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Lechien JR, Carroll TL, Huston MN, Naunheim MR. ChatGPT-4 accuracy for patient education in laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2024; 281:2547-2552. [PMID: 38492008 DOI: 10.1007/s00405-024-08560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Chatbot Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence-powered language model chatbot able to help otolaryngologists in practice and research. The ability of ChatGPT in generating patient-centered information related to laryngopharyngeal reflux disease (LPRD) was evaluated. METHODS Twenty-five questions dedicated to definition, clinical presentation, diagnosis, and treatment of LPRD were developed from the Dubai definition and management of LPRD consensus and recent reviews. Questions about the four aforementioned categories were entered into ChatGPT-4. Four board-certified laryngologists evaluated the accuracy of ChatGPT-4 with a 5-point Likert scale. Interrater reliability was evaluated. RESULTS The mean scores (SD) of ChatGPT-4 answers for definition, clinical presentation, additional examination, and treatments were 4.13 (0.52), 4.50 (0.72), 3.75 (0.61), and 4.18 (0.47), respectively. Experts reported high interrater reliability for sub-scores (ICC = 0.973). The lowest performances of ChatGPT-4 were on answers about the most prevalent LPR signs, the most reliable objective tool for the diagnosis (hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH)), and the criteria for the diagnosis of LPR using HEMII-pH. CONCLUSION ChatGPT-4 may provide adequate information on the definition of LPR, differences compared to GERD (gastroesophageal reflux disease), and clinical presentation. Information provided upon extra-laryngeal manifestations and HEMII-pH may need further optimization. Regarding the recent trends identifying increasing patient use of internet sources for self-education, the findings of the present study may help draw attention to ChatGPT-4's accuracy on the topic of LPR.
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Affiliation(s)
- Jerome R Lechien
- Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (IFOS), Paris, France.
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France.
- Polyclinique Elsan de Poitiers, Poitiers, France.
| | - Thomas L Carroll
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Molly N Huston
- Department of Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew R Naunheim
- Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (IFOS), Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngology, Massachusetts Eye and Ear, Boston, MA, USA
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Balouch B, Vaid A, Vontela S, Alnouri G, Sataloff RT. Anatomic and Manometric Abnormalities of the Upper and Lower Esophageal Sphincters in Patients With Reflux Disease. J Voice 2024; 38:746-753. [PMID: 35022151 DOI: 10.1016/j.jvoice.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
RESEARCH QUESTION Laryngopharyngeal reflux (LPR) may cause inflammation of the laryngeal and pharyngeal mucosa. Gastroesophageal reflux disease (GERD) involves retrograde flow of gastric content into the esophagus below the upper esophageal sphincter (UES). The goal of this study was to investigate the esophageal anatomical and manometric variations of the esophagus in patients with LPR and/or GERD. METHODS Adult voice center patients who underwent diagnostic workup for reflux complaints with 24-hour multichannel intraluminal pH-impedance testing and esophageal manometry were included in this retrospective study. Subjects were classified as having LPR (>10 proximal reflux events), LPR + GERD (>10 proximal reflux events plus >73 distal reflux events) or were assigned to a control group (≤10 proximal events and ≤73 distal reflux events) based on pH study results. Anatomic and manometric parameters were evaluated between groups. RESULTS There were 169 cases (65 male, 104 female) included in this study. The average age was 50.50 ± 17.29. Subjects in the LPR group had significantly higher UES relaxation pressures and greater UES length compared with the control group. Lower esophageal sphincter relaxation pressure was significantly higher in the control group compared with the LPR group or the GERD + LPR group. Subjects in the GERD + LPR group had a significantly shorter intra-abdominal portion of the lower esophageal sphincter compared with the LPR only group and the control group. Intrabolus pressure was significantly lower in both the LPR group and the LPR + GERD group compared with the control group. Distal wave amplitude was significantly lower in the LPR + GERD group compared to both the LPR group and the control group. The percentage of swallows with incomplete clearance was significantly greater in the LPR + GERD group than both the control group and the LPR group. The LPR group had significantly fewer swallows with incomplete clearance than the control group. CONCLUSIONS Anatomic and manometric abnormalities are present in subjects with LPR with or without GERD and may contribute to the pathogenesis of reflux disease. Further research is needed to confirm or refute these findings.
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Affiliation(s)
- Bailey Balouch
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anuj Vaid
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Swetha Vontela
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Director of Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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Chandran SK, Doucet M. Neurogenic Dysphagia. Otolaryngol Clin North Am 2024:S0030-6665(24)00037-9. [PMID: 38575486 DOI: 10.1016/j.otc.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis.
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Affiliation(s)
- Swapna K Chandran
- Department of Otolaryngology, Head and Neck Surgery and Communicative Disorders, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA.
| | - Manon Doucet
- Department of Otolaryngology, Head and Neck Surgery and Communicative Disorders, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA
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Krause AJ, Yadlapati R. Review article: Diagnosis and management of laryngopharyngeal reflux. Aliment Pharmacol Ther 2024; 59:616-631. [PMID: 38192086 PMCID: PMC10997336 DOI: 10.1111/apt.17858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Laryngopharyngeal reflux has classically referred to gastroesophageal reflux leading to chronic laryngeal symptoms such as throat clearing, dysphonia, cough, globus sensation, sore throat or mucus in the throat. Current lack of clear diagnostic criteria significantly impairs practitioners' ability to identify and manage laryngopharyngeal reflux. AIMS To discuss current evidence-based diagnostic and management strategies in patients with laryngopharyngeal reflux. METHODS We selected studies primarily based on current guidelines for gastroesophageal reflux disease and laryngopharyngeal reflux, and through PubMed searches. RESULTS We assess the current diagnostic modalities that can be used to determine if laryngopharyngeal reflux is the cause of a patient's laryngeal symptoms, as well as review some of the common treatments that have been used for these patients. In addition, we note that the lack of a clear diagnostic gold-standard, as well as specific diagnostic criteria, significantly limit clinicians' ability to determine adequate therapies for these patients. Finally, we identify areas of future research that are needed to better manage these patients. CONCLUSIONS Patients with chronic laryngeal symptoms are complex due to the heterogenous nature of symptom pathology, inconsistent definitions and variable response to therapies. Further outcomes data are critically needed to help elucidate ideal diagnostic workup and therapeutic management for these challenging patients.
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Affiliation(s)
- Amanda J Krause
- Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Diego, La Jolla, California, USA
| | - Rena Yadlapati
- Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Diego, La Jolla, California, USA
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Min HK, Jeon SY, Lechien JR, Park JM, Park H, Yu JW, Kim S, Jeong SJ, Kang JW, Su Il K, Young Chan L, Eun YG, Ko SG. Translation and validation of the Korean Version of the Reflux Symptom Score. J Voice 2024; 38:545.e1-545.e8. [PMID: 34656394 DOI: 10.1016/j.jvoice.2021.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the validity and reliability of the Korean version of the reflux symptom score (K-RSS). MATERIALS AND METHODS The English version of the RSS was translated into Korean and completed by 77 people (44 and 33 people in the patient group and control group, respectively). They completed the K-RSS (K-RSS-1) and reflux symptom index (RSI) questionnaires and answered questions about age, sex, underlying disease, smoking history, and alcohol and coffee consumption. They completed the K-RSS once more (K-RSS-2) after 1 - 2 weeks. Internal consistency was evaluated using Cronbach's α and test-retest reliability using the intraclass correlation coefficient (ICC). External validity was evaluated using the Spearman rank test between the RSI and K-RSS. The Mann-Whitney U test was used to assess internal validity by comparing the K-RSS-1 scores between the patient and control groups. RESULTS The most common symptoms were globus sensation, throat clearing, and throat pain. The K-RSS reported high internal consistency (α = 0.894). The ICC for the total score was 0.883, indicating excellent test-retest reliability. According to the Spearman analysis, there was a significant correlation between the total score of the K-RSS and that of the RSI (rs = 0.902; P < 0.001), demonstrating strong external validity. Furthermore, the patient group showed significantly higher values than the control group in all K-RSS scores, suggesting high internal validity. CONCLUSION The K-RSS is a patient-reported outcome questionnaire with excellent criterion-referenced validity and ideal reliability.
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Affiliation(s)
- Hye Kyu Min
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - So Young Jeon
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France; Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Jung Min Park
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hwanhee Park
- Department of English Language & Literature, College of Humanities, Kyung Hee University, Seoul, Korea
| | - Jung-Wan Yu
- Department of English Language & Literature, College of Humanities, Kyung Hee University, Seoul, Korea
| | - Suk Kim
- Department of English Language & Literature, College of Humanities, Kyung Hee University, Seoul, Korea
| | - Su Jin Jeong
- Statistics Support Part, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Jung Wook Kang
- Department of Biomedical science and technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Kim Su Il
- Department of Biomedical science and technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Lee Young Chan
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Young-Gyu Eun
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea; Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France; Department of Biomedical science and technology, Graduate School, Kyung Hee University, Seoul, Korea.
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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Lechien JR, Maniaci A, Gengler IM, Al Barajraji M, Mayo-Yanez M. Laryngopharyngeal reflux in otitis media with effusion. Am J Otolaryngol 2024; 45:104152. [PMID: 38134846 DOI: 10.1016/j.amjoto.2023.104152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Jerome R Lechien
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Antonino Maniaci
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Catania 95123, Italy
| | - Isabelle M Gengler
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Mejdeddine Al Barajraji
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France
| | - Miguel Mayo-Yanez
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
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7
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Zheng X, Chen Z, Chen T, Zhou L, Liu C, Zheng J, Hu R. Assessing the role of dryness and burning sensation in diagnosing laryngopharyngeal reflux. Sci Rep 2024; 14:4542. [PMID: 38402357 PMCID: PMC10894288 DOI: 10.1038/s41598-024-55420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 02/23/2024] [Indexed: 02/26/2024] Open
Abstract
Laryngopharyngeal reflux disease (LPRD) is a condition characterized by the regurgitation of stomach and duodenal contents into the laryngopharynx, with variable and non-specific symptoms. Therefore, developing an accurate symptom scale for different regions is essential. Notably, the symptoms of "dryness and burning sensation in the laryngopharynx or mouth" are prevalent among the Chinese population but are often omitted from conventional symptom assessment scales, such as the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) scales. To address this gap, our study incorporated the symptoms into the RSI and RSS-12 scales, developing the RSI-10/RSS-13 scales. Afterward, we assessed the role of the new scale's reliability (Cronbach's α and test-retest reliability), construct validity (confirmatory factor analysis and confirmatory factor analysis), and diagnostic efficiency. Our study encompassed 479 participants (average = 39.5 ± 13.4 years, 242 female) and 91 (average = 34.01 ± 13.50 years, 44 female) completed 24 h MII-pH monitoring. The Cronbach's α values of 0.80 and 0.82 for the RSI-10 and RSS-13 scales, respectively. RSI-10 and RSS-13 exhibited strong test-retest reliability (ICCs = 0.82-0.96) and diagnostic efficacy (AUC = 0.84-0.85). Furthermore, the factor analysis identified the RSS-13 and its three sub-scales (ear-nose-throat, digestive tract, respiratory tract) exhibited good to excellent structural validity (χ2/df = 1.95, P < 0.01; CFI = 0.95, RMSEA = 0.06, SRMR = 0.05). The AUC optimal thresholds for the RSI-10 and RSS-13 in the Chinese population were 13 and 36, respectively. Besides, the inclusion of the new item significantly improved the diagnostic efficiency of the RSI scale (P = 0.04), suggesting that RSI-10 holds promise as a more effective screening tool for LPRD, and global validation is needed to demonstrate the impact of this new symptom on the diagnosis of LPRD.
