Prevalence of pH-documented laryngopharyngeal reflux in Chinese patients with clinically suspected reflux laryngitis

PURPOSE: Laryngopharyngeal reflux (LPR) is one of the main factors behind different laryngeal pathology according to the Western literature. Literature reported that the prevalence of gastroesophageal reflux disease (GERD) in Chinese population was considerably lower than that in Western countries. To date, however, there is no study to evaluate the prevalence of pH-documented LPR in the Chinese ethnicity. MATERIALS AND METHODS: We thus recruited 28 consecutive Chinese patients with reflux symptoms including globus, throat discomfort, throat clearing, chronic cough, or burping lasting more than 1 month in the preceding 1 year, together with stroboscopic evidence suggestive of reflux laryngitis according to the reflux finding score in our study. All patients underwent thorough head and neck examination and transnasal endoscopic assessment. The prevalence of pH-documented LPR and GERD was then documented using ambulatory 24-hour pH biprobe study. RESULTS: Six (21%) of the 28 patients had pH-documented LPR. Four (14%) of the 28 patients had GERD with 3 of them having concomitant LPR. Only burping was associated with pH-documented LPR (P < .05). No relationship was observed between pH-documented LPR and other factors, including age, sex, other reflux symptoms except burping, and the reflux finding score. CONCLUSION: Chinese patients do have and present with symptoms of extraesophageal reflux, and we observed a lower prevalence of pH-documented LPR in Chinese patients with clinically suspected reflux laryngitis compared with white patients.     

Molecular pathways and genetic factors in the pathogenesis of laryngopharyngeal reflux

The prevalence of laryngopharyngeal reflux (LPR) has been constantly rising in the western world and affects today an alarmingly high percentage of the general population. Even though LPR and gastroesophageal reflux disease (GERD) are both the product of gastroesophageal reflux and seem to be sibling disorders, they constitute largely different pathological entities. While GERD has been for a long time identified as a source of esophageal disease, LPR has only recently been associated with head and neck disorders. Despite the high incidence of LPR and its great impact on patients’ quality of life, little is known regarding its pathogenesis. On the other hand, studying the molecular and genetic basis of a disease is of fundamental importance in medicine as it offers better insight into the pathogenesis and opens new, disease-specific therapeutic trends. The aim of this study is to enlighten any known or suspected molecular mechanisms that contribute to the pathogenesis of LPR, and to suggest new trends for future research.     

Esophageal motor function in laryngopharyngeal reflux is superior to that in classic gastroesophageal reflux disease.

Laryngopharyngeal reflux (LPR) in otolaryngology patients appears to be different from classic gastroesophageal reflux disease (GERD). In particular, esophagitis and its principal symptom, heartburn, considered the diagnostic sine qua non of GERD, are often absent in LPR. It has therefore been postulated that LPR patients have superior esophageal function. Esophageal acid clearance (EAC) is a measure of the ability of the esophagus to restore neutral pH after reflux events have occurred. It is considered an excellent overall measure of esophageal function. The mean EAC can be calculated from 24-hour pH monitoring data. A comparison of EAC in patients with GERD and LPR has not been previously reported. To compare the EAC of 1) patients with LPR alone, 2) patients with GERD alone, 3) patients with both LPR and GERD, and 4) patients without either LPR or GERD, we studied 200 otolaryngological patients who had undergone 24-hour double-probe (simultaneous pharyngeal and distal esophageal) pH monitoring, 50 in each group. The subgrouping of each patient was determined by previously established pH monitoring criteria. We defined GERD as abnormal esophageal reflux and LPR as abnormal pharyngeal reflux. The patients with GERD had a mean (+/-SD) EAC of 1.44 +/- 1.2 minutes, and those with LPR had a mean EAC of 1.00 +/- 1.00 minutes (p < .05). The patients with both GERD and LPR had a mean EAC of 1.53 +/- 1.01 minutes. The patients without reflux had a mean EAC of 0.53 +/- 0.38 minutes. We conclude that patients with LPR have significantly better EAC than those with GERD. These data suggest that patients with LPR have superior esophageal function. This finding may clarify our understanding of the differences in mechanisms, symptoms, and incidence of esophagitis in patients with LPR and GERD.     

