Laryngopharyngeal reflux

  • Maja Šereg-Bahar
  • Rado Janša
  • Irena Hočevar-Boltežar
Keywords: gastroesophageal reflux, laringopharyngeal reflux, laryngeal and pharyngeal endoscopy, diagnostic procedures, therapy

Abstract

Background: In 4–10 % of patients with gastroesophageal reflux (GER) some atypical symptoms are found (cough, hoarseness, globus pharyngeus, dyspnea) which are characteristic for laryngopharyngeal reflux (LPR). The signs of LPR can be detected in more than 50 % of dysphonic patients. In the diagnostics of LPR, a meticulous history and a videoendoscopy of the larynx and pharynx are the most important procedures. The diagnosis of LPR can be confirmed by the 24-hour double probe pH monitoring and the treatment test with proton pump inhibitors. The best diagnostic results can be obtained with a combination of several diagnostic procedures.

Conclusions: An otorhinolaryngologist can start a treatment test with proton pump inhibitors in a patient in whom a laryngopharyngeal reflux is suspected on the basis of history and laryngopharyngeal endoscopy. A successful treatment requires at least 12 weeks regimen with high doses 20 mg twice a day. In the case of alarm signs and unsuccessful treatment a gastroenterologic intervention is necessary.

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References

Koufman JA, Dettmar PW, Johnston N. Laryngopharyngeal reflux (LPR). ENT News 2005; 14: 42–5.

Johnston N, Knight J, Dettmar PW, Lively MO, Koufman J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope 2004; 114: 2129–34.

Richter JE. Ear, nose and throat and respiratory manifestations of gastro-esophageal reflux disease: an increasing conundrum. Eur J Gastroenterol Hepatol 2004; 16: 837–45.

Ford CN. Evaluation and management of laryngopharyngeal refluks. JAMA 2005; 294(12): 1534–40.

Gruden A, Hafner M, Jereb J, Jerman J, Koželj M, Markovič S, et al. Gastroezofagealna refluksna bolezen. Slovenske smernice za obravnavo bolnikov z GERB-om. Ljubljana: Lek; 2001.

Tepeš B. Gastroezofagealna refluksna bolezen. Med Razgl 2004; 43: 261–77.

Pleterski G, Ivanuša M, Drinovec J, Mrhar A. Epidemiološka ocena pogostnosti gastroezofagealne refluksne bolezni za Slovenijo. Zdrav Vestn 2002; 71: 379–84.

Tutuian R, Castel D. Diagnosis of laryngopharyngeal reflux. Curr Opin Otolaryng Head Neck Surg 2004; 12: 174–9.

Sataloff RT, Castell DO, Katz OP, Sataloff DM. Reflux laryngitis and related disorders. San Diego, Oxford: Plural Publishing; 2005.

Šereg-Bahar M, Janša R, Hočevar-Boltežar I. Voice disorders and gastroesophageal reflux. Logoped Phoniatr Vocol 2005; 30(3): 120–4.

Kambič V, Radšel Z. Acid posterior laryngitis. J Laryngol Otol 1984; 98: 1237–40.

Carr MM, Nagy ML, Pizzuto MP, Poje CP. Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children. Arch Otolaryngol Head Neck Surg 2001; 127: 369–74.

Maier W, Kohlberger I, Sontheimer J, Lohle E. Gastro-esophageal reflux in patients suffering from contact ulcer of the larynx. Eufos Congres Budapest 1996: 151.

Ylitalo R, Lindestad PA. Laryngeal findings in patients with contact granuloma: a long-term follow-up study. Acta Otolaryngol 2000; 120: 655–9.

Greene, Mathieson. The voice and its disorders. Maryland: Whurr Publishers Ltd.; 2001.

Kaufman JA. The otolaryngologic manifestations of gastroesophageal 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(53): 1–78.