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Affiliation(s)
- Xiaowei Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, 134 Dong Jie, Gulou District, Fuzhou City, 350001, Fujian Province, China
| | - Zhiwei Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, 134 Dong Jie, Gulou District, Fuzhou City, 350001, Fujian Province, China
| | - Ting Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, 134 Dong Jie, Gulou District, Fuzhou City, 350001, Fujian Province, China.
| | - Liqun Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, 134 Dong Jie, Gulou District, Fuzhou City, 350001, Fujian Province, China
| | - Chaofeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, 134 Dong Jie, Gulou District, Fuzhou City, 350001, Fujian Province, China
| | - Jingyi Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, 134 Dong Jie, Gulou District, Fuzhou City, 350001, Fujian Province, China
| | - Renyou Hu
- Chongqing Jinshan Science and Technology (Group) Co Ltd, Chongqing, 401120, China
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Valdovinos Díaz MA, Amieva-Balmori M, Carmona-Sánchez R, Coss-Adame E, Gómez-Escudero O, González-Martínez M, Huerta-Iga F, Morel-Cerda E, Remes-Troche JM, Tamayo-de la Cuesta JL, Torres-Villalobos G, Valdovinos-García LR, Vázquez-Elizondo G, Villar-Chávez AS, Arenas-Martínez JA. Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:121-143. [PMID: 38580493 DOI: 10.1016/j.rgmxen.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment. AIM The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD. METHODS The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires. RESULTS Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient. CONCLUSIONS An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.
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Affiliation(s)
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - R Carmona-Sánchez
- Servicio de Gastroenterología, Práctica privada, San Luis Potosí, Mexico
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia y Motilidad Gastrointestinal, Endoneurogastro, Hospital Ángeles Puebla, Puebla, Mexico
| | - M González-Martínez
- Departamento de Endoscopia, Hospital de Especialidades del CMN Siglo XXI IMSS, Mexico City, Mexico
| | - F Huerta-Iga
- Servicio de Gastroenterología, Hospital Ángeles Torreón, Torreón, Mexico
| | - E Morel-Cerda
- Departamento de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - J L Tamayo-de la Cuesta
- Servicio de Gastroenterología y Endoscopia Gastrointestinal, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - G Torres-Villalobos
- Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - G Vázquez-Elizondo
- Servicio de Gastroenterología, Centro de Enfermedades Digestivas ONCARE, Monterrey, Mexico
| | - A S Villar-Chávez
- Servicio de Gastroenterología, Hospital Ángeles Acoxpa, Mexico City, Mexico
| | - J A Arenas-Martínez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Yun JM, Kim KW, Kim S, So YK. Salivary pepsin as an independent predictor of treatment response for laryngopharyngeal reflux: prospective cohort study with multivariate analysis. Sci Rep 2023; 13:22893. [PMID: 38129481 PMCID: PMC10739976 DOI: 10.1038/s41598-023-50014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
To analyze the predictive value of salivary pepsin for treatment outcomes in laryngopharyngeal reflux (LPR) using multivariate analysis that includes various associated factors. This prospective cohort study was conducted between August 2020 and August 2022. Patients with LPR who had symptoms lasting more than 1 month and a reflux symptom index (RSI) of 14 or higher were enrolled. The participants received a 2-month regimen of proton pump inhibitors (PPIs) treatment and lifestyle modification. Salivary pepsin was checked using fasting saliva before treatment. Salivary pepsin was detected more frequently in the good treatment response group (61.1%), compared to 14.3% in the poor response group. Similarly, patients with higher compliance to lifestyle modifications (> 90%) had a higher chance of a good response (91.7%) compared to those with lower compliance, who had a 53.8% chance of a good response. Other clinical factors have no significant association with treatment response. In multivariate analysis, both pretreatment salivary pepsin and higher compliance with lifestyle modification were found to be independent factors for treatment response (OR 14.457, CI 1.075 ~ 194.37 for both). This study found that positive salivary pepsin and strict lifestyle modification are independent predictors of treatment outcomes in LPR.
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Affiliation(s)
- Ji Min Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea
| | - Suji Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea
| | - Yoon Kyoung So
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea.
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10
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Quigley N, Mistry SG, Vasant DH, Vasani S. Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms. BMJ Open Gastroenterol 2023; 10:e000883. [PMID: 37996120 PMCID: PMC10668155 DOI: 10.1136/bmjgast-2022-000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation. DESIGN This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches. RESULTS The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed. CONCLUSION Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.
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Affiliation(s)
- Nathan Quigley
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Sandeep G Mistry
- Department of Ear Nose and Throat, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Sarju Vasani
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
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Lechien JR. Personalized Treatments Based on Laryngopharyngeal Reflux Patient Profiles: A Narrative Review. J Pers Med 2023; 13:1567. [PMID: 38003882 PMCID: PMC10671871 DOI: 10.3390/jpm13111567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To review the current findings of the literature on the existence of several profiles of laryngopharyngeal reflux (LPR) patients and to propose personalized diagnostic and therapeutic approaches. METHODS A state-of-the art review of the literature was conducted using the PubMED, Scopus, and Cochrane Library databases. The information related to epidemiology, demographics, clinical presentations, diagnostic approaches, and therapeutic responses were extracted to identify outcomes that may influence the clinical and therapeutic courses of LPR. RESULTS The clinical presentation and therapeutic courses of LPR may be influenced by gender, age, weight, comorbidities, dietary habits and culture, anxiety, stress, and saliva enzyme profile. The clinical expression of reflux, including laryngopharyngeal, respiratory, nasal, and eye symptoms, and the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring profile of patients are important issues to improve in patient management. The use of more personalized therapeutic strategies appears to be associated with better symptom relief and cures over the long-term. The role of pepsin in LPR physiology is well-established but the lack of information about the role of other gastrointestinal enzymes in the development of LPR-related mucosa inflammation limits the development of future enzyme-based personalized diagnostic and therapeutic approaches. CONCLUSION Laryngopharyngeal reflux is a challenging ear, nose, and throat condition associated with poor therapeutic responses and a long-term burden in Western countries. Artificial intelligence should be used for developing personalized therapeutic strategies based on patient features.
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Affiliation(s)
- Jerome R. Lechien
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Baudour, Belgium;
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, (Paris Saclay University), 92150 Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, B1000 Brussels, Belgium
- Research Committee of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), 92150 Paris, France
- Department of Otolaryngology, Elsan Hospital, 92150 Paris, France
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12
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Fossmark R, Ness-Jensen E, Sørdal Ø. Is empiric proton pump inhibition in patients with symptoms of extraesophageal gastroesophageal reflux justified? BMC Gastroenterol 2023; 23:303. [PMID: 37674110 PMCID: PMC10483799 DOI: 10.1186/s12876-023-02945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The prevalence of gastroesophageal reflux disease (GERD) has had a marked increase in Western countries with a paralleling interest in extraesophageal (EE) manifestations of GERD, including laryngopharyngeal reflux (LPR). There are considerable differences in clinical practice between gastroenterologists, otolaryngologists and pulmonologists. METHODS In this narrative review we address some of these controversies concerning EE manifestations of GERD and LPR. RESULTS It is disputed whether there is causal relationship between reflux and the numerous symptoms and conditions suggested to be EE manifestations of GERD. Similarly, the pathophysiology is uncertain and there are disagreements concerning diagnostic criteria. Consequently, it is challenging to provide evidence-based treatment recommendations. A significant number of patients are given a trial course with a proton pump inhibitor (PPI) for several months before symptoms are evaluated. In randomized controlled trials (RCTs) and meta-analyses of RCTs PPI treatment does not seem to be advantageous over placebo, and the evidence supporting that patients without verified GERD have any benefit of PPI treatment is negligible. There is a large increase in both over the counter and prescribed PPI use in several countries and a significant proportion of this use is without any symptomatic benefit for the patients. Whereas short-term treatment has few side effects, there is concern about side-effects after long-term use. Although empiric PPI treatment for suspected EE manifestations of GERD instead of prior esophageal 24-hour pH and impedance monitoring is included in several guidelines by various societies, this practice contributes to overtreatment with PPI. CONCLUSION We argue that the current knowledge suggests that diagnostic testing with pH and impedance monitoring rather than empiric PPI treatment should be chosen in a higher proportion of patients presenting with symptoms possibly attributable to EE reflux.
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Affiliation(s)
- Reidar Fossmark
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Prinsesse Kristinas gate 1, Trondheim, 7030, Norway.
- Medicus Endoscopy, Trondheim, Norway.
| | - Eivind Ness-Jensen
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Balouch B, Melley LE, Yeakel H, Ranjbar PA, Tong J, Eichorn D, Alnouri G, Brennan M, Tran Q, Sataloff RT. Gluten Sensitivity Underlying Resistant "Laryngopharyngeal Reflux" Symptoms and Signs. J Voice 2023:S0892-1997(23)00131-5. [PMID: 37666745 DOI: 10.1016/j.jvoice.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Laryngopharyngeal reflux (LPR) is one of the most common conditions encountered in otolaryngology. Gluten sensitivity may mimic the signs and symptoms of LPR or act as an aggravating cofactor with LPR. Gluten sensitivity and food intolerance also have been implicated as conditions that may be associated specifically with LPR symptoms and signs resistant to traditional medical treatment. Medical management of LPR may be insufficient to control symptoms and laryngeal signs of reflux, constituting resistant LPR. Eliminating gluten from the diet could provide symptomatic relief to patients with gluten sensitivity and LPR that is not controlled adequately by current regimens. The purpose of our study was to investigate the relationship between gluten sensitivity and LPR. We aimed to evaluate reflux finding score (RFS) improvement following elimination of gluten from the diet in patients with resistant LPR who had positive blood tests associated with gluten sensitivity. Symptom improvement was also assessed following dietary gluten elimination. Lastly, we aimed to identify predictors for a positive response to a gluten-free diet. METHODS Adult patients who underwent gluten sensitivity testing for treatment-resistant LPR symptoms and/or signs were included. Patients with ≥1 positive test were advised to begin a therapeutic trial of a gluten-free diet. Subjects who chose not to trial a gluten-free diet or tested negative for gluten sensitivity markers served as controls. RFS was the primary outcome measure. RESULTS One hundred ninety-seven patients were included; 81 trialed a gluten-free diet. Subjects who trialed the gluten-free diet were significantly more likely to demonstrate objective improvement in RFS (77.14% vs 43.88%), and report subjective improvement (55.41% vs 25.77%) than those who did not. RFS had decreased significantly from baseline at 1-3, 3-6, 6-12, and >12-month interval follow-up examinations in subjects who trialed a gluten-free diet. Comparison between subjects who trialed the gluten-free diet, tested positive for a gluten sensitivity marker but did not trial the gluten-free diet, and subjects who were negative for all gluten sensitivity markers revealed that a gluten-free diet was associated with a significantly greater percent improvement in RFS compared to controls at 1-3, 6-12, and >12-months. CONCLUSION Gluten sensitivity can mimic or aggravate LPR. A gluten-free diet should be considered for patients with resistant LPR, especially if blood test abnormalities that suggest gluten sensitivity are identified. The diet should be maintained for a minimum of three months to demonstrate objective improvement using RFS.
