Clinical aspects of laryngopharyngeal reflux

Angotoeva, I. B.; Schepkina, E.V.; Magomedova, M. M.

doi:10.18692/1810-4800-2022-1-19-26

2022

DOI: 10.18692/1810-4800-2022-1-19-26

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Clinical aspects of laryngopharyngeal reflux

I. B. Angotoeva¹,

E.V. Schepkina²,

M. M. Magomedova³

Abstract: Laryngopharyngeal reflux (LPR) as the cause of symptoms in the absence of symptomatic gastroesophageal reflux disease (GERD) is often questioned. But it is worth remembering that GERD is a whole complex of symptoms that occur when the mucous membrane is damaged. We aimed to study the clinical symptoms of LPR without esophageal symptoms. The study included 66 women and 34 men with complaints typical of LPR, aged 18 to 70. The study included patients with typical LPR complaints without esophageal symptoms who ra… Show more

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Analysis of the development dynamics of cough syndrome in acute nasopharyngitis with intoxication syndrome

Савлевич

Markus²,

Дорощенко

et al. 2023

Medicinskij sovet

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Introduction. Although acute cough in acute inflammatory diseases of the upper respiratory tract seems to be a minor problem and can be stopped on its own, it holds the leading position among all reasons for population receiving health care due to significant decrease in life quality.Purpose. To analyze the cough severity in patients with acute nasopharyngitis with intoxication syndrome in the treatment of systemic non-steroidal anti-inflammatory drugs (NSAIDs) and local interferon therapy.Materials and methods. The study included 62 patients with acute nasopharyngitis with intoxication syndrome, in the period from the onset of the first symptoms to the visit to the doctor was no more than 24 hours. They were divided into 2 groups: group 1 − 32 people (14 men, 18 women, age 34.4 ± 10.3 years) received traditional systemic therapy with NSAIDs, group 2 − 30 people (13 men, 17 women, age 41.1 ± 13.7 years) received interferon-α2b intranasally. Cough severity was assessed using a 3-point visual analog scale (VAS) on the day of admission and for the next 7 days.Results. On the 1st day dry cough was observed in 62.5–63.3% of cases. Starting from the 3rd day of observation, there were statistically significant differences in the intensity of this symptom between the groups. In the traditional therapy of NSAIDs, an increase in the number of patients with a complaint of cough, and an increase in its severity compared with the first day of observation was revealed. They lasted until the 6th day of illness, which was explained by the spread of the inflammatory process to the trachea and bronchi. In the treatment of local interferon therapy, cough regression was noted on day 4 in 83.3% of cases, with its complete disappearance in this group on day 6. The total duration of cough in group 1 was 6.0 (5.0; 8.0) days, in group 2 – 2.0 (1.0; 3.0) days.Conclusion. In acute inflammatory diseases of the upper respiratory tract, cough in the absence of prescribing drugs that affect this symptom persists on the eighth day of observation in 56.2% of patients with traditional therapy with systemic NSAIDs.

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Analysis of the development dynamics of cough syndrome in acute nasopharyngitis with intoxication syndrome

Савлевич

Markus²,

Дорощенко

et al. 2023

Medicinskij sovet

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On the issue of preoperative preparation of patients with chronic suppurative otitis media

2023

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Introduction. In the otosurgeon practice, there are often cases of exacerbation of chronic suppurative otitis media (CSOM) refractory to conservative therapy. The direct irritant effect of gastric contents due to the gastroesophageal reflux disease (GERD) often leads to alteration of the middle ear mucosa and persistence of the inflammation process.Aim. To substantiate the significance of GERD therapy in the treatment of CSOM exacerbation refractory to the standard conservative therapy protocols.Materials and methods. The study group included 42 patients aged 19 to 67 years (mean age 47.6 years), 13 men and 29 women, who received treatment and daily observations of the attending otorhinolaryngologist. Of these, 31 patients were users of oral nicotine products (chewing gum, smoking, tobacco heating systems). The conservative treatment of CSOM was carried out in accordance with the medical care standards and clinical guidelines as in force on the time of the treatment process. The conservative treatment of GERD was carried out in accordance with the clinical guidelines approved by the Russian Gastroenterological Association.Results and discussion. 25 patients were diagnosed with isolated incompetence of the gastric cardia, 13 — with incompetence of the gastric cardia accompanied by reflux esophagitis, 4 — with hiatal hernia. The efficacy of anti-reflux therapy for chronic otitis media exacerbation was assessed on Day 10 after start of the therapy. Due to the gastroenterological therapy, the “dry” ear status could be achieved in 34 patients, which made it possible to offer them reconstructive intervention in the future. 5 patients achieved the CSOM remission by the end of the first month of anti-reflux therapy. 3 patients failed to achieve the state of CSOM remissionConclusions. The high efficacy of anti-reflux therapy for the management of CHSO exacerbation refractory to the standard conservative therapy regimens at the level of 81% allows us to recommend further research to prove the causal relationship between GERD and ineffectiveness of treatment of ear pathology.

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Noninvasive diagnosis of laryngopharyngeal reflux as an extraesophageal manifestation of gastroesophageal reflux disease: A literature review

Starostina,

Nazarov,

Loskutova

et al. 2024

Medicinskij sovet

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Тo date, gastroesophageal reflux disease (GERD) is considered as a condition that includes various subgroups: erosive esophagitis, non-erosive reflux disease, Barrett’s esophagus, hypersensitive esophagus and functional heartburn. A common extraesophageal manifestation of GERD is laryngopharyngeal reflux (LFR), in which, in addition to dyspeptic symptoms, patients note hoarseness, cough, tickling and a feeling of a foreign body in the throat. When LFR occurs, the direct effect of gastroduodenal reflux on the mucous membrane of the larynx and pharynx leads to morphological changes, the development of pachyderma and laryngeal granuloma; indirect activation of reflex mechanisms causes the manifestation of esophagobronchial reflux. The diagnosis of LFR includes an analysis of the patient’s life history, registration of complaints using questionnaires (Index of reflux symptoms), assessment of the clinical and functional state of the larynx using a visually analog scale of reflux signs and videolaryngostroboscopy, the use of instrumental methods and laboratory tests. The detected laryngoscopic signs are not always pathognomonic for GERD-associated LFR: extraesophageal manifestations of the disease can also be observed in the absence of the most typical esophageal symptoms, which is a serious diagnostic problem. Due to the fact that not all instrumental diagnostic methods are informative in various cases of reflux-associated diseases, non-invasive methods are more convenient at the outpatient stage of patient examination questioning patients using special scales and questionnaires. The article presents the most informative and rational methods of noninvasive screening of GERD-associated diseases available in the available literature, aimed at identifying the severity of reflux manifestations, the level of patient satisfaction with their condition and the effectiveness of therapy. In order to improve the screening diagnostic process of LFR, it is necessary to develop and implement a reliable and sensitive questionnaire with an interdisciplinary approach.

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Clinical aspects of laryngopharyngeal reflux

Cited by 4 publications

References 0 publications

Analysis of the development dynamics of cough syndrome in acute nasopharyngitis with intoxication syndrome

Analysis of the development dynamics of cough syndrome in acute nasopharyngitis with intoxication syndrome

On the issue of preoperative preparation of patients with chronic suppurative otitis media

Noninvasive diagnosis of laryngopharyngeal reflux as an extraesophageal manifestation of gastroesophageal reflux disease: A literature review

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