Powitzky ES. Extraesophageal reflux: the role in laryngeal disease. Curr Opin Otolaryngol Head Neck Surg 2002; 10: 485–91.

Axford SE, Sharp N, Ross PE, Pearson JP, et al. Cell biology of laryngeal epithelial defenses in health and disease: preliminary studies. Ann Otol Rhinol Laryngol 2001; 110: 1099–108.

Wilson JA. What is the evidence that gastroesophageal reflux is involved in the etiology of laryngeal cancer? Curr Opin Otolaryngol Head Neck Surg 2005; 13: 97–100.

Markovič S. Ekstraezofagealni simptomi gastroezofagealnega refluksa (GER). Gastroenterolog 2002; 1: 22–6.

Rouey P, Chakarski I, Doskov D, Dimov G. Laryngopharyngeal symptoms and gastroesophageal reflux disease. J Voice 2005; 19(3): 476–80.

Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002; 16: 274–7.

Šereg-Bahar M, Janša R, Hočevar-Boltežar I. Glasovne motnje in gastroezofagealni refluks. Med Razgl 2004; 43: 221–4.

Keith R, Simpson CB, Velazquez R, Larson N. Pachydermia is not diagnostic of active laryngopharyngeal reflux disease. Laryngoscope 2004; 114: 1557–61.

Belafsky P, Postma G, Koufman J. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001; 111: 1313–7.

Richter JE. Ear, nose and throat and respiratory manifestations of gastro-esophageal reflux disease: an increasing conundrum. Eur J Gastroenterol Hepatol 2004; 16: 837–45.

Vaezi MF. Laryngitis and gastroesophageal reflux disease: increasing prevalence or poor diagnostic tests? Am J Gastroenterol 2004; 2: 786–8.

Branski RC, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease. Laryngoscope 2002; 112: 1019–24.

Habermann W, Kiesler K, Eherer A, Friedrich G. Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux. J Voice 2002; 16: 425–32.

Williams RBH, Szczesniak MM, Maclean JC, Brake HM. Predictors of outcome in an open label, therapeutic trial of high-dose omeprazole in laryngitis. Am J Gastroenterol 2004; 10: 777–85.

Tomažič M, Jamar B. Pomen rentgenskih preiskav požiralnika pri gastroezofagealni refluksni bolezni (GERB). Gastroenterolog 2002; 1: 19–21.

Zidar N. Vloga patologa v diagnostiki in spremljanju gastroezofagealne refluksne bolezni. Gastroenterolog 2002; 1: 17–18.

Hanson DG, Conley D, Jiang J, Kahrilas P. Role of esophageal pH recording in management of chronic laryngitis: an overview. Ann Otol Rhinol Laryngol 2000; 109: 4–9.

Postma G. Ambulatory pH monitoring methodology. Ann Otol Rhinol Laryngol 2000; 109: 10–4.

Strople J, Kaul A. Pediatric gastroesophageal reflux disease-current perspectives. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 447–51.

Marsh RE, Perdue CL, Awad ZT, et al. Is analysis of lower esophageal sphincter vector volumes of value in diagnosing gastroesophageal reflux disease? World J Gastroenterol 2003; 9: 174–8.

Malhi-Chowla N, Achem SR, Stark ME, DeVault KR. Manometry of the upper esophageal sphincter and pharynx is not useful in unselected patients reffered for esophageal testing. Am J Gastroenterol 2000; 95: 1417–21.

Knight J, Lively MO, Johnston N, Dettmar PW et al. Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux. Laryngoscope 2005; 115: 1473–8.

Šereg Bahar M. Glasovne motnje in gastroezofagealni refluks [magistrsko delo]. Ljubljana: Univerza v Ljubljani; 2006.

How to Cite
1.
Šereg-Bahar M, Janša R, Hočevar-Boltežar I. Laryngopharyngeal reflux. ZdravVestn [Internet]. 1 [cited 15Nov.2019];76(1). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1628
Section
Review article