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Affiliation(s)
- Bailey Balouch
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lauren E Melley
- Department of Otolaryngology - Facial Plastic Surgery and Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Heather Yeakel
- Department of Otolaryngology - Head and Neck Surgery, St. Luke's Health Network, Bethlehem, Pennsylvania
| | | | - Jane Tong
- Department Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Daniel Eichorn
- Department of Otolaryngology - Facial Plastic Surgery and Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Matthew Brennan
- Department of Otolaryngology - Facial Plastic Surgery and Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Quynh Tran
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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14
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Zhang C, Liu Z, Zhang J, Wang X, Wang J, Zhao J, Li J, Liu L. Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux. Laryngoscope 2023; 133:2104-2109. [PMID: 36453478 DOI: 10.1002/lary.30489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To compare the screening value of the Reflux Symptom Score (RSS) and the Reflux Symptom Index (RSI) for laryngopharyngeal reflux (LPR). METHODS All included patients attending the Department of Otolaryngology at the Sixth Medical Center of the PLA General Hospital from February 2022 to August 2022, completed the RSS and the RSI and underwent 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (24 h HEMII-pH) monitoring. The results of 24 h HEMII-pH were used as a diagnostic criterion for LPR, consistency between two questionnaires (RSS, RSI) and 24 h HEMII-pH was compared by the weighted Cohen's kappa statistic and the screening value of RSS and RSI for LPR was compared by receiver operating characteristics analysis. RESULTS A total of 77 patients, 58 males, and 19 females, were included. The Kappa values of between RSS, RSI, and 24 h HEMII-pH were 0.663 (p < 0.001) and 0.213 (p < 0.05), respectively. The sensitivity of RSS and RSI were 92.8% and 48.2%, respectively, the specificity was 71.4% and 80.9%. The negative predictive value and positive predictive value of RSI were 36.9%, 87.1%, and that of RSS were 78.9%, 89.6%. The area under curve of the RSS (0.783; 95% CI = 0.53, 0.75) is significantly higher than RSI (0.633; 95% CI = 0.72, 0.90). CONCLUSION The RSS has a higher consistency and better screening value for LPR compared to RSI. In addition, the RSS includes more reflux symptoms, which may reduce the number of missed diagnoses in patients with LPR to some extent. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2104-2109, 2023.
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Affiliation(s)
- Chun Zhang
- Department of otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Zhi Liu
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jinhong Zhang
- Department of otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Xiaoyu Wang
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jiasen Wang
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jing Zhao
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - Jinrang Li
- Department of otolaryngology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
| | - LianLian Liu
- Department of otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, China
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15
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Kwon SK, Park SJ, Chung EJ, Sohn JH, Sun DI, Jin SM, Lee BJ, Park IS, Cho JG, Park YH. Predictors of Early and Late Response to Esomezol and Lifestyle Modification in Adults With Laryngopharyngeal Reflux Disease: A Prospective, Multicenter, Open-Label Cohort Study. Clin Exp Otorhinolaryngol 2023; 16:259-274. [PMID: 37350172 PMCID: PMC10471909 DOI: 10.21053/ceo.2023.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES This study aimed to assess predictors of the response to varying durations of proton pump inhibitor (PPI) use and lifestyle modification treatment for laryngopharyngeal reflux disease (LPRD). METHODS Between October 2014 and June 2016, a prospective, multicenter, open-label, single-cohort, intention-to-treat, observational study was conducted at eight referral hospitals across the Republic of Korea to examine predictors of early and late response to treatment in adult patients (age ≥19 years) with LPRD. Participants underwent standard treatment (PPI [Esomezol] and lifestyle modification) for 3 months. Response to treatment was defined as greater than 50% improvement in reflux symptom index score. The primary outcome was potential predictors of treatment response at 1 and 3 months. The secondary outcome was potential predictors distinguishing early from late responders. RESULTS In total, 394 patients were enrolled. Improved sleep habits was a positive predictor (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.06-3.007; P=0.029), while initial alcohol consumption (OR, 0.587; 95% CI, 0.355-0.969; P=0.037) and past medication history (OR, 0.438; 95% CI, 0.215-0.891; P=0.005) were negative predictors of response after 1 month of treatment. High pre-reflux finding score was a positive predictor (OR, 1.187; 95% CI, 1.049- 1.344; P=0.007), while male sex (OR, 0.516; 95% CI, 0.269-0.987; P=0.046), higher depression score (OR, 0.867; 95% CI, 0.784-0.958; P=0.005), and past thyroid hormone medication history (OR, 0.161; 95% CI, 0.033-0.788; P=0.024) were negative predictors of response after 3 months of treatment. Past medication history (OR, 0.438; 95% CI, 0.215-0.891; P=0.023) was the only negative predictor for early responders compared to late responders. CONCLUSION Adult patients with LPRD and a history of prior medication use may require longer treatment durations to achieve a therapeutic response. Future research should explore the incorporation of diverse treatment approaches to improve treatment outcomes for patients exhibiting negative prognostic indicators.
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Affiliation(s)
- Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong-Il Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Min Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Hak Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Guimarães I, Batista AP, Quintal A, Bom R, Romeiro C, Saraiva M, Cunha M, Ferreira DB, Correia P, Almeida L, Torrejano G. The Reflux Symptom Score-12: Cross-cultural Adaptation and Validation for European Portuguese Speakers With Laryngopharyngeal Reflux. J Voice 2023:S0892-1997(23)00190-X. [PMID: 37524579 DOI: 10.1016/j.jvoice.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To translate and cross-culturally adapt the 12-item reflux symptom score (RSS-12) to European Portuguese (EP) and determine its clinimetric properties for symptomatic individuals with laryngopharyngeal reflux (LPR). STUDY DESIGN Multinational cross-sectional cohort study. METHODS The English RSS-12 was cross-culturally adapted according to the recommendations of the international guidelines. The validation study included the completion of the RSS-12, reflux symptom index, and voice handicap index by symptomatic and asymptomatic subjects with LPR. The RSS-12 was completed a second time by symptomatic subjects. Nine clinimetric properties were analyzed according to the international guidelines for validation of patient-reported outcome measures. RESULTS The EP RSS-12 is equivalent to the English version (content, depth, and scoring). A total of 155 adults (84 with LPR symptoms) aged 21-78 years participated in the validation study. Statistical analyses revealed high internal consistency (Cronbach alpha >0.90), high test-retest reliability (intraclass correlation coefficient > 0.70, P < 0.001), low measurement error (Standard measure error of 5.21 for RSS and 1.59 for quality of life), good content validity (omission data <1% and item-total correlations > 0.652), good construct validity (61.9% of the total item variance with moderate item loadings), strong concurrent validity with reflux symptom index (rp = 0.772, P < 0.001) and moderate validity with voice handicap index (rp = 0.531, P < 0.001), and significantly known-groups validity (P < 0.001). The EP RSS-12 showed cross-cultural validity with French and Persian versions and high predictive validity with a cut-off value >8 for a sensitivity of 91.7% and a specificity of 91.5%. CONCLUSIONS The EP RSS-12 retained the features of the English version and is a reliable and valid patient-reported outcome measure for EP individuals with LPR in the study.
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Affiliation(s)
- Isabel Guimarães
- Speech and Language Pathologist (SLP), Speech Therapy Department, Alcoitão Health School of Sciences; Clinical and Therapeutics Pharmacological Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Portugal
| | - Ana P Batista
- PMR Department, Centro Hospitalar e Universitário do Algarve, Portimão, Portugal.
| | - Aldora Quintal
- ENT Department, Hospital Garcia de Orta, Almada, Portugal
| | - Rita Bom
- ENT Department, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal
| | - Cláudia Romeiro
- ENT Department, Hospital do Divino Espírito Santo, Ponta Delgada, EPE, Portugal
| | - Madalena Saraiva
- ENT Department, Hospital do Divino Espírito Santo, Ponta Delgada, EPE, Portugal
| | - Maura Cunha
- PMR Department, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
| | - Daniela B Ferreira
- ENT Department Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Paula Correia
- ENT Department, Hospital Garcia de Orta, Almada, Portugal
| | - Lina Almeida
- ENT Department, Hospital dos Lusíadas, Lisboa, Portugal
| | - Gabriela Torrejano
- ENT Department, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
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Wang G, Wang L, Sun Z, Li L, Guo Y, Wu J, Wang Q, Fang J, Lv Q, Li G, Han H, Zhong C, Qu C, Li B, Sui X, Zhou Y, Liu H, Sataloff RT, Wu W. A Comparison Between W Score and RYAN Score in Diagnosing Laryngopharyngeal Reflux Disease. J Voice 2023:S0892-1997(23)00174-1. [PMID: 37429810 DOI: 10.1016/j.jvoice.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To assess the diagnostic value of the W score in differentiating laryngopharyngeal reflux disease (LPRD) patients from the normal population by pharyngeal pH (Dx-pH) monitoring, compared with the RYAN score. METHODS One hundred and eight patients with suspected LPRD and complete follow-up results after more than 8 weeks of anti-reflux therapy were enrolled from the Department of Otolaryngology-Head and Neck Surgery, Gastroenterology and Respiratory Medicine of seven hospitals. Their Dx-pH monitoring data before treatment were reanalyzed to obtain the W score in addition to the RYAN score and then the diagnostic sensitivity and specificity were compared and evaluated with reference to the result of anti-reflux therapy. RESULTS In eighty-seven (80.6%) cases, anti-reflux therapy was effective, and in 21 patients (19.4%), therapy was ineffective. Twenty-seven patients (25.0%) had a positive RYAN score. The W score was positive in 79 (73.1%) patients. There were 52 patients who had a negative RYAN score, but a positive W score. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of the RYAN score were 28.7%, 90.5%, 92.6%, and 23.5%, respectively (kappa = 0.092, P = 0.068), whereas those of the W score for LPRD was 83.9%, 71.4%, 92.4%, and 51.7%, respectively (kappa = 0.484, P < 0.001). CONCLUSIONS W score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve diagnostic efficacy. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1800014931.
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Affiliation(s)
- Gang Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Lei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Zhezhe Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Lianyong Li
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yuzhu Guo
- Department of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Jimin Wu
- Department of Gastroesophageal Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Qi Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital of the Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital of the Capital Medical University, Beijing, China
| | - Qiuping Lv
- Department of Otorhinolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Gelin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital of the Capital Medical University, Beijing, China
| | - Haolun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Changqing Zhong
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Changmin Qu
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Baowei Li
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Xinke Sui
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Ying Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Hongdan Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Robert T Sataloff
- Department of Otorhinolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China.
