Advertisement

Laryngopharyngeal Reflux (LPR)

  • Krzysztof Nowak
  • Saurabh Sharma
  • Subhash KiniEmail author
Chapter

Abstract

Laryngopharyngeal reflux (LPR) results from influx of stomach contents into the upper airway. Affected individuals complain of multiple laryngopharyngeal and respiratory symptoms, which are non-specific and clinically confusing. As a result, LPR is notoriously difficult to diagnose. We still lack reliable testing methods, and there are no agreed diagnostic criteria for this condition. Consequently, LPR is often underdiagnosed and undertreated in spite of being a very common and often disabling condition. Conservative measures, which include pharmacotherapy, lifestyle, and diet modifications, are often not helpful. In such cases, surgical intervention may be the final viable option.

Keywords

Laryngopharyngeal reflux Chronic cough Proton pump inhibitors Endoluminal treatment Anti-reflux surgery Fundoplication 

References

  1. 1.
    Koufman 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. Laryngoscope. 1991;101:1–78.CrossRefGoogle Scholar
  2. 2.
    Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal 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 Surg. 2002;127:32–5.CrossRefGoogle Scholar
  3. 3.
    Koufman J. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg. 2000;123:385–8.CrossRefGoogle Scholar
  4. 4.
    Francis DO, Rymer JA, Slaughter JC, et al. High economic burden of caring for patients with suspected Extraesophageal reflux. Am J Gastroenterol. 2013;108:905–11.CrossRefGoogle Scholar
  5. 5.
    Peters JH, Demeester TR. Gastroesophageal barrier. 7th ed: Shackelford’s Surg Aliment Tract; 2007.  https://doi.org/10.1016/B978-1-4377-2206-2.00015-4.
  6. 6.
    Samuels TL, Johnston N. Pepsin as a causal agent of inflammation during nonacidic reflux. Otolaryngol Head Neck Surg. 2009;141:559–63.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    Sasaki CT, Marotta J, Chow J, Hundal J, Eisen RN. Bile-induced laryngitis: is there a basis in evidence? Ann Otol Rhinol Laryngol. 2005;114:192–7.CrossRefGoogle Scholar
  9. 9.
    Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16:274–7.CrossRefGoogle Scholar
  10. 10.
    Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111:1313–7.CrossRefGoogle Scholar
  11. 11.
    Wiener GJ, Tsukashima R, Kelly C, Wolf E, Schmeltzer M, Bankert C, Fisk L, Vaezi M. Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux. J Voice. 2009;23:498–504.CrossRefGoogle Scholar
  12. 12.
    Desjardin M, Roman S, Des SB, Gourcerol G, Coffin B, Ropert A, Mion F, Zerbib F. Pharyngeal pH alone is not reliable for the detection of pharyngeal reflux events:a study with oesophageal and pharyngeal pH-impedance monitoring. United Eur Gastroenterol J. 2013;1:438–44.CrossRefGoogle Scholar
  13. 13.
    Calvo-Henríquez C, Ruano-Ravina A, Vaamonde P, Martínez-Capoccioni G, et al. Is pepsin a reliable marker of Laryngopharyngeal reflux? A systematic review. Otolaryngol Neck Surg. 2017;19459981770943Google Scholar
  14. 14.
    Saritas Yuksel E, Hong SKS, Strugala V, Slaughter JC, Goutte M, Garrett CG, Dettmar PW, Vaezi MF. Rapid salivary pepsin test: blinded assessment of test performance in gastroesophageal reflux disease. Laryngoscope. 2012;122:1312–6.CrossRefGoogle Scholar
  15. 15.
    Chappity P, Kumar R, Deka RC, Chokkalingam V, Saraya A, Sikka K. Proton pump inhibitors versus solitary lifestyle modification in Management of Laryngopharyngeal Reflux and Evaluating who is at risk: scenario in a developing country. Clin Med Insights Ear Nose Throat. 2014;7:1–5.  https://doi.org/10.4137/CMENT.S13799.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Guo H, Ma H, Wang J. Proton pump inhibitor therapy for the treatment of laryngopharyngeal reflux. J Clin Gastroenterol. 2015;50:1–6.Google Scholar
