The Role of Helicobacter pylori in Laryngopharyngeal Reflux: A Systematic Review and Meta‐analysis

Abstract

Objective The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone. Data Sources EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Review Methods A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies. Results Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies. Conclusion There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.

Issues and controversies in esophageal inlet patch

“…Similar gastric histological changes (inflammation, metaplasia, atrophy dysplasia and even adenocarcinoma of the IP with H. pylori colonization) have been reported[9]. Although there are insufficient data to recommend testing and eradicating H. pylori infections among patients with laryngopharyngeal reflux[73], we suggest that the endoscopist should consider searching for cervical IPs. Then, a rapid urease test from the IP can be considered to determine the presence of H. pylori in patients with an unexplained persistent globus sensation or a dyspepsia despite the PPI treatment and without H. pylori -positive gastritis, or to decide to pursue further treatment in patients with persistent dyspepsia after previous gastric H. pylori eradication.…”

Possible association between Helicobacter pylori infection and vocal fold leukoplakia

“…The ROC curve analysis also indicated a reference value of LPR for determining H. pylori infection. The presence of H. pylori showed a link with LPR, corroborating the data obtained in a meta‐analysis . A recent finding showed a positive relationship between H. pylori and LPR signs assessed by the Reflux Finding Score .…”

“…The presence of H. pylori showed a link with LPR, corroborating the data obtained in a meta-analysis. 35 A recent finding showed a positive relationship between H. pylori and LPR signs assessed by the Reflux Finding Score. 36 The mode of transmission of this bacterium to the upper airway has been described.…”

Intranasal Helicobacter pylori infection in patients with chronic rhinosinusitis with polyposis

“…A possible explanation is that not all episodes of extra-oesophageal reflux could reach the nasopharynx and nasal cavity, which has been proven by diagnostic tests with 24-hour nasopharyngeal pH-metry using a four-channel pH probe 27 . Additionally, perhaps not all patients had intragastric H pylori that could be transmitted to the upper airway 28 . Furthermore, nasopharyngeal reflux is more commonly severely refractory to treatment in chronic rhinosinusitis patients 26 , 29 .…”