Role of Refluxed Acid in Pathogenesis of Laryngeal Disorders

Toohill, Robert J.; Kuhn, Joan C.

doi:10.1016/s0002-9343(97)00333-1

Cited by 127 publications

(71 citation statements)

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“…Since symptoms of laryngopharyngeal reflux may predict esophageal adenocarcinoma, every patient with laryngopharyngeal reflux should have an upper gastrointestinal endoscopy, even if no classical symptoms of gastroesophageal reflux disease are present. Copyright © 2009 S. Karger AG, Basel mittent hoarseness, paroxysmal laryngeal spasms, weakening of the voice or aphonia, chronic need to clear the throat, increased pharyngeal mucus secretion, postnasal drip, chronic cough, dysphagia and glossodynia [6][7][8] . Up to 55% of patients with hoarseness have laryngopharyngeal reflux [9] and hoarseness is present in 92% of patients with laryngopharyngeal reflux [7] .…”

Section: Introductionmentioning

confidence: 99%

Reflux-Associated Laryngitis and Laryngopharyngeal Reflux: A Gastroenterologist’s Point of View

Hammer

2009

Dig Dis

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Laryngopharyngeal reflux of liquid and gaseous gastric contents should be considered in every patient with unexplained hoarseness. Pathophysiology and treatment of reflux-associated laryngitis are different from those of reflux esophagitis and therefore remain an unsolved puzzle. The laryngeal mucosa is considerably more sensitive to acid and pepsin than the mucosa of the esophagogastric junction. Therefore definitions of acid and nonacid reflux used for gastroesophageal reflux disease may not be helpful for explaining pathophysiologic mechanisms in the larynx or pharynx. A reflux symptom index and reflux finding score may be useful in helping to select the minority of patients who may benefit from acid-suppressive therapy; however, further research is needed. Further research is also needed to identify those patients who may require higher doses or prolonged duration of proton pump inhibitors or alternative treatments like prokinetics or alginate, or those patients who may benefit from surgical treatment of gastroesophageal reflux. Since symptoms of laryngopharyngeal reflux may predict esophageal adenocarcinoma, every patient with laryngopharyngeal reflux should have an upper gastrointestinal endoscopy, even if no classical symptoms of gastroesophageal reflux disease are present.

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Section: Introductionmentioning

confidence: 99%

Reflux-Associated Laryngitis and Laryngopharyngeal Reflux: A Gastroenterologist’s Point of View

Hammer

2009

Dig Dis

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“…Chronic throat clearing, excessive throat phlegm, and feelings of postnasal drip are reported to be almost invariably present in patients with suspected supraesophageal reflux (3,7,22,23). It has been suggested that, whether transparent, white, yellow, or green, the coloration of excessive throat phlegm and postnasal drip represents the gastric content in many cases (22,23).…”

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confidence: 99%

The Role of (Duodeno)gastroesophagopharyngeal Reflux in Unexplained Excessive Throat Phlegm

2005

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Gastroesophageal reflux (GER), through the occurrence of gastroesophagopharyngeal reflux (GEPR), is an established cause of several otorhinolaryngological (ORL) manifestations. It has been suggested that unexplained excessive throat phlegm might also be a manifestation of GER, but formal evidence is lacking. The aim of the present study was to investigate the prevalence of GER as well as duodenogastroesophageal reflux (DGER) in consecutive patients with chronic complaints of excessive throat phlegm. Fifty-nine consecutive patients with chronic unexplained excessive throat phlegm, transparent in 33 patients (TTP) and yellow in 26 patients (YTP), underwent gastrointestinal endoscopy, 24-hr dual esophageal pH monitoring, and fiberoptic DGER monitoring. Proximal esophageal DGER monitoring was performed in seven YTP patients and analysis of bile acids in throat phlegm was performed on 16 samples. The effect of high-dose acid suppressive therapy was evaluated at 2-week intervals. Endoscopy and pH monitoring established a diagnosis of pathological GER in 75% of the patients. Pathological DGER was present in 56% of the patients and this was associated with YTP. Proximal DGER exposure was high in all investigated subjects and chemical analysis revealed a median bile acid concentration of 0.184 microM in nine YTP samples and no detectable bile acids in seven TTP samples. After a median of 4 weeks of acid suppressive therapy, most patients improved and 61% became asymptomatic. YTP patients were more likely to require maintenance acid suppressive therapy than TTP patients. Unexplained excessive throat phlegm is a sign suggestive of GER and GEPR, and unexplained yellow throat phlegm a sign suggestive of duodenogastroesophagopharyngeal reflux (DGEPR).

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“…Este estudo confirma achados da literatura internacional 1,2,16,20,27,28 , contudo requer ainda uma amostra maior de casos e a utilização de estudos epidemiológicos mais complexos, sejam eles populacionais ou experimentais.…”

Section: Conclusãounclassified

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais

Marambaia

Andrade

Varela

et al. 2002

Rev. Bras. Otorrinolaringol.

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Introdução: Manifestações laríngeas do refluxo gastro-esofágico são problemas cada vez mais comuns. Estudos revelam alta associação com sensação de "globus", rouquidão crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigação diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivos: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificações dietéticas. Forma de estudo: clínico prospectivo randomizado. Método: 61 pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesões laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6% apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), "globus" (23,5%) e sialorréia (19,6%). Associação de sintomas: dois (67,4%); três (41,2%) e quatro (21,5%). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7% cursaram com melhora dos sintomas após 6 meses. Em 95,9% dos pacientes tratados houve melhora laringoscópica. Conclusões: Houve uma correlação importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderão fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeição do especialista.

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Role of Refluxed Acid in Pathogenesis of Laryngeal Disorders

Cited by 127 publications

References 10 publications

Reflux-Associated Laryngitis and Laryngopharyngeal Reflux: A Gastroenterologist’s Point of View

Reflux-Associated Laryngitis and Laryngopharyngeal Reflux: A Gastroenterologist’s Point of View

The Role of (Duodeno)gastroesophagopharyngeal Reflux in Unexplained Excessive Throat Phlegm

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais

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