Patients with acid, high-fat and low-protein diet have higher laryngopharyngeal reflux episodes at the impedance-pH monitoring

  • Jerome R. LechienEmail author
  • Francois Bobin
  • Vinciane Muls
  • Mihaela Horoi
  • Marie-Paule Thill
  • Didier Dequanter
  • Alexandra Rodriguez
  • Sven Saussez



To assess the impact of diet on the occurrence of proximal reflux episodes at the multichannel intraluminal impedance-pH monitoring (MII-pH) in patients with laryngopharyngeal reflux (LPR).


Patients with LPR symptoms and findings were recruited from three European hospitals. The LPR diagnostic was confirmed through MII-pH and patients were benefited from gastrointestinal (GI) endoscopy. Regarding the types of reflux at the MII-pH (acid, nonacid, mixed), patients received a 3 month-therapy based on the association of alkaline, low-fat and high-protein diet, proton pump inhibitors, alginate or magaldrate. Reflux symptom score (RSS) and reflux sign assessment (RSA) were used to evaluate laryngeal and extra-laryngeal symptoms and findings from pretreatment to posttreatment. The Global Refluxogenic Score (GRES) was used to assess the refluxogenic potential of the diet of the patients at baseline and posttreatment. The relationship between GRES severity; the MII-pH findings; GI endoscopy; and the therapeutic response was explored through multiple linear regression.


Eighty-five LPR patients were included. The mean GRES significantly improved from pretreatment (50.7 ± 23.8) to posttreatment (27.3 ± 23.2; P = 0.001). Similarly, RSS and RSA significantly improved from baseline to posttreatment. The baseline GRES was significantly associated with the occurrence of proximal reflux episodes at the MII-pH (P = 0.001). Trends were found regarding the association between GRES and the occurrence of esophagitis (P = 0.06) and between hiatal hernia and DeMeester score (P = 0.06). There was a significant and strong association between the concomitant respect of diet and medication and the improvement of RSS (P = 0.001).


The consumption of high-fat, low-protein, high-sugar, acid foods, and beverages is associated with a higher number of proximal reflux episodes at the MII-pH, according to the global refluxogenic score of LPR patients.


Reflux Laryngitis Impedance pH monitoring Laryngopharyngeal Diet Foods Beverages 



Vesale Grant and IRIS-Recherche Grant (Foundation Roi Baudouin).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.

Supplementary material

405_2019_5711_MOESM1_ESM.xlsx (70 kb)
Appendix 1: The pH and the composition of lipids, carbohydrates, and proteins of the selected foods. The unit of the composition of food is g/100g. Some foods/beverages are characterized by the lack of components due their nature (water-pH; sugar; lipid) and, therefore, REDS is not available for these foods. C. Score score of composition of foods/beverages, L/P ratio lipid/protein ratio, REDS refluxogenic diet score. (XLSX 70 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jerome R. Lechien
    • 1
    • 2
    • 3
    • 4
    Email author
  • Francois Bobin
    • 1
    • 5
  • Vinciane Muls
    • 1
    • 6
  • Mihaela Horoi
    • 4
  • Marie-Paule Thill
    • 4
  • Didier Dequanter
    • 1
    • 4
  • Alexandra Rodriguez
    • 1
    • 4
  • Sven Saussez
    • 1
    • 2
    • 4
  1. 1.Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS)ParisFrance
  2. 2.Laboratory of Anatomy and Cell Biology, Faculty of MedicineUMONS Research Institute for Health Sciences and Technology, University of Mons (UMons)MonsBelgium
  3. 3.Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and TechnologyUniversity of Mons (UMons)MonsBelgium
  4. 4.Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of MedicineUniversité Libre de BruxellesBrusselsBelgium
  5. 5.Polyclinique Elsan de PoitiersPoitiersFrance
  6. 6.Department of GastroenterologyCHU Saint-Pierre, Université Libre de BruxellesBrusselsBelgium

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