See related patient information handout on gastroesophageal reflux disease, written by the authors of this article . Globus pharyngeus and hoarseness are the most common LPR symptoms.
Many are covered elsewhere in other sources (Sataloff et al., 2006c). Mainstays of therapy are lifestyle modification, proton pump inhibitors, H2 receptor antagonists, over-the-counter antacids, and prokinetic agents. Treatment of Helicobacter pylori also may be appropriate.
On laryngoscopy, more than 80% had at least one “abnormal” finding, including (in order of frequency from most frequent to least) interarytenoid bar, medial arytenoid erythema, posterior pharyngeal cobblestoning, medial arytenoid granularity, and true vocal fold erythema. This study did not include 24-hour pH monitoring or any other tests to rule out the presence of “silent” reflux as a cause of the laryngoscopic abnormalities.
Indeed, obesity generates a mechanical disruption of EGJ by promoting an axial separation between the lower esophageal sphincter (LES) and the extrinsic crural diaphragm [Pandolfino et al. 2006]. LES incompetence has also been observed in obese patients [Fisher et al. 1999; Suter et al. 2004] and among morbidly obese patients a higher esophageal acid exposure was significantly associated with a lower LES pressure [Sabate et al. 2008].
For patients who show no response to reflux therapy, some otolaryngologists assume reflux has been ruled out and discontinue the PPI, substituting treatment for allergy or some other conditions. In the absence of studies, this approach is particularly problematic since many patients continue to produce at least some acid despite proton pump inhibitors twice daily, and it has been recognized for many years that some patients with reflux do not respond to proton pump inhibitors and continue to produce normal amounts of acid despite treatment (Bough et al., 1995). Other otolaryngologists assume that if the patient has failed a therapeutic trial, the LPR is severe and requires even higher doses of PPI therapy, and the addition of other reflux or promotility medications which often are prescribed empirically (without tests objective for reflux).
Laryngopharyngeal reflux is defined as the reflux of gastric content into larynx and pharynx. A large number of data suggest the growing prevalence of laryngopharyngeal symptoms in patients with gastroesophageal reflux disease. However, laryngopharyngeal reflux is a multifactorial syndrome and gastroesophageal reflux disease is not the only cause involved in its pathogenesis. Current critical issues in diagnosing laryngopharyngeal reflux are many nonspecific laryngeal symptoms and signs, and poor sensitivity and specificity of all currently available diagnostic tests. Although it is a pragmatic clinical strategy to start with empiric trials of proton pump inhibitors, many patients with suspected laryngopharyngeal reflux have persistent symptoms despite maximal acid suppression therapy.
- Several researchers have tried to develop more-efficient and better-tolerated compounds (i.e. lesogaberan, ADX10059, arbaclofen) without attempting such results [Vakil et al. 2011; Zerbib et al. 2011].
- Essentially my vocal cords had been singed.
- In some patients with LPR severe enough to involve the oral cavity, there is also loss of dental enamel.
- Both should be avoided.
- In 2006, a prospective multicenter randomized study, with 145 patients having symptoms and endoscopic signs of LPR, did not show any benefit in patients treated with esomeprazole 40 mg twice daily for 4 months versus placebo [Vaezi et al. 2006b].
48. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. 35. Francis DO, Maynard C, Weymuller EA, Reiber G, Merati AL, Yueh B. Reevaluation of gastroesophageal reflux disease as a risk factor for laryngeal cancer. 27.
Who gets laryngopharyngeal reflux?
Many people with LPR do not have any of the typical GERD symptoms. Fundoplication is a type of surgery which involves wrapping the upper part of the stomach around the lower esophagus to create a stronger valve between the esophagus and stomach. It is usually done laparoscopically, with small surgical incisions and use of small surgical equipment and a laparoscope to help the surgeon see inside. Fundoplication can also be done as a traditional open surgery with a larger incision.
Sometimes, non-prescription antacids/alginate preparations (e.g. Gaviscon Advance) are recommended. These work by forming a ‘raft’ over the stomach contents so that if anything spills back it is less damaging. This treatment is often very effective as the enzymes and bile contained in the stomach juices may cause more damage for many people than the acid. These should be taken four times each day – 10ml after each meal and 20ml at bedtime. Simple antacids without alginate (e.g. Maalox or Rennies) are much less effective and therefore not recommended to treat LPR.
In addition, lifestyle and behavioral modifications, termed reflux precautions, are recommended. Gastroesophageal reflux disease (GERD) is a digestive condition in which the stomach’s contents often come back up into the food pipe. Dietary changes can help to ease symptoms. For example, high-fat and salty foods can make GERD worse, while eggs and some fruits can improve it.