Laryngopharyngeal reflux finding scores correlate with gastroesophageal reflux disease and Helicobacter pylori expression

Conclusion. The expression of Helicobacter pylori (HP) positivity and degree of gastroesophageal reflux disease (GERD) correlate with laryngopharyngeal reflux (LPR). HP positivity and degree of GERD were more adverse in patients with a reflux finding score (RFS) of 7 or more. Objective. We aimed to investigate the relationship between RFS and inflammation of the lower part of the esophagus as well as RFS and HP infection. Patients and methods. Forty-five consecutive patients were analyzed prospectively. The degree of LPR was evaluated using the RFS method. The degree of GERD, lower esophageal mucosal inflammation, and antral HP positivity were evaluated using endoscopic surveys. Results. The mean RFS of the whole population was 11.5±4.4. The mean RFS of patients who had lower esophageal mucosal inflammation was 7±0.1, 8.1±1.3, 13.9±3.7, and 16.6±3.5, for grades A, B, C and D, respectively. The RFS of patients according to HP expression was as follows: 7.2±0.4, 9.3±3.07, 12.7±3.16, and 17.8±2.1, for normal (score 0), score I, score II, and score III, respectively.     

Incongruence between histologic and endoscopic diagnoses of Barrett's esophagus using transnasal esophagoscopy

OBJECTIVES: The symptoms, patterns of reflux, and clinical manifestations of laryngopharyngeal reflux (LPR) differ from those of gastroesophageal reflux disease (GERD) in many ways. The purposes of this study were to determine the prevalence of Barrett's esophagus in patients with LPR using transnasal esophagoscopy (TNE) and to determine if there is agreement between TNE clinical findings and pathology results when using TNE for Barrett's screening. STUDY DESIGN: This study involved a retrospective review of the records of 200 consecutive patients with LPR undergoing esophageal screening. METHODS: The prevalence of patients with findings clinically suspicious for Barrett's and the biopsy results for those patients were reviewed. RESULTS: Of the 200 patients with LPR who were screened with TNE, 10% (20 of 200) had findings suspicious for Barrett's esophagus, and, of those, only 30% (six of 20) had biopsy-proven Barrett's metaplasia. CONCLUSION: Although TNE may be a useful screening tool for Barrett's, there is incongruence between TNE findings and biopsy results, which likely reflects suboptimal biopsy methods with TNE. New biopsy techniques such as the CDx brush biopsy may enhance the sensitivity of TNE biopsies, and future studies are needed in this area.     

Nissen fundoplication surgery for extraesophageal manifestations of gastroesophageal reflux (EER)

OBJECTIVE: To determine the outcome of Nissen fundoplication surgery for the treatment of patients with chronic extraesophageal manifestations of reflux (EER). METHODS: A retrospective medical record analysis was performed. Patient demographics, extraesophageal disease secondary to gastroesophageal reflux (GER), methods of GER diagnosis, acid suppression therapy before antireflux surgery, and response to surgical intervention were evaluated. RESULTS: The charts of 29 patients who underwent Nissen fundoplication surgery for EER were included in the study. Hoarseness was present in 17 patients; laryngopharyngeal reflux (LPR) was the most common diagnosis (n = 20). Barium esophagram was done in all patients and revealed abnormalities indicative of GER in 26 patients. Twenty-four-hour ambulatory pH study was done in 27 patients and pharyngeal reflux was present in 19. Preoperative esophageal endoscopy was performed in 22 patients. This study revealed evidence of gastroesophageal reflux disease (GERD) in 14 patients with 8 having evidence of Barrett's esophagus. Sixteen of the 29 patients had symptoms or findings of GERD. Twenty-eight patients had laparoscopic Nissen fundoplication (LNF) and 1 had an open procedure. Twenty-five of the 29 patients (follow-up ranging from 6-108 mo) had excellent results with near-total freedom from symptoms and are taking no acid-suppressive medications. CONCLUSIONS: GER has an important role in the cause of many otolaryngologic and pulmonary disorders. Nissen fundoplication is an effective modality to treat EER in selected cases.     