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18
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S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:862-933. [PMID: 37494073 DOI: 10.1055/a-2060-1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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19
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Tawaranurak K, Werathammo M. Effect of positive airway pressure compliance on laryngopharyngeal reflux in obstructive sleep apnea patients. BMC Res Notes 2023; 16:124. [PMID: 37370165 DOI: 10.1186/s13104-023-06390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES To determine the effect of continuous positive airway pressure (CPAP) compliance on symptoms and signs of laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA). RESULTS Thirty patients were included. The participants were divided into good compliance (n = 21) and poor compliance (n = 9) groups. After 6-month CPAP treatment, the reflux symptom index score significantly decreased in both the good compliance group (20 (17,24) vs. 14 (10,18), p < 0.001) and the poor compliance group (21 (18,25) vs. 10 (5,16), p < 0.05). Reflux finding score was significantly reduced in both the good compliance group (8 (6,9) vs. 4 (3,5), p < 0.001) and the poor compliance group (6 (4,8) vs. 3 (2,4), p < 0.05). However, there were no statistically significant differences between the groups. CPAP treatment reduces the symptoms and signs of LPR. However, CPAP compliance does not correlate with improvement in LPR in patients with OSA.
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Affiliation(s)
- Krongthong Tawaranurak
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.
| | - Methini Werathammo
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand
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Wang J, Li J, Zhao J, Wu J. Can pepsin immunohistochemical staining of laryngeal lesions accurately diagnose non-acid laryngeal reflux? Acta Otolaryngol 2023:1-4. [PMID: 37326288 DOI: 10.1080/00016489.2023.2221694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Non-acid reflux is the most common form of laryngopharyngeal reflux (LPR). However, the damage caused by non-acid reflux to the laryngeal mucosa is weaker than that caused by acid reflux. AIMS To evaluate whether pepsin immunohistochemical (IHC) staining of laryngeal lesions can accurately diagnose acidic and non-acidic LPR. MATERIALS AND METHODS Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring was performed, and the patients were divided into acid reflux and non-acid reflux groups. Pathological sections of laryngeal lesions were examined using pepsin IHC staining, which was positive when pepsin was detected in the cytoplasm. RESULTS The study included 136 patients, with 58 in the acid reflux group, 43 in the non-acid reflux group, and 35 in the without reflux group. There were no significant differences in the positive rate of pepsin IHC staining between the non-acid and acid reflux groups (p = .421). The sensitivity of pepsin IHC staining for the diagnosis of acid and non-acid reflux was 94.8% and 90.7%, respectively. CONCLUSIONS The sensitivity of pepsin IHC staining for laryngeal lesions in the diagnosis of non-acidic LPR is satisfactory. SIGNIFICANCE Pepsin IHC staining is suitable for LPR screening of patients with laryngeal lesions as it is economical, non-invasive, and highly sensitive.
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Affiliation(s)
- Jiasen Wang
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Jinrang Li
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Jing Zhao
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Jing Wu
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Centre of Chinese PLA General Hospital, Beijing, China
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Lin Y, Peng S. Current Treatment of Laryngopharyngeal Reflux. EAR, NOSE & THROAT JOURNAL 2023:1455613231180031. [PMID: 37296536 DOI: 10.1177/01455613231180031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Objectives: Laryngopharyngeal reflux (LPR) is a complex syndrome characterized by the reflux of gastroduodenal contents into the pharynx or larynx, resulting in a range of symptoms, including chronic cough, throat clearing, pain, dysphagia, hoarseness, and dysphonia. Despite the lack of a gold standard for diagnosis or treatment, various strategies have been proposed to manage LPR. However, the effectiveness of these treatments is compromised by the lack of a uniform treatment protocol, which places a burden on patients, physicians, and the healthcare system. This study aims to systematically review the treatments of LPR and provide updated and useful clinical information to clinical physicians. Methods: The literature with an emphasis on LPR and related keywords is searched and reviewed in PubMed. Results: Treatment of LPR includes health education, lifestyle modification, dietary changes, medications, and surgery, as well as the emergence of a novel treatment method involving external upper esophageal sphincter compression devices. Conclusions: Currently, medication is the main treatment, supplemented with lifestyle and dietary changes, but there is still a lack of effective means for patients with drug-resistant or intolerant LPR. More high-quality and rigorous trials must continue to be conducted to determine the best treatment options and find novel treatments. Taking into account the complexity of LPR, this study proposes a simple algorithm to help clinicians with the initial management of this disease.
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Affiliation(s)
- Yang Lin
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Shunlin Peng
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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Kapil A, Acharya S, Bepari K, V. D, Rajan S. Clinical Evaluation of Laryngopharyngeal Reflux and its Response to Proton Pump Inhibitors. Indian J Otolaryngol Head Neck Surg 2023; 75:409-415. [PMID: 37275040 PMCID: PMC10235294 DOI: 10.1007/s12070-022-03219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To clinically evaluate the patients of laryngopharyngeal reflux(LPR) and their response to Proton Pump Inhibitors(PPIs) using laryngeal Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Method This prospective observational study was conducted on 128 patients attending the ENT-OPD of VSSIMSAR,Burla,India, who had persistent laryngeal symptoms for more than 2 months.Data was collected using standardized RSI and RFS after taking detailed history and laryngoscopic examination.Patients who were diagnosed of LPR on the basis of their RSI & RFS were subjected to treatment with PPI-Pantoprazole & were called back for follow up at 2nd, 4th and 6th months.Pre and post treatment RSI & RFS were compared using appropriate statistical tests and results with p-value< 0.01 were considered statistically significant. Results The overall effect of PPIs on all symptoms & signs of LPR,included in RSI and RFS respectively,is statistically significant except on swallowing (not statistically significant at p <0.01) showing a careful usage of RSI & RFS while diagnosing LPR clinically.Study also elucidated that PPI are effective in relieving symptoms of LPR patients.Evaluating Pearson correlation coefficient,the value of R=0.3717;R2 =0.1382 shows low positive correlation between the RSI & RFS.RSI & RFS are related to each other and any change in the RSI will affect the value of RFI and vice versa. Conclusion From this study we conclude that LPR is prevalent in age of 28-37 years & has female preponderance.PPIs are effective in treating LPR.Though RSI and RFS are effective and valid parameters for managing LPR cases but have to be used cautiously while interpreting the results.
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Affiliation(s)
- Alka Kapil
- Department of ENT & HNS, VSSIMSAR, 768017 Burla, Odisha India
- Dept of ENT & HNS, Panimalar Medical College hospital, Poonamallee, Chennai India
| | | | - Kamalini Bepari
- Department of ENT & HNS, VSSIMSAR, 768017 Burla, Odisha India
| | - Deepakraj V.
- Dept of ENT & HNS, Panimalar Medical College hospital, Poonamallee, Chennai India
| | - Sandrendu Rajan
- Department of ENT & HNS, VSSIMSAR, 768017 Burla, Odisha India
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23
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Chen JW, Vela MF, Peterson KA, Carlson DA. AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review. Clin Gastroenterol Hepatol 2023; 21:1414-1421.e3. [PMID: 37061897 DOI: 10.1016/j.cgh.2023.01.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 04/17/2023]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update is to review the available evidence and expert advice regarding the clinical management of patients with suspected extraesophageal gastroesophageal reflux disease. METHODS This article provides practical advice based on the available published evidence including that identified from recently published reviews from leading investigators in the field, prospective and population studies, clinical trials, and recent clinical guidelines and technical reviews. This best practice document is not based on a formal systematic review. The best practice advice as presented in this document applies to patients with symptoms or conditions suspected to be related to extraesophageal reflux (EER). This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice (BPA) statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings of the quality of evidence or strength of the presented considerations. BEST PRACTICE ADVICE 1: Gastroenterologists should be aware of potential extraesophageal manifestations of gastroesophageal reflux disease (GERD) and should inquire about such disorders including laryngitis, chronic cough, asthma, and dental erosions in GERD patients to determine whether GERD may be a contributing factor to these conditions. BEST PRACTICE ADVICE 2: Development of a multidisciplinary approach to extraesophageal (EER) manifestations is an important consideration because the conditions are often multifactorial, requiring input from non-gastroenterology (GI) specialties. Results from diagnostic testing (ie, bronchoscopy, thoracic imaging, laryngoscopy, etc) from non-GI disciplines should be taken into consideration when gastroesophageal reflux (GER) is considered as a cause for extraesophageal symptoms. BEST PRACTICE ADVICE 3: Currently, there is no single diagnostic tool that can conclusively identify GER as the cause of EER symptoms. Determination of the contribution of GER to EER symptoms should be based on the global clinical impression derived from patients' symptoms, response to GER therapy, and results of endoscopy and reflux testing. BEST PRACTICE ADVICE 4: Consideration should be given toward diagnostic testing for reflux before initiation of proton pump inhibitor (PPI) therapy in patients with potential extraesophageal manifestations of GERD, but without typical GERD symptoms. Initial single-dose PPI trial, titrating up to twice daily in those with typical GERD symptoms, is reasonable. BEST PRACTICE ADVICE 5: Symptom improvement of EER manifestations while on PPI therapy may result from mechanisms of action other than acid suppression and should not be regarded as confirmation for GERD. BEST PRACTICE ADVICE 6: In patients with suspected extraesophageal manifestation of GERD who have failed one trial (up to 12 weeks) of PPI therapy, one should consider objective testing for pathologic GER, because additional trials of different PPIs are low yield. BEST PRACTICE ADVICE 7: Initial testing to evaluate for reflux should be tailored to patients' clinical presentation and can include upper endoscopy and ambulatory reflux monitoring studies of acid suppressive therapy. BEST PRACTICE ADVICE 8: Testing can be considered for those with an established objective diagnosis of GERD who do not respond to high doses of acid suppression. Testing can include pH-impedance monitoring while on acid suppression to evaluate the role of ongoing acid or non-acid reflux. BEST PRACTICE ADVICE 9: Alternative treatment methods to acid suppressive therapy (eg, lifestyle modifications, alginate-containing antacids, external upper esophageal sphincter compression device, cognitive-behavioral therapy, neuromodulators) may serve a role in management of EER symptoms. BEST PRACTICE ADVICE 10: Shared decision-making should be performed before referral for anti-reflux surgery for EER when the patient has clear, objectively defined evidence of GERD. However, a lack of response to PPI therapy predicts lack of response to anti-reflux surgery and should be incorporated into the decision process.
