Laryngopharyngeal Reflux Disease is More Severe in Obese Patients: A Prospective Multicenter Study

Abstract

Objectives/Hypothesis To investigate whether there is an impact of obesity and overweight on the clinical findings and therapeutic responses of patients with laryngopharyngeal reflux (LPR). Study Design Prospective uncontrolled. Methods Patients with LPR‐related symptoms and positive LPR diagnosis at the hypopharyngeal‐esophageal multichannel intraluminal impedance pH‐monitoring (HEMII‐pH) were recruited from December 2017 to December 2020. Patients were treated with a combination of diet, proton pump inhibitors, and alginate for 3 to 6 months. The following outcomes were studied according to the weight of patients: HEMII‐pH, gastrointestinal endoscopy features, symptoms, findings, and therapeutic response. Results A total of 262 patients completed the study, accounting for 134, 85, and 43 patients with normal weight (body mass index [BMI] <25), overweight (BMI = 25–29.99), and obesity (BMI >30). Obese patients reported significant higher prevalence of gastroesophageal reflux disease (GERD), acid LPR, and a more severe LPR disease regarding the number of pharyngeal reflux events, reflux symptom score (RSS), and reflux sign assessment (RSA). RSS and RSA scores significantly improved from baseline to 3‐month posttreatment irrespective of the patient weight group. Symptoms and signs continued to improve from 3 to 6‐month posttreatment only in patients with a normal weight. Conclusion Obesity is associated with a more severe LPR disease and a higher proportion of GERD and acid LPR. Obese LPR patients may require more frequently PPI‐therapy regarding the higher prevalence of GERD. Level of Evidence 3 Laryngoscope, 131:E2742–E2748, 2021

Correlation Between Refractory Laryngopharyngeal Reflux Disease and Symptoms of Anxiety and Depression

“…Acid suppressive therapy with PPIs has been internationally recognized as the preferred drug treatment for LPRD. However, in recent years, due to the comprehensive influence of various factors such as diet, 4 sleep, 5 , 6 and work stress, 7 some patients still show no significant improvement in LPRD symptoms after acid-suppressive therapy; in one study, PPIs and a placebo showed no significant difference in improving the symptoms of LPRD patients. 8 Further, because of the limitations of clinical tools, many symptoms and extrapharyngeal manifestations were not considered.…”

Analysis of effects of laryngopharyngeal reflux disease and proton pump inhibitor treatment on Eustachian tube function in patients with obstructive sleep apnea hypopnea

“…Although there is no consensus regarding standardization of the diagnostic criteria, an increasing number of authors used multichannel intraluminal impedance-pH monitoring, and new tests such as the salivary pepsin dosage for the diagnosis of LPRD are continuously applied. [22][23][24] Another limitation is that being a preliminary exploration, the present study could not establish causality. It is still necessary to conduct further prospective research with a large sample size and multi-center data to examine this point.…”

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population‐Based Study

“…As pointed out by Halum et al in 2005, LPR correlates with obesity only in conjunction with esophageal reflux; when laryngeal reflux occurred in isolation, there was no association with obesity 40 . Recently, Lechien et al observed that LPR disease was more severe in obese patients regarding HEMII‐pH features, symptoms, and findings as well as GERD was a severity factor in LPR disease 39 . Some studies demonstrated that LPR is more frequent in OSA patients with high IMC 10,29,30 .…”

“…Contrary, our data did not show any significant correlation between IMC value and LPR symptoms, neither in overall sample nor in OSA patients. The overweight and obese are well‐known favoring factors of GERD but the impact of obesity and overweight on LPR was not extensively investigated 39 . As pointed out by Halum et al in 2005, LPR correlates with obesity only in conjunction with esophageal reflux; when laryngeal reflux occurred in isolation, there was no association with obesity 40 .…”