change. The RSS cutoff for determining the presence and absence of LPR was examined by receiver operating characteristic analysis. Results Test‐retest reliability (rs = 0.921) and internal consistency reliability (α = 0.969) were high. RSS exhibited high external validity indicated by a significant correlation with the RSI (rs = 0.831). Internal validity was excellent based on the higher RSS in patients compared with controls (P = .001). RSS, RSI, and VHI scores significantly improved from pre‐ to posttreatment, indicating a high responsiveness to change. RSS >13 can be considered suggestive of LPR‐related symptoms. RSS was not influenced by the occurrence of gastroesophageal reflux disease, LPR subtypes, or patient characteristics. Conclusions RSS is a self‐administered patient‐reported outcome questionnaire that demonstrates high reliability and excellent criterion‐based validity. RSS can be used in diagnosing and monitoring LPR disease. Level of Evidence 3b Laryngoscope, 130:E98–E107, 2020

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“…In practice, 50.5% of both laryngologists and non-laryngologists recognize to just advise diet and behavioral changes for patients with mild LPR. This trend makes particular sense regarding the studies reporting a significant improvement of LPR symptoms or findings in patients treated by low-fat, high-protein, and alkaline diet [42][43][44] but, nowadays, there is no clear definition of "mild" LPR, and no clinical criteria for considering a diet versus a medical treatment for LPR patients. These two points require further clinical studies for developing cost-effective therapeutic approach for the management of LPR.…”

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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Alkaline, protein, low‐fat and low‐acid diet in laryngopharyngeal reflux disease: Our experience on 65 patients

Cited by 42 publications

References 11 publications

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

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

Validity and reliability of the reflux symptom score

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

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