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Affiliation(s)
- Joan W Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
| | - Marcelo F Vela
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Dustin A Carlson
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Shen H, Han Y, Yao C, Tao Y, Wu J, Gao C, Wu F, Liu Y. Transcutaneous electrical acupoint stimulation for suspected laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 2023; 280:1815-1825. [PMID: 36239783 DOI: 10.1007/s00405-022-07698-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with proton pump inhibitor (PPI) therapy on symptoms and signs of patients with suspected laryngopharyngeal reflux disease (LPRD). METHODS This was a prospective randomized controlled study. Seventy patients with reflux symptom index (RSI) > 13 and reflux finding score (RFS) > 7 were recruited and received PPI alone (control group) or TEAS combined with PPI (experimental group) for 12 weeks. Patients in the experimental group received TEAS at Tiantu (RN22), Renying (ST9), and Neiguan (PC6) once a day, five times a week. RSI, RFS, throat pain visual analog score (VAS), and LPR-health-related quality-of-life (LPR-HRQL) scores were evaluated at baseline and after 4 and 12 weeks. RESULTS The decreases in total RSI and RFS, along with several subscores, were significantly higher in the experimental group than in the control group after 12 weeks (P < 0.05). The throat pain VAS and LPR-HRQL scores decreased significantly at 4 and 12 weeks after treatment in both groups, with significant differences between the groups (P < 0.001). No severe adverse events occurred, and the rates of adverse events were similar between the two groups. CONCLUSION Compared with PPI alone, TEAS combined with PPI showed a significantly greater improvement in symptoms, signs, and quality of life in the treatment of LPRD without increasing the occurrence of adverse effects. Therefore, TEAS could serve as a useful and safe treatment method for LPRD. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2100046755.
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Affiliation(s)
- Hailong Shen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China
| | - Yanxun Han
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China
| | - Changyu Yao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China
| | - Ye Tao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China
| | - Jing Wu
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China
| | - Chaobing Gao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China
| | - Feihu Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Yehai Liu
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230000, People's Republic of China.
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Nacci A, Capobianco S, Mazzoni L, Fattori B, Barillari MR, Genovese E, Berrettini S, Bastiani L. Development of a New Self-Assessment Tool for Laryngopharyngeal Reflux Screening in Singers (SVHI-12-LPR). Folia Phoniatr Logop 2023; 75:284-294. [PMID: 36822157 DOI: 10.1159/000529800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION The present study aimed to develop a new tool for the evaluation of singers with self-reported symptoms suggestive of laryngopharyngeal reflux (LPR) (the SVHI-12-LPR), by correlating RSI with SVHI in a population sample of 163 subjects (both professional and amateur singers), evaluated also by videolaryngostroboscopy. This study was a cross-sectional, double-observational study. METHODS RSI and SVHI were administered to 159 singers (amateurs, singing students, and professional singers). All subjects underwent videolaryngostroboscopy to objectively identify four subgroups: normal subjects (41.5%), subjects with organic lesions occupying the glottic space (17.6%), subjects with functional dysphonia (18.2%), and subjects presenting solely signs suggestive of LPR (22.6%). Using the validated RSI threshold, 33.9% of participants presented an RSI total score >13, suggestive of LPR. RESULTS Subjects with a suspected diagnosis of LPR at videolaryngostroboscopy presented a mean RSI significantly higher than other subgroups (p < 0.001). Moreover, the SVHI-36 score did not statistically differ between pathological subgroups. A significant positive relationship was observed between RSI and SVHI total score (Spearman's rank correlation coefficient [ρ] = 0.474, p < 0.001). 12 SVHI items (items 1, 2, 4, 5, 6, 7, 12, 20, 24, 25, 26, 30) showed a significant association with RSI pathology classification. Statistical analysis demonstrated for the 12 selected items (SVHI-12-LPR) acceptable specificity (0.691) and sensibility (0.833) for the suspected diagnosis of LPR with a cut-off of 15. CONCLUSIONS From the SVHI-36, 12 items were extracted that correlated with the specific impact that LPR has on the singer's voice (SVHI-12-LPR), as evaluated by RSI and videolaryngostroboscopy. Such questionnaire represents a new tool that could be applied to singers with symptoms suggestive of LPR to select which patients would benefit from a further phoniatric and videolaryngostroboscopic evaluation.
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Affiliation(s)
- Andrea Nacci
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Silvia Capobianco
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Laura Mazzoni
- Department of Diagnostic, Clinical and Public Health, Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Fattori
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Italy
| | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
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26
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Runggaldier D, van Schie B, Marti S, Bohlender JE. [Current possibilities and challenges in the treatment of laryngopharyngeal reflux]. HNO 2023; 71:294-303. [PMID: 36795120 PMCID: PMC10125953 DOI: 10.1007/s00106-023-01280-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with a variety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.
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Affiliation(s)
- Daniel Runggaldier
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz. .,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz.
| | - Bram van Schie
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz
| | - Silvan Marti
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz
| | - Jörg E Bohlender
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz
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Korsunsky SRA, Camejo L, Nguyen D, Mhaskar R, Chharath K, Gaziano J, Richter J, Velanovich V. Voice Hoarseness with Reflux as a Suspected Etiology: Incidence, Evaluation, Treatment, and Symptom Outcomes. J Gastrointest Surg 2023; 27:658-665. [PMID: 36652177 DOI: 10.1007/s11605-022-05574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To describe the clinical evaluation course, treatments, and outcomes of patients with a primary complaint of hoarseness due to suspected laryngopharyngeal reflux (LPR). METHODS A retrospective chart review was conducted of patients with a primary complaint of hoarseness with acid reflux as the suspected cause at a single institution between October 2011 and March 2020 who underwent clinical evaluation, treatment, and follow-up. Data collected included diagnostic procedures and treatments received, subjective symptom outcomes, and final diagnosis as determined by the treating physician. RESULTS A total of 134 patients met the inclusion criteria. Videostroboscopy was the most performed procedure (n = 59, 44%) followed by endoscopy (n = 38, 28%) and pH monitoring (n = 28, 21%). Three patients were removed for statistical analysis of treatment differences and outcomes due to variant treatment plans. Most patients received sole medical management (n = 86, 66%), 7 patients received only voice therapy (5%), and 10 patients underwent surgical management (8%). Several patients received combined medical management and voice therapy (n = 21, 16%). Final diagnoses included gastroesophageal reflux disease (GERD) (25%), followed by multifactorial causes (17%) and dysphonia with unclear etiology (13%). Among all patients, 82 (61%) reported symptom improvement. Twenty-eight patients were diagnosed with LPR or LPR with GERD (21%), and 22 reported symptom improvement (79%). There was a statistically significant relationship between a final diagnosis with a reflux component and symptom improvement (p = .038). There was no statistically significant difference between treatment types and symptom outcomes both within the total patient population (p = .051) and patients diagnosed with a reflux condition (p = .572). CONCLUSION LPR remains a difficult diagnosis to establish and represents a minority of patients with voice complaints. Despite varying evaluation and treatment modalities, most patients with LPR improved during their treatment and evaluation period without a clear association with any specific type of treatment. Further studies should explore diagnostic criteria for LPR, the necessary and efficient clinical evaluation to establish a diagnosis, and possible beneficial treatments.
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Affiliation(s)
| | | | - Diep Nguyen
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | | | - Joy Gaziano
- USF Health Joy McCann Culverhouse Center for Swallowing Disorders, Tampa, FL, USA
| | - Joel Richter
- USF Health Joy McCann Culverhouse Center for Swallowing Disorders, Tampa, FL, USA
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Menon R, Vasani SS, Widdicombe NJ, Lipman J. Laryngeal injury following endotracheal intubation: Have you considered reflux? Anaesth Intensive Care 2023; 51:14-19. [PMID: 36168788 DOI: 10.1177/0310057x221102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Laryngotracheal injury is an increasingly common complication of intubation and mechanical ventilation, with an estimated 87% of intubated and ventilated patients developing a laryngotracheal injury often preventing their rehabilitation from acute illness. Laryngotracheal injuries encompass a diverse set of pathologies including inflammation and oedema in addition to vocal cord ulceration and paralysis, granuloma, stenosis, and scarring. The existing literature has identified several factors including intubation duration, endotracheal tube size, type and cuff pressures, and technical factors including the skill and experience of the endoscopist. Despite these associations, a key aspect in the sequelae of laryngotracheal injuries is due to reflux and is not clearly related to iatrogenic and mechanical factors.Laryngopharyngeal reflux is a type of reflux that contaminates the upper aerodigestive tract. The combination of patient positioning and continuous nasogastric tube feeding act to affect the upper aerodigestive tract with acidic and non-acidic refluxate that causes direct and indirect mucosal injury impeding healing.Despite laryngopharyngeal reflux being an established and recognised causative factor of upper aerodigestive tract inflammatory pathology and laryngotracheal injury, it is very understudied in critical care. Further, there is yet to be an agreed pathway to assess, manage and prevent laryngotracheal injury in intubated and ventilated patients. The incidence of laryngopharyngeal reflux in the intubated and mechanically ventilated patient in the intensive care unit is currently unknown. Prospective studies may allow us to understand further potential mechanisms of upper aerodigestive tract injury due to laryngopharyngeal reflux and herald the development of preventative and management strategies of laryngopharyngeal reflux-mediated upper aerodigestive tract injury in critically ill patients.
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Affiliation(s)
- Rahul Menon
- Department of Otorhinolaryngology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Sarju S Vasani
- Department of Otorhinolaryngology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Neil J Widdicombe
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jeffrey Lipman
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia
- The University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nimes University Hospital, Nimes, France
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Chouhdry H, Villwock J. Patient Perspective on Adherence to Reflux Lifestyle Modifications: A Qualitative Study. J Prim Care Community Health 2023; 14:21501319231207320. [PMID: 37849281 PMCID: PMC10585988 DOI: 10.1177/21501319231207320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Acid reflux disease is a common condition with recurrent symptoms affecting the quality of life of many Americans. Lifestyle/dietary modification is critical for management of acid reflux disease. Adherence to these recommendations is variable. The purpose of this study was to better understand the experience of patients with reflux disease (GERD/LPR) and explore factors that impact the integration of lifestyle modifications into their daily lives. METHODS Patient with diagnoses of GERD and/or LPR were recruited from an outpatient laryngology clinic and completed the Reflux Symptom Index (RSI) and a semi-structured interview. Interviews were transcribed and underwent thematic analysis. RESULTS Twenty-three patients-mean age and RSI of 61 and 16.1 respectively-were recruited. Four main themes emerged: (1) Care team interaction-focus and quality of physician counseling, useful educational handouts, dietician/nutritionist counseling; (2) Motivation to change-impact on symptom severity, avoiding undesired interventions, and poor health outcomes; (3) Implementing lifestyle changes; and (4) Impact of disease on patient. No patient had seen a dietician. Patients who experienced dietary counseling for other conditions felt reflux-specific counseling with a dietician would be beneficial. While patients found educational material on diet to be helpful, lists of foods to avoid were discouraging; providing a positive list of preferred foods may be more helpful. CONCLUSION Lifestyle modification counseling should incorporate multiple aspects of the patient experience. Patients desire information regarding medication side effects. Educational handouts should include prioritized list of recommended dietary restrictions and acceptable/alternative food options. Referral for dedicated dietician counseling can also be considered to increase understanding of the importance of, and adherence to, lifestyle modification.
