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

Abstract

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.