Comparative outcomes of antireflux treatment for laryngopharyngeal reflux symptoms and upper abdominal symptoms in patients with endoscopic esophagitis

The objectives of this prospective study are to determine the prevalence of laryngopharyngeal reflux (LPR) symptoms in patients with endoscopic esophagitis, to investigate the relationship between LPR symptoms and upper abdominal symptoms of gastroesophageal reflux disease (GERD) and to compare the treatment responses of both symptom groups. 120 consecutive patients having complaints of GERD were included. Group I consisted of 62 patients with a diagnosis of endoscopic esophagitis. The second group consisted of 58 subjects with no detectable pathology at gastroscopy. LPR symptoms and upper abdominal symptoms were graded. Proton pump inhibitors (PPI) were prescribed to patients. Both groups of symptoms were compared in two groups of patients. The improvement in symptoms was evaluated after treatment. The frequencies of LPR symptoms were statistically higher in patients with endoscopic esophagitis. All LPR symptoms were statistically relieved in their frequency after treatment. The decrease in LPR symptom scores after treatment in group I was statistically significant. FSSG (frequency scale for the symptoms of GERD) scores were statistically higher in group I than in group II before treatment. After treatment, FSSG scores were significantly decreased in group I. There was statistically significant positive correlation between the LPR symptom scores and FSSG scores before treatment. In conclusion, there is a high incidence of LPR symptoms and upper abdominal symptoms in patients with endoscopic esophagitis. LPR and upper abdominal symptoms responded well to antireflux treatment in patients with endoscopic esophagitis.     

Dilation of intercellular spaces is associated with laryngo-pharyngeal reflux: an ultrastructural morphometric analysis of laryngeal epithelium

Gastroesophageal reflux disease (GERD) can be associated with ear, nose, and throat signs and symptoms, a condition often referred to as laryngopharyngeal reflux (LPR). However, the morphologic alterations of laryngeal mucosa associated with LPR are currently poorly understood. Since the dilation of intercellular spaces (DIS) between squamous epithelial cells is considered a morphologic marker of acid damage to esophageal mucosa in GERD, we evaluated whether similar changes can be detected in the laryngeal epithelium of patients affected by LPR. The study group included 15 patients affected by LPR and 7 normal controls, who underwent laryngeal biopsies at the interarytenoid area. Specimens were routinely processed for light microscopic and ultrastructural examination. The intercellular spaces were measured in electron microscopy images using a computer assisted morphometric system. Ultrastructural analysis demonstrated an irregular intercellular space dilation in specimens from the group of patients with LPR. Another ultrastructural abnormality observed in a minority of patients was the presence of numerous cytoplasmic vacuoles. Computer assisted morphometric analysis demonstrated that the intercellular space between squamous cells was significantly wider in patients with LPR than in control subjects (411.7 nm ± 188.6 SD vs. 155.8 nm ± 56.4 SD, P = 0.003). These data indicate that ultrastructural evidence of DIS of epithelial cells may be a morphologic marker of acid reflux, as already described in esophageal mucosa. If this result will be confirmed in larger series it may provide a useful diagnostic tool for the identification of LPR.     

Gastroesophageal reflux disease and chronic sinusitis

BACKGROUND: It is increasingly suggested that there may be a connection between gastrooesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) and chronic sinusitis. We therefore wished to establish whether the literature contains sufficient evidence to support this assumption. MATERIAL AND METHODS: We performed a search in Medline (PubMed) and EMBASE with the key words "GERD, GER, reflux, sinusitis, chronic sinusitis". The literature obtained was assessed with regard to the reported results and their evidence levels. The level of evidence was classified according to the usual levels I - IV, only levels Ia or Ib being considered sufficient evidence for a knowledge gain confirmed by therapeutic trials. RESULTS: A total of 77 references were found in Medline and 142 in EMBASE. A large number of these were narrative review articles addressing the connection between GERD or sinusitis and asthma or GERD or sinusitis and chronic cough. Only 12 papers and one case report dealt more or less directly with the question of a connection between chronic sinusitis and reflux. None of the studies could be classed as evidence level I (randomised controlled trials), ten were classed as level III studies, one as level IIb and one as level IV. DISCUSSION AND CONCLUSIONS: The existing studies do not allow us to pinpoint LPR (and even less so GERD) as a clear-cut factor in the aetiopathogenesis of chronic sinusitis. However, despite all their deficiencies and limitations the studies nevertheless do show that reflux into the pharynx and nasopharynx is possible. This reflux (= LPR) can lead to chronic inflammation which can be successfully treated with antireflux therapy with proton pump inhibitors. Quantification of the association is not currently possible. An above-average proportion of the patients with chronic rhinosinusitis appear to have GERD/LPR. However the prevalence of GERD in the population is generally high. It has not yet been established with sufficient certainty whether the LPR must be regarded as a causative factor, whether it exacerbates or chronifies the disease or whether it is merely an epi-phenomenon which does not require specific treatment. To answer this important question we need prospective randomised controlled studies which will provide evidence of sufficient quality. These should be conducted with the help of standardised documentation.     