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Affiliation(s)
- Hira Chouhdry
- University of Kansas School of Medicine, Kansas City, KS, USA
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Koh J, Phyland D, Baxter M, Leong P, Bardin PG. Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics. Expert Rev Respir Med 2023; 17:429-445. [PMID: 37194252 DOI: 10.1080/17476348.2023.2215434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based. AREAS COVERED A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure. EXPERT OPINION Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.
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Affiliation(s)
- Joo Koh
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Debra Phyland
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Malcolm Baxter
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
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Kang HJ, Noh JK, Lee MK, Woo SR, Park JM, Lee YC, Ko SG, Eun YG. Changes of Pepsin Concentration in Saliva Sample According to Storage Period. J Voice 2022:S0892-1997(22)00411-8. [PMID: 36588013 DOI: 10.1016/j.jvoice.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether the concentration of pepsin in the saliva sample changes according to the storage period of the sample. METHODS Forty eight patients with suspected laryngopharyngeal reflux were included in this study. Saliva samples were collected from each patient and each sample divided into six and stored for different period of time. Pepsin concentration was measured using enzyme-linked immunosorbent assay. A comparison was made between the pepsin concentration measured immediately and the concentration measured after storage for 1 week, 2 weeks, 1 month, 3 months, and 6 months. RESULTS No significant difference in pepsin concentrations were detected between the sample analyzed immediately and those analyzed at 1 week, 2 weeks, 1 month, and 3 months after saliva collection. A significant difference in pepsin concentration was observed in the sample analyzed immediately and the sample analyzed 6 months after saliva collection. CONCLUSIONS Pepsin concentration in saliva samples did not demonstrate a significant difference between the concentration measured immediately and the concentration measured 3 months after saliva collection, although a significant difference was observed in the concentration measured 6 months after collection.
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Affiliation(s)
- Hee Jin Kang
- Department of Otolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Joo Kyung Noh
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Min Kyeong Lee
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seon Rang Woo
- Department of Otolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Central Laboratory, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jung Min Park
- Department of Otolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Young Chan Lee
- Department of Otolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young-Gyu Eun
- Department of Otolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
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Yu L, Li R, Du L, Zhao Y. The diagnostic value of pepsin concentration in saliva for laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 2022; 279:5783-5789. [PMID: 35689682 DOI: 10.1007/s00405-022-07472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore the diagnostic efficacy of pepsin concentration in saliva for laryngopharyngeal reflux (LPR) disease. METHODS In this study, we recruited 40 participants with abnormal sensation of throat into the study who visited our hospital from March 2020 to December 2020. The 24 h multichannel intraluminal impedance and pH monitoring (24 h MII-pH), reflux symptom index (RSI) and reflux finding score (RFS), pepsin concentration in saliva were collected. The Cohen's kappa test and receiver-operating characteristic (ROC) curves were performed to determine and compare the sensitivity and specificity of five diagnostic methods: RSI; RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration. RESULTS The area under the curve (AUC) of RSI, RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration were 0.767, 0.733, 0.870, 0.750,0.867, respectively. That is, the pepsin concentration has maximum AUC (the cutoff point is 219.47 (ng/mL); the sensitivity and 1-specificity is 0.300, 0.933, respectively.). The positive predictive value was 90.3% (28/31), and the negative predictive value was 77.8% (7/9). The Cohen's kappa coefficients of the five diagnostic subgroups were: RSI 0.486 (95% CI 0.207-0.764, P = 0.001); RFS 0.333 (95% CI 0.021-0.644, P = 0.032); RSI + RFS: 0.517 (95% CI 0.205-0.829, P = 0.001); pepsin concentration: 0.699 (95% CI 0.379-0.931, P = 0.001); RSI + RFS + pepsin concentration: 0.500 (95% CI 0.181-0.819, P < 0.001). CONCLUSION The pepsin concentration has the maximum AUC area and highest consistency with the 24 h MII-pH. Therefore, it has certain value in the screening and diagnosis of diseases related to LPR disease.
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Affiliation(s)
- Lei Yu
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Rui Li
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Linnan Du
- Chemical Engineering Institute, Shijiazhuang University, Shijiazhuang, China
| | - Yuliang Zhao
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Bobin F, Lechien JR. The role of pH-impedance monitoring in swallowing disorders. Curr Opin Otolaryngol Head Neck Surg 2022; 30:406-416. [PMID: 36004789 DOI: 10.1097/moo.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the current evidence about the usefulness and the place of pH study in the management of patients with swallowing disorders. RECENT FINDINGS Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are found in approximately 30% of patients with esophageal or oropharyngeal dysphagia. Patients with suspected GERD may benefit from gastrointestinal endoscopy and proton pump inhibitors according to guidelines. The diagnosis of LPR in patients with oropharyngeal dysphagia is more controversial because there are no gold standard and diagnostic guidelines. The clinical diagnosis based on empirical therapeutic trial is a reasonable first-line strategy, but many dysphagic patients should not respond to treatment. These patients require hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH), which is the most effective examination providing important information on GERD and LPR features. At the HEMII-pH, GERD patients often report upright (daytime) and supine (nighttime) liquid acid esophageal events with significant esophageal distal acid exposure time. LPR patients have more frequently upright (daytime) gaseous weakly acid or nonacid pharyngeal reflux events without distal esophageal acid exposure abnormalities in many times. The features of reflux at the HEMII-pH may indicate a personalized treatment for dysphagic patients combining proton pump inhibitors, alginate/magaldrate or gastroprokinetic in cases of esophageal dysmotility. SUMMARY GERD and LPR are prevalent causes of dysphagia. The large number of reflux patients who do not respond to empirical treatment makes important the awareness of otolaryngologists about pH-impedance monitoring indication, features, and interpretation.
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Affiliation(s)
- Francois Bobin
- Polyclinic of Poitiers, Elsan Hospital, Poitiers, France
| | - Jerome R Lechien
- Polyclinic of Poitiers, Elsan Hospital, Poitiers, France
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons
- Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
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Kommentar zu „PPI bei Halsbeschwerden nicht besser als Placebo“. Laryngorhinootologie 2022; 101:779-780. [PMID: 36174564 DOI: 10.1055/a-1873-5477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lechien JR. Sensitivity, Specificity, and Predictive Values of Laryngopharyngeal Reflux Symptoms and Signs in Clinical Practice. Otolaryngol Head Neck Surg 2022:1945998221121822. [PMID: 36040820 DOI: 10.1177/01945998221121822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the sensitivity (SE), specificity (SP), and positive and negative predictive value (PPV and NPV) of symptoms and signs of laryngopharyngeal reflux (LPR). STUDY DESIGN Prospective controlled. SETTING University medical center. METHODS Patients presenting with LPR symptoms and signs were consecutively included after diagnosis confirmation through 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring. Healthy individuals were recruited to compose a control group. Symptoms and signs were evaluated with the reflux symptom score and reflux sign assessment. The SE, SP, PPV, and NPV of symptoms and signs were assessed. RESULTS The study included 403 patients with LPR and 144 healthy individuals. Throat clearing, globus sensation, heartburn, and excess throat mucus were symptoms with the highest SE (67.5%-69.7%), SP (12.5%-20.8%), and NPV (48.3%-49.2%). The combination of throat clearing, heartburn, globus sensation, and excess throat mucus led to a high SE (96.0%) and NPV (85.2%). Anterior pillar erythema, tongue tonsil hypertrophy, and posterior commissure hypertrophy resulted in the highest SE (75.5%-83.5%). The highest SP was found for uvula erythema/edema, epiglottis erythema, and interarytenoid granulatory tissue (97.1%-97.2%). The association of nonendoscopic signs (anterior pillar erythema, uvula erythema/edema, and coated tongue) had an SE and SP of 80.1% and 47.2%, respectively. The association of throat clearing, heartburn, globus, anterior pillar erythema, and uvula erythema/edema had the highest SE (98.8%), SP (33.3%), PPV (94.3%), and NPV (70.6%). CONCLUSION LPR symptoms and signs reported low SP and NPV. The SE, SP, PPV, and NPV may be maximized with the association of throat clearing, heartburn, globus sensation, anterior pillar erythema, and uvula erythema/edema.
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Affiliation(s)
- Jérôme R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Brussels, Belgium
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Kohansal A, Khoddami SM, Ansari NN, Lechien JR, Aghazadeh K. Validity and Reliability of the Persian Version of Reflux Symptom Score-12 in Patients with Laryngopharyngeal Reflux Disease. J Voice 2022:S0892-1997(22)00224-7. [PMID: 36030157 DOI: 10.1016/j.jvoice.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Cross cultural adaptation of the reflux symptom score-12 (RSS-12) into Persian language and to evaluate its validity and reliability in the assessment of patients with laryngopharyngeal reflux disease (LPRD). STUDY DESIGN A cross-sectional and prospective cohort design. METHODS A standard forward and backward translation was followed to cross-culturally adapt the RSS-12 into Persian language. To study discriminative validity, the RSS-12p was administrated to 63 patients with LPRD (40 men and 23 women; mean age: 39.26 ± 9.79 years) and 50 healthy volunteers (31 men and 19 women; mean age: 37.24 ± 10.28 years). The patients completed the reflux symptom index (RSI) to assess construct validity. The test-retest reliability was investigated in 31 patients (time interval = 7 days). RESULTS There were no missing responses and floor or ceiling effects. The assessing of discriminative validity showed that the questionnaire was able to discriminate between patients with LPRD and healthy participants (P<0.001). Construct validity was confirmed by the Pearson correlation between the RSS-12p and the RSI (rp= 0.87; P<0.00). The internal consistency was confirmed with Cronbach α 0.85 and 0.72 for the RSS-12p and quality of life (QoL), respectively. Test-retest reliability was excellent (ICCagreement = 0.98 for the RSS-12p and 0.94 for QoL). CONCLUSIONS The Persian version of RSS-12 is a valid and reliable self-administered questionnaire for assessing LPRD in Persian-speaking patients.
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Affiliation(s)
- Azin Kohansal
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Polyclinique de Poitiers, Elsan, Poitiers, France
| | - Kayvan Aghazadeh
- Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Lechien JR, Lisan Q, Eckley CA, Hamdan A, Eun Y, Hans S, Saussez S, Akst LM, Carroll TL. Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The
IFOS
Classification. Laryngoscope 2022; 133:1073-1080. [PMID: 36250977 DOI: 10.1002/lary.30322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 07/13/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients. METHODS Patients with LPR diagnosed by hypopharyngeal-esophageal impedance-pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3-to 9-month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated. RESULTS One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life-RSS (QoL-RSS) and RSS total scores were significantly higher in chronic LPR patients. The post-treatment decrease of QoL-RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL-RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL-RSS thresholds defined acute (QoL-RSS = 6-25), recurrent (QoL-RSS = 26-38), and chronic (QoL-RSS > 38) LPR. CONCLUSION Baseline QoL-RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR. LEVEL OF EVIDENCE 3 Laryngoscope, 133:1073-1080, 2023.