  17. 17.
    Wei C. A meta-analysis for the role of proton pump inhibitor therapy in patients with laryngopharyngeal reflux. Eur Arch Otorhinolaryngol. 2016;273:3795–801.CrossRefGoogle Scholar
  18. 18.
    Lam PKY, Ng ML, Cheung TK, Wong BYH, Tan VPY, Fong DYT, Wei WI, Wong BCY. Rabeprazole is effective in treating laryngopharyngeal reflux in a randomized placebo-controlled trial. Clin Gastroenterol Hepatol. 2010;8:770–6.CrossRefGoogle Scholar
  19. 19.
    Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z. Risk of death among users of proton pump inhibitors: a longitudinal observational cohort study of United States veterans. BMJ Open. 2017;7:e015735.CrossRefGoogle Scholar
  20. 20.
    Trad KS, Turgeon DG, Deljkich E. Long-term outcomes after transoral incisionless fundoplication in patients with GERD and LPR symptoms. Surg Endosc Other Interv Tech. 2012;26:650–60.CrossRefGoogle Scholar
  21. 21.
    Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx (Tif 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc Other Interv Tech. 2015;29:2770–80.CrossRefGoogle Scholar
  22. 22.
    Yan C, Liang WT, Wang ZG, Hu ZW, Wu JM, Zhang C, Chen MP. Comparison of Stretta procedure and toupet fundoplication for gastroesophageal reflux disease-related extra-esophageal symptoms. World J Gastroenterol. 2015;21:12882–7.CrossRefGoogle Scholar
  23. 23.
    Sidhwa F, Moore A, Alligood E, Fisichella PM. Diagnosis and treatment of the Extraesophageal manifestations of gastroesophageal reflux disease. Ann Surg. 2017;265:63–7.CrossRefGoogle Scholar
  24. 24.
    Koch OO, Antoniou SA, Kaindlstorfer A, Asche KU, Granderath FA, Pointner R. Effectiveness of laparoscopic total and partial fundoplication on extraesophageal manifestations of gastroesophageal reflux disease: a randomized study. Surg Laparosc Endosc Percutaneous Tech. 2012;22:387–91.CrossRefGoogle Scholar
  25. 25.
    Brown SR, Gyawali CP, Melman L, Jenkins ED, Bader J, Frisella MM, Brunt LM, Eagon JC, Matthews BD. Clinical outcomes of atypical extra-esophageal reflux symptoms following laparoscopic antireflux surgery. Surg Endosc Other Interv Tech. 2011;25:3852–8.CrossRefGoogle Scholar
  26. 26.
    Zhang C, Hu Z-W, Yan C, Wu Q, Wu J-M, Du X, Liu D-G, Luo T, Li F, Wang Z-G. Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale. World J Gastroenterol. 2017;23:3546.CrossRefGoogle Scholar
  27. 27.
    Sontag SJ, O’Connell S, Khandelwal S, Greenlee H, Schnell T, Nemchausky B, Chejfec G, Miller T, Seidel J, Sonnenberg A. Asthmatics with gastroesophageal reflux: long term results of a randomized trial of medical and surgical antireflux therapies. Am J Gastroenterol. 2003;98:987–99.PubMedGoogle Scholar
  28. 28.
    Da SAPC, Tercioti-Junior V, Lopes LR, Coelho-Neto JDS, Bertanha L, Rodrigues PRDF, Andreollo NA. Laparoscopic antireflux surgery in patients with extra esophageal symptoms related to asthma. Arq Bras Cir Dig. 2014;27:92–5.CrossRefGoogle Scholar
  29. 29.
    Eckley CA, Sardinha LR, Rizzo LV. Salivary concentration of epidermal growth factor in adults with reflux laryngitis before and after treatment. Ann Otol Rhinol Laryngol. 2013;122:440–4.CrossRefGoogle Scholar
  30. 30.
    Wood JM, Hussey DJ, Woods CM, Astill D, I Watson D, Lee B, Carney AS. Does gene expression in laryngeal subsites differ between patients with laryngopharyngeal reflux and controls? Clin Otolaryngol. 2018;43(1):158–63.  https://doi.org/10.1111/coa.12918.CrossRefPubMedGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.ENT and Allergy AssociatesYonkersUSA
  2. 2.Department of Bariatric and Robotic Surgery Fortis HospitalMohaliIndia
  3. 3.Department of SurgeryIcahn School of Medicine at Mount Sinai St. Luke’sNew YorkUSA

Personalised recommendations