Patients with isolated laryngopharyngeal reflux are not obese

OBJECTIVES: The gastroenterology literature suggests that gastroesophageal reflux disease (GERD) is often associated with obesity. The National Institutes of Health uses body mass index (BMI) to identify patients who are overweight (BMI 25-30) or obese (BMI > 30). The aim of this study was to determine whether there is a relationship between laryngopharyngeal reflux (LPR) and elevated BMI. STUDY DESIGN: The study involved a retrospective review of 500 pH-probe studies performed consecutively within the department. METHODS: Studies performed on antireflux medication or after fundoplication were excluded. From the included study reports, age, sex, height, weight, use of tobacco or alcohol, and pharyngeal and esophageal probe findings were recorded. After controlling for other factors, the relationship between LPR and BMI was determined and statistical analysis performed. RESULTS: Two hundred and eighty-five of the 500 pH studies met inclusion criteria. The overall mean BMI was 27.9 +/- 6.42. The mean BMI for patients with normal studies was 25.6 +/- 5.07, for those with isolated LPR 25.9 +/- 6.44, for those with isolated GERD 28.3 +/- 6.81, and for those with globally abnormal studies (LPR and GERD) 28.8 +/- 6.55. Abnormal pharyngeal reflux did not correlate with increasing BMI; however, abnormal esophageal reflux events correlated with increasing BMI (P = .002). The mean number of pharyngeal reflux events was not elevated in obese patients, whereas the mean number of esophageal reflux events was significantly elevated in obese (P = .02) when compared with nonobese patients. CONCLUSION: This study demonstrates that pharyngeal reflux is not associated with increasing BMI or obesity in LPR patients. In contrast, abnormal esophageal reflux (GERD) is associated with increasing BMI and obesity. Because of the LPR patient selection bias of this study, these findings may not be applicable to the GERD populations routinely seen by gastroenterologists.     

Pachydermia is not diagnostic of active laryngopharyngeal reflux disease

OBJECTIVE: To determine the change in pachydermia/posterior commissure hypertrophy in patients with laryngopharyngeal reflux disease (LPR) on long-term acid-suppressive therapy. STUDY DESIGN: Retrospective chart review. METHODS: Seventeen patients with LPR who were compliant with long-term acid-suppressive treatment and had good control of their symptoms for at least 20 months were examined. Pre- and posttreatment still laryngeal images from these patients were analyzed by five otolaryngologists blinded to patient information and were scored for pachydermia/posterior commissure hypertrophy according to the Reflux Finding Score (RFS) subset. Test-retest intraobserver reliability, intergrader correlations, as well as a paired t test for means of the data sets were then calculated. RESULTS: There was no significant difference in the grading scores between the pre- and posttreatment group for degree of pachydermia/posterior commissure hypertrophy despite a prolonged treatment interval (mean = 32 months) (P = .25). CONCLUSIONS: There is no statistically significant difference in the degree of pachydermia/posterior commissure hypertrophy found at diagnosis and after long-term acid suppressive therapy in patients with LPR. Therefore, it appears that pachydermia, as an isolated finding, is unreliable in determining the presence of active LPR.     

Association of laryngopharyngeal manifestations and gatroesophageal reflux

The aim of this study was to investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms, the relationship between laryngopharyngeal reflux (LPR) and Helicobacter Pylori infection and treatment response to proton pump inhibitors. Forty-five patients with suspected gastroesophageal reflux diseases related symptoms (sore throat, throat burning, throat clearing, globus sensation, cough, halitozis, dysphonia, dysphagia, postnasal dripping, vocal fatigue, and sputum) were included in this study. For pre-therapeutic and post-therapeutic comparison, symptoms and laryngological findings were graded on a 4-point scale. The patients underwent upper gastrointestinal system endoscopy. During endoscopy, antral biopsies from the stomach were obtained to detect H. Pylori. Antireflux medication with proton pump inhibitors (PPI) and H. Pylori eradication therapy if present were prescribed to the patients. The improvement in symptoms and laryngological findings were evaluated after treatment. By means of esophagogastroduodenoscopy (EGD), reflux was detected in only 11% of patients. But there can be reflux patients other than the detected ones. Although, H. Pylori was present in 62% of patients, no correlation was found between H. Pylori positivity and symptoms. All patients responded well to antireflux treatment and H. Pylori eradication therapy. Laryngopharyngeal symptoms and findings can be predictors of gastroesophageal diseases when response to reflux treatment is taken into account.     