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Affiliation(s)
- Jérôme R. Lechien
- Department of Otolaryngology Elsan Hospital Paris France
- Department of Otolaryngology–Head and Neck Surgery Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University) Paris France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons) Mons Belgium
- Department of Otolaryngology–Head and Neck Surgery CHU Saint‐Pierre (CHU de Bruxelles) Brussels Belgium
| | - Quentin Lisan
- Department of Otolaryngology–Head and Neck Surgery Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University) Paris France
| | - Claudia A. Eckley
- Divisão de Otorrinolaringologia Fleury Medicina e Saúde Laboratórios de Diagnóstico São Paulo Brazil
| | - Abdul‐Latif Hamdan
- Department of Otorhinolaryngology–Head and Neck Surgery American University of Beirut Medical Center Beirut Lebanon
| | - Young‐Gyu Eun
- Department of Otorhinolaryngology–Head and Neck Surgery School of Medicine, Kyung Hee University Seoul South Korea
| | - Stéphane Hans
- Department of Otolaryngology–Head and Neck Surgery Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University) Paris France
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons) Mons Belgium
- Department of Otolaryngology–Head and Neck Surgery CHU Saint‐Pierre (CHU de Bruxelles) Brussels Belgium
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery Johns Hopkins Hospital, Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Thomas L. Carroll
- Department of Otolaryngology–Head and Neck Surgery Harvard Medical School Boston Massachusetts U.S.A
- Division of Otolaryngology, Department of Surgery Brigham and Women's Hospital Boston Massachusetts U.S.A
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Meta-analysis of Proton Pump Inhibitors in the Treatment of Pharyngeal Reflux Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9105814. [PMID: 35912160 PMCID: PMC9334091 DOI: 10.1155/2022/9105814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
The present study aimed to examine the safety and healing effects of proton pump inhibitors (PPIs) in people with laryngopharyngeal reflux disease (LPRD). To find all relevant studies published before April 1, 2022, we searched the PubMed, Embase, Web of Science, Clinical Trials, Cochrane Library, CNKI, and Wanfang databases. For SLE, we looked for all randomized controlled clinical trials related to PPIs versus placebo-controlled treatment of LPRD. Overall efficiency, reflux symptom index (RSI), reflux finding score (RFS), improvement in cough and hoarseness, and adverse reactions were compared using the Review Manager 5.3. Using the reflux symptom index (RSI) as an outcome indicator for efficacy assessment, the PPI group showed significant improvement compared with the placebo group [MD = 3.35, 95% CI (1.34, 5.37, P < 0.05)]. In terms of overall efficacy, the PPI group showed effectiveness, but its efficacy was not statistically significantly dissimilar from that of the placebo group [OR = 1.62, 95% CI (0.89, 2.95), P > 0.05].
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Karkos PD, Lechien JR. Laryngopharyngeal Reflux: The Last Decade. J Clin Med 2022; 11:jcm11133592. [PMID: 35806876 PMCID: PMC9267816 DOI: 10.3390/jcm11133592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Laryngopharyngeal reflux (LPR) and its consequences for the upper aerodigestive tract have been an issue of debate and controversy for more than three decades [...]
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Affiliation(s)
- Petros D. Karkos
- 1st Academic ORL Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, 91190 Paris, France;
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Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients. J Clin Med 2022; 11:jcm11113158. [PMID: 35683545 PMCID: PMC9181144 DOI: 10.3390/jcm11113158] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.
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Translation and cultural adaptation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score-12 into Brazilian Portuguese. Braz J Otorhinolaryngol 2022; 89:264-270. [PMID: 35760754 PMCID: PMC10071531 DOI: 10.1016/j.bjorl.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the process of translation into Brazilian Portuguese and cross-cultural adaptation of the French Reflux Symptom Score-12 questionnaire used for the diagnosis of laryngopharyngeal reflux. METHODS This was a cross-cultural translation and adaptation study of a health instrument, with a cross-sectional design. It was carried out in eight stages: translation from French into Brazilian Portuguese, cultural adaptation by a panel of experts, application of the first version (pilot test 1), adaptation by a panel of experts, application of the second version (pilot test 2), back translation, reviewing by a committee in conjunction with the author of the original instrument and, application of the final version. The Brazilian Portuguese versions of the questionnaire were applied to individuals with symptoms and signs of laryngopharyngeal reflux who underwent pHmetry and esophageal manometry at the study site. RESULTS In pilot test 1, the first version of the RSS-12 in Brazilian Portuguese was applied to 30 patients. The patients had no difficulty to understand any of the 12 symptom items, but 15 patients (50%) had difficulty interpreting the symptom frequency score. After adapting the format of the frequency score, a version 2 of the RSS-12 in Brazilian Portuguese was applied to another 23 patients, who completed the questionnaire in full without any difficulty. Along with the review committee, the author of the original RSS-12 considered the version 2 to be adequate and did not propose any changes, so it was approved as the final version of the Brazilian Portuguese RSS-12. CONCLUSION The Brazilian Portuguese version of the instrument, called Reflux Symptom Score-12 PT-BR, shows good understanding and linguistic, conceptual and content equivalence, in relation to the original Reflux Symptom Score-12.
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Snow GE, Dbouk M, Akst LM, Ihde G, Zarnegar R, Janu P, Murray M, Eskarous H, Sohagia A, Dhar SI, Irene Canto M. Response of Laryngopharyngeal Symptoms to Transoral Incisionless Fundoplication in Patients with Refractory Proven Gastroesophageal Reflux. Ann Otol Rhinol Laryngol 2022; 131:662-670. [PMID: 34378427 DOI: 10.1177/00034894211037414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. METHODS Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett's esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. RESULTS Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P < .001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF (P < .001). CONCLUSION In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Grace E Snow
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad Dbouk
- Division of Gastrointestinal and Liver Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lee M Akst
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Glenn Ihde
- Department of General Surgery, The Matagorda Regional Medical Group, Bay City, TX, USA
| | | | - Peter Janu
- Department of Surgery, Fox Valley Surgical Associates, Appleton, WI, USA
| | - Michael Murray
- Department of Surgery, Northern Nevada Medical Center, Sparks, NV, USA
| | - Hany Eskarous
- Department of Medicine, Easton Hospital, Easton, PA, USA
| | - Amit Sohagia
- Department of Medicine, Easton Hospital, Easton, PA, USA
| | - Shumon I Dhar
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marcia Irene Canto
- Division of Gastroenterology, Department of Medicine and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Xu X, Wang Y, Silverman M, Liu L, Jiang JJ, Li X, Zhuang P. Glottic Insufficiency in the Vertical Plane in Patients With Unknown-Source Unilateral Vocal Fold Hypomobility. J Voice 2022:S0892-1997(22)00098-4. [PMID: 35469727 DOI: 10.1016/j.jvoice.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To observe the laryngeal CT and strobe laryngoscopy signs of unilateral vocal fold hypomobility (UVFHM) in patients with well-closed glottises in the horizontal plane. METHODS A retrospective analysis was performed on 18 subjects with well-closed glottises in the horizontal plane using strobe laryngoscopy, 9 patients diagnosed with unilateral vocal fold hypomobility with an unknown etiology were enrolled in the UVFHM group, and 9 healthy matched subjects with symmetrical bilateral vocal fold movement were enrolled in the control group. Vertical plane distances of bilateral vocal folds and three-dimensional structural parameters of vocal folds were measured through laryngeal CT. Glottic insufficiency in the vertical plane and reflux findings scores (RFS) were assessed under laryngeal CT and strobe laryngoscopy. Reflux symptom index (RSI) were collected. SPSS25.0 software was used for statistical analysis. RESULTS The height differences in vertical plane and thicknesses of bilateral vocal folds in the UVFHM group were larger than those in the control (P < 0.05), while the length, width and subglottic convergence angle of the vocal folds were not statistically significant between the two groups (P > 0.05). In the UVFHM group, laryngeal CT showed that 77.78% of patients (7/9) had glottic insufficiency in the vertical plane, with height differences ranging from 0.3 to 1.9 mm and a mean of 0.76mm. However, strobe laryngoscopy showed that 33.33% (3/9) had glottic insufficiency in the vertical plane. The proportion of patients with glottic insufficiency in vertical plane in the UVFHM group was significantly higher than that in the control group (P < 0.05). RSI and RFS scores of the UVFHM group were higher than those of the control group (P < 0.05). CONCLUSION Glottic insufficiency in the vertical plane often occurred in patients with UVFHM with an unknown cause of hoarseness, so the presence of glottic insufficiency in the vertical plane should be considered when hoarseness is detected by clinicians. Laryngeal dynamic CT can enhance the diagnostic rate compared to strobe laryngoscopy. Unexplained UVFHM patients have higher RSI and RFS compared to control subjects, warranting further research about the relationship between UVFHM and laryngopharyngeal reflux.
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Affiliation(s)
- Xinlin Xu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yong Wang
- Department of Radiology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Matthew Silverman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Liying Liu
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Xiangping Li
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Peiyun Zhuang
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Shen H, Han Y, Wu D, Hu L, Ma Y, Wu F, Tao Y, Liu Y. Trial of transcutaneous electrical acupoint stimulation in laryngopharyngeal reflux disease: study protocol for a randomized controlled trial. Trials 2022; 23:272. [PMID: 35395946 PMCID: PMC8991573 DOI: 10.1186/s13063-022-06193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients with persistent globus sensation, throat clearing, chronic cough, hoarseness, and other throat symptoms account for a large proportion of patients in ears, nose, and throat clinics. Laryngopharyngeal reflux disease (LPRD) is increasingly valued by otolaryngologists. Transcutaneous electrical acupoint stimulation (TEAS) is possibly a new method for the treatment of LPRD. This trial aims to determine whether TEAS combined with proton pump inhibitor (PPI) is better than PPI alone in the treatment of LPRD. Methods This prospective randomized controlled trial will be implemented in a tertiary hospital in China. Seventy patients diagnosed with LPRD will be randomly assigned to the TEAS + PPI group (intervention group) or PPI group (control group), at a ratio of 1:1. In addition to using PPI, the intervention group will receive TEAS at four groups of acupoints, and each group will be treated for 15 min, once for 60 min, five times a week, for 12 weeks, 60 times. The main outcome will be changes in the Reflux Symptom Index scores at 4, 12, and 24 weeks after treatment. The secondary outcomes will include changes in the reflux finding score, Laryngopharyngeal Reflux-Health-related Quality of Life score, and throat pain visual analog scale score. Discussion This trial will explore the feasibility of TEAS combined with PPI for the treatment of LPRD and provide potential evidence for its effectiveness and safety. The results of this study will be published in a peer-reviewed journal. Trial registration Chinese Clinical Trial Registry ChiCTR2100046755. Registered on May 28, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06193-0.
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Affiliation(s)
- Hailong Shen
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Yanxun Han
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Di Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, People's Republic of China
| | - Lihong Hu
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Yunxia Ma
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Feihu Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, People's Republic of China
| | - Ye Tao
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China
| | - Yehai Liu
- Department of Otolaryngology-Head & Neck Surgery, The First Affiliated Hospital of Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui, 230022, People's Republic of China.
