Laryngopharyngeal Reflux Disease; How to Evaluate
Objective: To study how to evaluate Laryngopharyngeal Reflux(LPR), and to formulate management strategy. Study design: Prospective study. Material and methods: A total of 112 patients were studied and followed for a period of at least six months. The study was conducted under the following headings: (1)establish the diagnosis of LPR by using Reflux Finding Score (RFS ) and Reflux Symptom Index(RSI), (2)establish diagnosis of GERD by history and endoscopy,(3)treat LPR by lifestyle modification and medical management using proton pump inhibitors(PPI) or surgical management. Results: Majority of patients were females (53.3%) and in the age group of 20-50 years.RSI was used to study symptoms and median RSI score was (17).The common symptoms were clearing of throat (97.1%),lump in throat (96.2%),excess throat mucus (93.3%) and heartburn (62.9%).The signs of LPR were studied by using RFS and median RFS was (11) .The common findings were vocal cord edema (97.1%) and erythema (93.3%).Symptoms of GERD were present in less than half of patients (47.6%). EGD was found to be normal in (64.8%). The most common finding on EGD was esophagitis (17.1%) followed by gastritis (14.3%) and hiatus hernia (8.6%). Majority of patients responded to medical management only (96.2%) . RSI improved from a mean score of 17.6% at initiation of treatment to 3.9 at 6 months follow up. RFS improved from a mean score of 11.9 at pre-treatment to (1.7) at 6 months follow up. Symptoms of GERD improved completely in all patients at 4 months only. Conclusion: LPR is common and RFS and RSI were used to evaluate LPR and they were reproducible and effective. GERD was present in less than half of the patients. Medical management using twice daily PPI was effective.
Laryngopharyngeal Reflux, Upper Esophageal Sphingter, Reflux Finding Score, Gastroesophageal Reflux
Amin MR, Postma GN, Johnson P, Koufman JA. Proton pump inhibitors resistance in the treatment of LPR. Otolaryngol Head & Neck Surg 2001; 25: 374-378.
Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score. Laryngoscope 2001; 111: 1313-1317.
Belafsky PC, Postma GN, Koufman JA. LPR symptoms improve before changes in physical findings. Laryngoscope 2001; 111(6): 979-981.
Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux symptom index. Journal of Voice 2002; 16: 274-7.
Bilgen C, Ogut F, Kesimili-Dinc H, Kirazli T, Bor S. The comparison of an empiric proton pump inhibitor trial vs. 24 hour double probe pH monitoring in laryngopharyngeal reflux. The Journal of Laryngology and Otology 2003; 117: 386-390.
Book DT, Rhee JS, Toohill RJ, Smith TL. Perspectives in laryngopharyngeal reflux: an international survey. Laryngoscope 2000; 112: 1399-1406.
DeMeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB. Patterns of gastroesophageal reflux in health and disease. Ann Surg 1976; 184: 459-70.
Eherer AJ, Habermann W, Hammer HF, Kiesler K, Friedrich G, Krejs GJ. Effect of pantoprazole on the course of reflux-associated laryngitis: a placebo-controlled double blind cross over study. Scand J Gastroenterol 2003; 38: 462-467.
El Seraj HB, Lee P, Buchner A, Inadomi JM, Gavin M, McCarthy DM. Lansoprazole treatment of patients with chronic idiopathic laryngitis: a placebo-controlled trial. Am J Gastroenterol 2001; 96: 979-983.
Fass R. Empirical trials in treatment of gastroesophageal reflux disease. Dig Dis 2000; 18: 20-26.
Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA 2005; 294; 1534-1540.
Fuchs KH, Breithaupt W, Feinn M, Maroske J, Hammer I. laparoscopic Nissen repair: indications, techniques and long-term benefits. Langenbecks Arch Surg 2005; 390: 197-202.
Hunter JG, Trus Ted L, Branum GD, Waring J. Patrick, Wood WC. A physiological approach to laproscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996; 223: 673-87.
Johnson PE, Kaufman JA, Nowah LJ, Belafsky PC, Postma GN. Ambulatory 24 hour double probe PH monitoring. The importance of monometry. Laryngoscope 2001; 111: 1970-5.
Koufman JA. The otolaryngologic manifestation of gastro-esophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24 hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101: 1-78.
Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head & Neck Surg 2000; 123: 385-8
Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngo-pharyngeal reflux: Position statement of the committee on speech, voice and swallowing disorders of the American Academy of Otolaryngology – Head and Neck Surgery. Otolaryngol Head Neck Surgery 2002; 127: 32-35.
Koufman JA, Belafsky PC, Bach KK, Daniel E, Postma GN. Prevalence of esophagitis in patients with PH-documented laryngopharyngeal reflux. Laryngoscope 2002; 112: 1606-1609.
Katz PO, Castell DO. Medical therapy of supra-esophageal gastroesophgeal reflux disease. Am J Med 2000; 108(suppl 4a): 170S-177S.
Noordziji JP, Khidr A, Evans BA et al. Evaluation of Omperazole in the treatment of reflux laryngitis: a prospective placebo-controlled randomized double-blind study. Laryngoscope 2001; 111: 2147-2151.
Noordzij JP, Khidr A, Desper E, Meek RB, Reibel JF, Levine PA. Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope 2002; 112: 2192-2195.
Oelsclager BK, Eubanks TR, Oleynikov D, Pope C, Pellegrini CA. Symptomatic and physiologic outcomes after operative treatment for extraesophageal reflux. Surg Endosc 2002; 16: 1032-1036.
Park W, Hicks DM, Khandwala F, Richter Vaezi MF. Laryngopharyngeal reflux; prospective cohort study evaluating optimal dose of PPI therapy and pretherapy predictors of response. Laryngoscope 2005; 115(7): 1230-1238.
Peghini PL, Katz PO, Bracy NA, et al. Noctural recovery of gastric acid secretion with twice daily dosing of PPI. Am J Gastroenterol 1998; 93: 763-7.
Postma GN. Ambulatory PH monitoring methodology. Ann Otol Rhinol Laryngol 2000; 109(10, Suppl 184): 10-14.
Postma GN, Tomek MS, Belafsky PC, Koufman JA. Esophageal motor function in laryngopharyngeal reflux is superior to that of classic gastroesophageal reflux disease. Ann Otol Rhinol Laryngol 2001; 110(12): 1114-6.
Tauber S, Gross M. Issing WJ. Association of laryngopharyngeal symptoms with gastroestophageal reflux disease. Laryngoscope 2002; 112: 879-886.
Tutuian R, Castell DO. Diagnosis of laryngopharyngeal reflux. Current opinion in otolaryngology and Head and Neck Surgery 2004; 12: 174-179.
Westcott CJ, Hopkins MB, Bach K, Postma GN, Belasfsky PC, Koufman JA. Fundoplication for LPR disease. J Am Coll Surg 2004; 199(1): 23-30.
Wetscher GJ, Gadenstaetter M, Klingler PJ et al. Efficacy of medical therapy and antireflux surgery to prevent Barett’s metaplasia in patients with gastroesophageal reflux disease. Ann Surg 2001; 234: 627-632.