Relationship between history, laryngoscopy and esophagogastroduodenoscopy for diagnosis of laryngopharyngeal reflux in patients with typical GERD

The techniques used in the diagnosis of gastroesophageal reflux disease (GERD) have insufficient specificity and sensitivity in diagnosing laryngopharyngeal reflux (LPR). The purpose of this study was to evaluate the role of esophagogastroduodenoscopy (EGD) and laryngological examination in the diagnosis of LPR. A total of 684 diagnosed GERD and suspected LPR patients were prospectively scored by the reflux finding score (RFS) which was suggested by Koufman. A total of 484 patients with GERD who had RFS ≥7 were accepted as having LPR. 248 patients with GERD plus LPR on whom an endoscopic examination was performed were evaluated. As a control group, results from 82 patients with GERD who had RFS <7 were available for comparison. The GERD symptom score (RSS) was counted according to the existence of symptoms (heartburn/regurgitation) and frequency, duration, and severity. The reflux symptom index (RSI) suggested by Belafsky et al. was also evaluated. The relationship between esophageal endoscopic findings, RSS, RFS and RSI was investigated. Mean age was 46 ± 12 (19–80). The mean values of RSS, RFS, and RSI were 18.9 ± 7.7, 10 ± 2.2, 16.6 ± 11.9, respectively. Erosive esophagitis was detected in 75 cases (30%). Hiatus hernia was observed in 32 patients (13%). There was no correlation between RSS and RFS, RSI. The severity of esophagitis did not correlate with the severity of the laryngeal findings. LPR should be suspected when the history and laryngoscopy findings are suggestive of the diagnosis. EGD has no role in the diagnosis of LPR.     

Laryngopharyngeal reflux symptoms improve before changes in physical findings

BACKGROUND: Patients with laryngopharyngeal reflux (LPR) undergoing treatment appear to have improvement in symptoms before the complete resolution of the laryngeal findings. OBJECTIVE: To determine whether patients with LPR experience an improvement in symptoms before the complete resolution of the laryngeal findings. METHODOLOGY: Forty consecutive patients with LPR documented by double-probe pH monitoring were evaluated prospectively. Symptom response to therapy with proton pump inhibitors was assessed at 2, 4, and 6 months of treatment with a self-administered reflux symptom index (RSI). In addition, transnasal fiberoptic laryngoscopy (TFL) was performed and a reflux finding score (RFS) was determined for each patient at each visit. RESULTS: The mean RSI at entry was 19.3 (+/- 8.9 standard deviation) and it improved to 13.9 (+/- 8.8) at 2 months of treatment (P <.05). No further significant improvement was noted at 4 months (13.1 +/- 9.8) or 6 months (12.2 +/- 8.1) of treatment. The RFS at entry was 11.5 (+/- 5.2), and it improved to 9.4 (+/- 4.7) at 2 months, 7.3 (+/- 5.5) at 4 months, and 6.1 (+/- 5.2) after 6 months of treatment (P <.05 with trend). CONCLUSIONS: Symptoms of LPR improve over 2 months of therapy. No significant improvement in symptoms occurs after 2 months. This preliminary report demonstrates that the physical findings of LPR resolve more slowly than the symptoms and this continues throughout at least 6 months of treatment. These data imply that the physical findings of LPR are not always associated with patient symptoms, and that treatment should continue for a minimum of 6 months or until complete resolution of the physical findings.     

