Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review

Lechien, Jérôme R.; Akst, Lee M.; Saussez, Sven; Crevier‐Buchman, Lise; Hans, Stéphane; Barillari, Maria Rosaria; Calvo‐Henríquez, Christian; Bock, Jonathan M.; Carroll, Thomas L.

doi:10.1177/0194599820933209

Cited by 17 publications

(13 citation statements)

References 70 publications

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“…This definition of LPR has recently been considered incomplete because the irritation from LPR due to pepsin, bile salts and other gastroduodenal proteins does not involve only laryngopharyngeal mucosa but extends to all upper aerodigestive tract mucosa [2]. Indeed, LPR is often involved in the development of many laryngeal [3], rhinological [4], and otological [5,6] conditions. Currently, LPR is defined as an inflammatory condition of the upper aerodigestive tract tissues related to the direct and indirect effect of gastric or duodenal content reflux, inducing morphological changes in the upper aerodigestive tract [2].…”

Section: Definitionmentioning

confidence: 99%

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Lechien¹,

Saussez²,

Muls³

et al. 2020

Preprint

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Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

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Section: Definitionmentioning

confidence: 99%

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Lechien¹,

Saussez²,

Muls³

et al. 2020

Preprint

Self Cite

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show abstract

“…Laryngopharyngeal reflux is occasionally associated with nonspecific symptoms and findings, which make diagnosis challenging for unaware physicians [ 15 ]. The involvement of LPR in the development of several inflammatory conditions of the upper aerodigestive tract has increasingly been studied over the past decades, reporting potential involvement in rhinological, otological, and laryngological diseases [ 5 , 6 , 7 , 8 ]. In this study, our team shared some clinical observations where the diagnosis and the treatment of LPR disease had a significant impact on the resolution of specific conditions that are currently not or poorly known to be associated with reflux.…”

Section: Discussionmentioning

confidence: 99%

“…Others identified LPR as a key condition responsible of nasal symptoms in patients who do not report sinonasal infection [ 5 ]. In the same way, pepsin and LPR were identified as important factors in the development of chronic otitis media in children and adults [ 6 ], laryngeal disorders [ 7 ], or bronchial irritation in patients with asthma [ 8 ]. The involvement of LPR in many respiratory and digestive conditions may lead to atypical clinical presentation of the disease, which may be difficult to detect in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Lechien

Hans

Bobin

et al. 2021

JCM

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Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. Conclusion: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

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“…Laryngopharyngeal reflux is occasionally associated with nonspecific symptoms and findings, which make diagnosis challenging for unaware physicians [16]. The involvement of LPR in the development of several inflammatory conditions of the upper aerodigestive tract was increasingly studied over the past decades, reporting potential involvement in rhinological, otological and laryngological diseases [5][6][7][8]. In this study, our team shared some clinical observations where the diagnosis and the treatment of LPR disease had a significant impact of the resolution of specific conditions that are currently not or poorly known to be associated with reflux.…”

Section: Discussionmentioning

confidence: 99%

“…Others identified LPR as a key condition responsible of nasal symptoms in patients who do not report sinonasal infection [5]. In the same way, pepsin and LPR were identified as important factors in the development of chronic media otitis in children and adults [6], laryngeal disorders [7], or bronchial irritation in patients with asthma [8]. The involvement of LPR in many respiratory and digestive conditions may lead to atypical clinical presentation of the disease, which may be difficult to detect in clinical practice.…”

Section: Introductionmentioning

confidence: 97%

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-year Case-Series

Lechien¹,

Hans²,

Bobin³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as etiological or favoring factor of laryngeal, oral, sinonasal or otological diseases. In this case-series, we reported atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with 24-hour hypopharyngeal-esophageal impedance pH-study and patients were treated with a combination of diet, proton pump inhibitors and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N=9), recurrent burps and abdominal disorders (N=2), posterior nasal obstruction (N=2), recurrent acute suppurative otitis media (N=2), severe vocal fold dysplasia (N=2), and recurrent acute rhinopharyngitis (N=1), tearing (N=1), aspirations (N=1) or tracheobronchitis (N=1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate anti-reflux treatment. Conclusion: LPR may present with various clinical presentations including mouth, eye, tracheobronchial, nasal or laryngeal findings, which may all regress with an adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzyme in the enflamed tissue.

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Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review

Cited by 17 publications

References 70 publications

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-year Case-Series

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