Evaluation and management of laryngopharyngeal reflux

被引:333
|
作者
Ford, CN [1 ]
机构
[1] Univ Wisconsin, Ctr Clin Sci, Dept Surg, Div Otolaryngol, Madison, WI 53792 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2005年 / 294卷 / 12期
关键词
D O I
10.1001/jama.294.12.1534
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Laryngopharyngeal reflux (LPR) is a major cause of laryngeal inflammation and presents with a constellation of symptoms different from classic gastroesophageal reflux disease. Objective To provide a practical approach to evaluating and managing cases of LPR. Evidence Acquisition The PubMed database and the Ovid Database of Systematic Reviews were systematically searched for laryngopharyngeal reflux, laryngopharyngeal reflux fundoplication, laryngopharyngeal reflux PPI treatment, and gastroesophageal reflux AND laryngitis. Pertinent subject matter journals and reference lists of key research articles were also hand-searched for articles relevant to the analysis. Evidence Synthesis Reflux of gastric contents is a major cause of laryngeal pathology. The pathophysiology and symptom complex of LPR differs from gastroesophageal reflux disease. Laryngeal pathology results from small amounts of refluxate-typically occurring while upright during the daytime-causing damage to laryngeal tissues and producing localized symptoms. Unlike classic gastroesophageal reflux, LPR is not usually associated with esophagitis, heartburn, or complaints of regurgitation. There is no pathognomonic symptom or finding, but characteristic symptoms and laryngoscopic findings provide the basis for validated assessment instruments (the Reflux Symptom Index and Reflux Finding Score) useful in initial diagnosis. There are 3 approaches to confirming the diagnosis of LPR: (1) response of symptoms to behavioral and empirical medical treatment, (2) endoscopic observation of mucosal injury, and (3) demonstration of reflux events by impedance and pH-monitoring studies and barium swallow esophagram. While pH monitoring remains the standard for confirming the diagnosis of gastroesophageal reflux, the addition of multichannel intraluminal impedance. technology improves diagnostic accuracy for describing LPR events. Ambulatory multichannel intraluminal impedance assessment allows for identification of gaseous as well as liquid refluxate and detection of nonacid reflux events that are likely significant in confirming LPR. Although some patients respond to conservative behavioral and medical management, as is the case with gastroesophageal reflux, most require more aggressive and prolonged treatment to achieve regression of symptoms and laryngeal tissue changes. Surgical intervention such as laparoscopic fundoplication is useful in selected recalcitrant cases with laxity of the gastroesophageal sphincter. Conclusions Laryngopharyngeal reflux should be suspected when the history and laryngoscopy findings are suggestive of the diagnosis. Failure to respond to a 3-month trial of behavioral change and gastric acid suppression by adequate doses of proton pump inhibitor medication dictates need for confirmatory studies. Multichannel intraluminal impedance and pH-monitoring studies are most useful in confirming LPR and assessing the magnitude of the problem.
引用
收藏
页码:1534 / 1540
页数:7
相关论文
共 50 条
  • [1] Evaluation of a laryngopharyngeal reflux management protocol
    Gupta, Nikita
    Green, Ross W.
    Megwalu, Uchechukwu C.
    AMERICAN JOURNAL OF OTOLARYNGOLOGY, 2016, 37 (03) : 245 - 250
  • [2] Management of Laryngopharyngeal Reflux Disease
    Ashoor, Abdul Aziz J.
    BAHRAIN MEDICAL BULLETIN, 2011, 33 (03)
  • [3] Management of Laryngopharyngeal Reflux in Asia
    Kim, Su Il
    Lechien, Jerome R.
    Ayad, Tareck
    Jia, Huan
    Khoddami, Seyyedeh Maryam
    Enver, Necati
    Raghunandhan, Sampath Kumar
    Hamdan, Abdul Latif
    Eun, Young-Gyu
    CLINICAL AND EXPERIMENTAL OTORHINOLARYNGOLOGY, 2020, 13 (03) : 299 - 307
  • [4] Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review
    Lechien, Jerome R.
    Akst, Lee M.
    Hamdan, Abdul Latif
    Schindler, Antonio
    Karkos, Petros D.
    Barillari, Maria Rosaria
    Calvo-Henriquez, Christian
    Crevier-Buchman, Lise
    Finck, Camille
    Eun, Young-Gyu
    Saussez, Sven
    Vaezi, Michael F.
    OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2019, 160 (05) : 762 - 782
  • [5] Review of management of laryngopharyngeal reflux disease
    Lechien, J. -R.
    Mouawad, F.
    Bobin, F.
    Bartaire, E.
    Crevier-Buchman, L.
    Saussez, S.
    EUROPEAN ANNALS OF OTORHINOLARYNGOLOGY-HEAD AND NECK DISEASES, 2021, 138 (04) : 257 - 267
  • [6] Screening Evaluation for Laryngopharyngeal Reflux Disease
    Lechien, Jerome R.
    Circiu, Marta P.
    Hans, Stephane
    Saussez, Sven
    INDIAN JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY, 2022, 74 (SUPPL 2) : 2593 - 2594
  • [7] Evaluation and Treatment of Laryngopharyngeal Reflux Symptoms
    Kwon, Yong S.
    Oelschlager, Brant K.
    Merati, Albert L.
    THORACIC SURGERY CLINICS, 2011, 21 (04) : 477 - +
  • [8] Screening Evaluation for Laryngopharyngeal Reflux Disease
    Jerome R. Lechien
    Marta P. Circiu
    Stephane Hans
    Sven Saussez
    Indian Journal of Otolaryngology and Head & Neck Surgery, 2022, 74 : 2593 - 2594
  • [9] Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders
    Bercin, Sami
    Kutluhan, Ahmet
    Yurttas, Veysel
    Yalciner, Gokhan
    Bozdemir, Kazim
    Sari, Neslihan
    EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, 2008, 265 (12) : 1539 - 1543
  • [10] Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders
    Sami Bercin
    Ahmet Kutluhan
    Veysel Yurttas
    Gokhan Yalcıner
    Kazım Bozdemir
    Neslihan Sarı
    European Archives of Oto-Rhino-Laryngology, 2008, 265 : 1539 - 1543