Risk factors for laryngopharyngeal reflux

The aim of this study was to evaluate the demographic and clinicopathologic characteristics of gastroesophageal reflux disease (GERD) with and without laryngopharyngeal reflux (LPR) to determine the risk factors for the occurrence of LPR in patients with GERD. This is a retrospective study of GERD patients with and without LPR. From the outpatient computer program of our hospital we randomly enrolled 45 GERD patients with LPR into the first group and another 45 GERD patients without LPR to the second group. Medical records of the patients in both groups were examined. All patients underwent upper gastrointestinal system endoscopy. LPR was confirmed by laryngoscopy, and LPR-related laryngoscopy scoring. Non-erosive GERD (NERD), erosive GERD (ERD) and Barrett’s esophagus (BE) were diagnosed by endoscopy and histopathology. Various clinical parameters including status of Helicobacter pylori (H. pylori) infection, topography of gastritis were analyzed. For therapy, lansoprazole in a dosage of 30 mg BID for at least 8 weeks were given to all patients in both groups. GERD patients with and without LPR were compared according to demographic, clinic, endoscopic and histopathological parameters. The results revealed that patients with LPR were younger than the patients without LPR (38.7 ± 10.2 years and 43.8 ± 11.5 years; p = 0.08); however, there was no statistical significance. Patients without LPR showed no gender predilection (55% male) while LPR patients showed male preponderance (71% male). In LPR group, 11 patients (24%) had NERD, while 28 (62%) and 6 (13%) patients had ERD and BE, respectively. Twenty-seven (60%) patients without LPR were diagnosed as NERD, 15 patients (33%) without LPR had ERD and only 3 patients (6.6%) showed the histological findings of BE. The patients in LPR group had higher body mass index. Hiatal hernia was more frequent in the patients with LPR (53%) than in the patients without LPR (24%) (p = 0.005). LPR patients had longer duration of reflux symptoms than the patients without LPR (p = 0.04). H. pylori status was not different in both groups but the patients without LPR had more corpus gastritis than the patients with LPR. Eight weeks of lansoprazole treatment was successful in 71% of patients with LPR, and 86% of patients without LPR. We concluded that male gender, hiatal hernia, longer duration of symptoms, high BMI, having ERD and BE seems as risk factors for the occurrence of LPR in patients with GERD. H. pylori status did not have any effect on the development of LPR. Corpus dominant gastritis may have a protective role against the development of LPR. Proton pump inhibitor therapy is less effective in patients with LPR.     

Silent reflux: ex juvantibus criteria for diagnosis and treatment of laryngeal disorders

CONCLUSIONS: Some primary laryngeal pathologies with specific clinical presentation may be related to silent laryngeal reflux. An ex adjuvantibus proton pump inhibitor (PPI) treatment may be helpful for showing evidence of such a hidden laryngeal disorder. OBJECTIVE: To assess the validity of PPI as an ex adjuvantibus criterion for diagnosis and treatment of suspected reflux-associated laryngitis. PATIENTS AND METHODS: Sixty patients with clinical suspicion of laryngo-pharyngeal reflux (LPR) were identified on the grounds of laryngeal symptoms (dysphonia, cough, globus sensation, increased throat clearing, bad taste, and laryngeal spasm), laryngeal features (arytenoid edema/erythema, partial or total vocal fold erythema, and posterior glottic edema) with or without gastro-esophageal reflux disorder (GERD). They were consequently subdivided in three groups: type I, with LPR symptoms and features without GERD; type II with LPR symptoms and features with GERD; and type III with LPR features only. Types I and III were randomly treated with omeprazole (group A) or with immunostimulating vaccine (group B) for 3 months. Pre- and post-treatment laryngeal features and symptoms in all groups were evaluated by laryngo-stroboscopy and analyzed for statistical correlation. RESULTS: All omeprazole-treated patients showed improvement of laryngeal features and symptoms. With PPI treatment, a more significant improvement was noticed with respect to nonspecific immunostimulant therapy. Also, patients without LPR symptoms showed improvement of laryngeal features.     

Is laryngopharyngeal reflux an important risk factor in the development of laryngeal carcinoma?