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Distinct Clinical Physiologic Phenotypes of Patients With Laryngeal Symptoms Referred for Reflux Evaluation. Clin Gastroenterol Hepatol 2022; 20:776-786.e1. [PMID: 34022451 PMCID: PMC8715518 DOI: 10.1016/j.cgh.2021.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Heterogeneous presentations and disease mechanisms among patients with laryngeal symptoms account for misdiagnosis of laryngopharyngeal reflux (LPR), variations in testing, and suboptimal outcomes. We aimed to derive phenotypes of patients with laryngeal symptoms based on clinical and physiologic data and to compare characteristics across phenotypes. METHODS A total of 302 adult patients with chronic laryngeal symptoms were prospectively enrolled at 3 centers between January 2018 to October 2020 (age 57.2 ± 15.2 years; 30% male; body mass index 27.2 ± 6.0 kg/m2). Discriminant analysis of principal components (DAPC) was applied to 12 clinical and 11 physiologic variables collected in stable condition to derive phenotypic groups. RESULTS DAPC identified 5 groups, with significant differences across symptoms, hiatal hernia size, and number of reflux events (P < .01). Group A had the greatest hiatal hernia size (3.1 ± 1.0 cm; P < .001) and reflux events (37.5 ± 51; P < .001), with frequent cough, laryngeal symptoms, heartburn, and regurgitation. Group B had the highest body mass index (28.2 ± 4.6 kg/m2; P < .001) and salivary pepsin (150 ± 157 ng/mL; P = .03), with frequent cough, laryngeal symptoms, globus, heartburn, and regurgitation. Group C frequently reported laryngeal symptoms (93%; P < .001), and had fewest esophageal symptoms (9.6%; P < .001) and reflux events (10.7 ± 11.0; P < .001). Group D commonly reported cough (88%; P < .001) and heartburn. Group E (18%) was oldest (62.9 ± 14.3 years; P < .001) and distinguished by highest integrated relaxation pressure. CONCLUSIONS DAPC identified distinct clinicophysiologic phenotypes of patients with laryngeal symptoms referred for reflux evaluation: group A, LPR and gastroesophageal reflux disease (GERD) with hiatal hernia; group B, mild LPR/GERD; group C, no LPR/No GERD; group D, reflex cough; and group E, mixed/possible obstructive esophagogastric junction. Phenotypic differences may inform targeted clinical trials design and improve outcomes.
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The Effect of Hyaluronic Acid and Chondroitin Sulphate-Based Medical Device Combined with Acid Suppression in the Treatment of Atypical Symptoms in Gastroesophageal Reflux Disease. J Clin Med 2022; 11:jcm11071890. [PMID: 35407497 PMCID: PMC9000081 DOI: 10.3390/jcm11071890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Extraesophageal reflux symptoms are increasingly common in the Western population and their clinical management is still controversial. Although therapy with proton-pump inhibitors (PPIs) represents the gold standard, to date, many patients are refractory to this treatment. The aim of this study was to evaluate, in patients with a recent diagnosis of GERD experiencing extraesophageal symptoms, the efficacy and safety of a 6-week treatment with PPI acid suppression in combination with Gerdoff® (a hyaluronic acid and chondroitin sulphate-based medical device) compared to PPI monotherapy. The trial verified the reduction in symptom frequency and severity by evaluating the proportion of Responders and Non-Responder patients after 6 weeks of treatment, compared to baseline. The effects of Gerdoff® + PPI treatment on extraesophageal symptoms were also evaluated after a 12-week follow up only in Responder patients. The analysis of the change in total Reflux Symptoms Index (RSI) score from baseline to the other time points showed that the extent of the decrease from baseline was higher in the Gerdoff® + PPI group than in the PPI group at any time point. However, the comparison between groups did not show statistically significant differences at any time point. A statistically significant difference, in favor of the Gerdoff® + PPI group, was observed for individual RSI items. Even if the trial showed some limitations, this is the first published study on the efficacy of a medical device containing hyaluronic acid and chondroitin sulphate with antacid in the treatment of extraesophageal reflux symptoms.
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O'Hara J, Fisher H, Hayes L, Wilson J. 'Persistent throat symptoms' versus 'laryngopharyngeal reflux': a cross-sectional study refining the clinical condition. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000850. [PMID: 35338049 PMCID: PMC8961157 DOI: 10.1136/bmjgast-2021-000850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Many patients are assessed for chronic symptoms including: dysphonia, ‘globus’, throat clearing, postnasal secretions and cough; commonly grouped together and attributed to ‘laryngopharyngeal reflux’. This study aimed to explore a clinical trial’s baseline dataset for patterns of presenting symptoms, which might provide a more rational basis for treatment. Design Baseline data were analysed for participants entering the Trial Of Proton-Pump Inhibitors in Throat Symptoms: age, body mass index, Reflux Symptom Index, Comprehensive Reflux Symptom Score, Laryngopharyngeal Reflux-Health-related Quality of Life questionnaire and Reflux Finding Score (RFS-endoscopic examination). The relationships between the questionnaires and demographic factors were assessed. Exploratory factor analysis (EFA) was conducted on individual symptom items in the combined questionnaires. The EFA factors were applied to a Cluster Analysis of participants, to explore the presence of identifiable patient. Results Throat clearing and globus were the highest ranked scores in the 344 participants. Increasing age was inversely associated with symptom severity (p<0.01). There was no relationship between the RFS and any of the three questionnaires. EFA resulted in a seven-factor model with clinically meaningful labels: voice, cough, gastrointestinal symptoms, airway symptoms and dysphagia, throat clearing, lump in throat, and life events. Cluster analysis failed to demonstrate any clinically meaningful clusters of patients. Conclusion This study offers a framework for future research and demonstrates that individual symptoms cannot be used to group patients. The analysis supports the use of a broad ‘umbrella’ term such as persistent throat symptoms. Trial registration number ISRCTN38578686.
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Affiliation(s)
- James O'Hara
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK james.o'.,Department of Otolaryngology - Head and Neck Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Holly Fisher
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Lechien JR, Saussez S, Muls V, Dequanter D, De Marrez LG, Hans S, Rodriguez A, Lisan Q. Laryngopharyngeal Reflux: Evolution and Predictive Value of Symptoms and pH-Impedance Features on Clinical Evolution. Otolaryngol Head Neck Surg 2022; 167:852-859. [PMID: 35104181 DOI: 10.1177/01945998221075009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the features of patients with laryngopharyngeal reflux (LPR) who did not respond to medical treatment. STUDY DESIGN Prospective uncontrolled study. SETTING Multicenter study. METHODS Patients with LPR at 24-hour HEMII-pH monitoring (hypopharyngeal-esophageal multichannel intraluminal impedance-pH) were prospectively recruited from 3 European university centers. Patients were treated with 3- to 6-month medication (proton pump inhibitor and alginate) and categorized as mild to moderate responders, high responders, or nonresponders according to Reflux Symptom Score (RSS) changes at 6 months posttreatment. The predictive value of the following outcomes was studied: epidemiologic data, HEMII-pH, gastrointestinal endoscopy findings, baseline RSS and Reflux Sign Assessment, and early therapeutic response (6-week RSS). RESULTS A total of 148 patients completed the evaluations, accounting for 40 mild to moderate responders (20%-60% RSS changes), 76 high responders (>60% RSS changes), and 32 nonresponders. Nonresponders presented more often with hiatal hernia and lower esophageal sphincter insufficiency when compared with mild to moderate and high responders (P = .032). Baseline otolaryngologic, digestive, and respiratory RSS and the number of pharyngeal reflux events at the HEMII-pH were predictive of the 6-month therapeutic response (P < .05). The early therapeutic response (6 weeks posttreatment) was predictive of the 6-month treatment response. CONCLUSION Hiatal hernia and baseline and 6-week RSS were the most predictive indicators of therapeutic effectiveness in patients with LPR.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otolaryngology, Elsan Hospital, Paris, France
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Vinciane Muls
- Division of Gastroenterology, CHU Saint-Pierre, Brussels, Belgium
| | - Didier Dequanter
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Lisa G De Marrez
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Quentin Lisan
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
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Pizzorni N, Ambrogi F, Eplite A, Rama S, Robotti C, Lechien J, Schindler A. Magnesium alginate versus proton pump inhibitors for the treatment of laryngopharyngeal reflux: a non-inferiority randomized controlled trial. Eur Arch Otorhinolaryngol 2022; 279:2533-2542. [PMID: 35032204 PMCID: PMC8760595 DOI: 10.1007/s00405-021-07219-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Proton pump inhibitors (PPIs) are commonly prescribed for laryngopharyngeal reflux (LPR), but their efficacy remains debated. Alginates is an option for the treatment of LPR with few adverse effects. The study aimed to investigate the non-inferiority of an alginate suspension (Gastrotuss®) compared to PPIs (Omeprazole) in reducing LPR symptoms and signs. METHODS A non-inferiority randomized controlled trial was conducted. Fifty patients with laryngopharyngeal symptoms (Reflux Symptom Index -RSI- ≥ 13) and signs (Reflux Finding Score -RFS- ≥ 7) were randomized in two treatment groups: (A) Gastrotuss® (20 ml, three daily doses) and, (B) Omeprazole (20 mg, once daily). The RSI and the RFS were assessed at baseline and after 2 months of treatment. RESULTS Groups had similar RSI and RFS scores at baseline. From pre- to 2-month posttreatment, the mean RSI significantly decreased (p = 0.001) in alginate and PPI group (p = 0.003). The difference between groups in the RSI change was not significant (95%CI: - 4.2-6.7, p = 0.639). The mean RFS significantly decreased in alginate (p = 0.006) and PPI groups (p = 0.006). The difference between groups in the mean change RFS was not significant (95%CI: - 0.8; 1.4, p = 0.608). CONCLUSION After 2 months of treatment, LPR symptoms and signs are significantly reduced irrespective of the treatment. Alginate was non-inferior to PPIs and may represent an alternative treatment to PPIs for the treatment of LPR.
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Affiliation(s)
- Nicole Pizzorni
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi Di Milano, Via G.B Grassi, 74, 20157, Milan, Italy.
| | - Federico Ambrogi
- Laboratory of Medical Statistics, Biometry, Epidemiology "G.A. Maccararo", Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Vanzetti, 5, 20133, Milan, Italy
| | - Angelo Eplite
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi Di Milano, Via G.B Grassi, 74, 20157, Milan, Italy
| | - Sibora Rama
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi Di Milano, Via G.B Grassi, 74, 20157, Milan, Italy
| | - Carlo Robotti
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi Di Milano, Via G.B Grassi, 74, 20157, Milan, Italy
| | - Jerome Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de mars, 6, B-7000, Mons, Belgium
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi Di Milano, Via G.B Grassi, 74, 20157, Milan, Italy
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ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022; 117:27-56. [PMID: 34807007 PMCID: PMC8754510 DOI: 10.14309/ajg.0000000000001538] [Citation(s) in RCA: 247] [Impact Index Per Article: 123.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/30/2021] [Indexed: 01/30/2023]
Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.
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