Laryngopharyngeal reflux (LPR) as a causative irritating factor in the development of laryngeal carcinoma has been suggested. However, the association between LPR and laryngeal carcinoma remains unclear. The aim of this study was to compare the prevalence and severity of reflux between patients with laryngeal carcinoma and clinical LPR. The intention was to find out if a correlation exists between the laryngeal findings and the level of acid reflux. The study population consisted of 29 patients with laryngeal cancer (group I), 33 LPR patients with normal laryngeal findings (group II) and 70 LPR patients with related laryngeal pathology (group III). The results of 24-h, double-channel ambulatory esophageal pH monitoring were analyzed comparing the three groups. The occurrence and severity of abnormal acid reflux at the upper and lower esophageal segments were evaluated. The incidence of LPR or gastroesophageal reflux (GER) did not vary in any of the three groups (LPR was present in 62, 42 and 56% of the patients, while GER was present in 45, 24 and 37% of the patients, respectively). Patients with LPR or GER from the three groups did not differ significantly in terms of the number of acid reflux episodes and percentage of times when the pH was <4. Our data do not support the hypothesis that LPR can be an independent risk factor in the development of larynx cancers. However, the data also do not thoroughly exclude the possibility. The reason why LPR leads to variable pathologies in the larynx may be uncovered by studies probing the differences between patients via detailed examinations of the local anti-reflux barriers such as epithelial morphology and functions.     

南京市居民咽喉返流疾病的流行病学调查分析

目的了解南京市居民的咽喉返流疾病（ Laryngopharyngeal reflux disease, LPR ）的现状,为临床工作提供诊疗依据。方法采取多阶段随机抽样法抽取2500例南京市居民,对其LPR的患病情况进行调查,返流指数量表（Therefluxsymptomindex,RSI）按咽喉返流问卷的评分定义,总积分大于13分为阳性,并对相关因素进行分析。结果有效问卷1950例,阳性75例,患病率为3．86％（75／1950）;其中男性的患病率为3．77％（43／1140）,女性的患病率为3．95％（32／810）,两组患病率比较差异无统计学意义（P〉0．05）。声嘶或发音障碍（症状1）和持续清嗓（症状2）与LPR相关性最大。51—70岁年龄组返流指数量表（RSI）阳性率显著高于其他年龄组。结论南京市LPR的发病率为3．86％,症状1和症状2是LPR的主要相关因素,51～70岁年龄组患者应特别警惕LPR可能性。     

Diagnosis and treatment of laryngopharyngeal reflux

BACKGROUND: During the last decades an increased prevalence of reflux disease can be observed. Otolaryngologists play an increasing role in the treatment of patients suffering from laryngopharyngeal reflux (LPR). Typical symptoms for LPR are globus sensation, dysphagia, throat clearing, chronic cough and hoarseness. The most frequent laryngoscopic finding in patients suffering from LPR is a posterior commissure hypertrophy. LPR is confirmed by laryngoscopy, LPR-related laryngoscopy scoring, 24-hour dual-probe pH-monitoring, and by empiric trial with proton pump inhibitors (PPI). For therapy PPI-medication in a dosage of 40 mg BID for at least 3 months is successful in many patients. Additional lifestyle modifications can also have a positive effect. When medical management fails, further diagnostic procedures should be initiated. CONCLUSION: In patients suffering from unspecific laryngeal and respiratory symptoms LPR is an important differential diagnosis.     

Silent reflux: Ex juvantibus criteria for diagnosis and treatment of laryngeal disorders

Conclusions. Some primary laryngeal pathologies with specific clinical presentation may be related to silent laryngeal reflux. An ex adjuvantibus proton pump inhibitor (PPI) treatment may be helpful for showing evidence of such a hidden laryngeal disorder. Objective. To assess the validity of PPI as an ex adjuvantibus criterion for diagnosis and treatment of suspected reflux-associated laryngitis. Patients and methods. Sixty patients with clinical suspicion of laryngo-pharyngeal reflux (LPR) were identified on the grounds of laryngeal symptoms (dysphonia, cough, globus sensation, increased throat clearing, bad taste, and laryngeal spasm), laryngeal features (arytenoid edema/erythema, partial or total vocal fold erythema, and posterior glottic edema) with or without gastro-esophageal reflux disorder (GERD). They were consequently subdivided in three groups: type I, with LPR symptoms and features without GERD; type II with LPR symptoms and features with GERD; and type III with LPR features only. Types I and III were randomly treated with omeprazole (group A) or with immunostimulating vaccine (group B) for 3 months. Pre- and post-treatment laryngeal features and symptoms in all groups were evaluated by laryngo-stroboscopy and analyzed for statistical correlation. Results. All omeprazole-treated patients showed improvement of laryngeal features and symptoms. With PPI treatment, a more significant improvement was noticed with respect to nonspecific immunostimulant therapy. Also, patients without LPR symptoms showed improvement of laryngeal features.