The efficacy of a personalised treatment depending on the characteristics of reflux at multichannel intraluminal impedance‐pH monitoring in patients with acid, non‐acid and mixed laryngopharyngeal reflux

2021 ◽  
Author(s):  
Jérôme R. Lechien ◽  
Francois Bobin ◽  
Vinciane Muls ◽  
Francois Mouawad ◽  
Didier Dequanter ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Multichannel Intraluminal Impedance ◽  
Intraluminal Impedance ◽  
Personalised Treatment ◽  
Multichannel Intraluminal Impedance Ph

Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review

2019 ◽  
Vol 160 (5) ◽  
pp. 762-782 ◽  
Author(s):  
Jerome R. Lechien ◽  
Lee M. Akst ◽  
Abdul Latif Hamdan ◽  
Antonio Schindler ◽  
Petros D. Karkos ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
Diagnostic Tools ◽  
Multichannel Intraluminal Impedance ◽  
Intraluminal Impedance ◽  
Number Of Patients ◽  
Multichannel Intraluminal Impedance Ph

Objective To review the current literature about the epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux (LPR). Data Sources PubMed, Cochrane Library, and Scopus. Methods A comprehensive review of the literature on LPR epidemiology, clinical presentation, diagnosis, and treatment was conducted. Using the PRISMA statement, 3 authors selected relevant publications to provide a critical analysis of the literature. Conclusions The important heterogeneity across studies in LPR diagnosis continues to make it difficult to summarize a single body of thought. Controversies persist concerning epidemiology, clinical presentation, diagnosis, and treatment. No recent epidemiologic study exists regarding prevalence and incidence with the use of objective diagnostic tools. There is no survey that evaluates the prevalence of symptoms and signs on a large number of patients with confirmed LPR. Regarding diagnosis, an increasing number of authors used multichannel intraluminal impedance–pH monitoring, although there is no consensus regarding standardization of the diagnostic criteria. The efficiency of proton pump inhibitor (PPI) therapy remains poorly demonstrated and misevaluated by incomplete clinical tools that do not take into consideration many symptoms and extralaryngeal findings. Despite the recent advances in knowledge about nonacid LPR, treatment protocols based on PPIs do not seem to have evolved. Implications for Practice The development of multichannel intraluminal impedance–pH monitoring and pepsin and bile salt detection should be considered for the establishment of a multiparameter diagnostic approach. LPR treatment should evolve to a more personalized regimen, including diet, PPIs, alginate, and magaldrate according to individual patient characteristics. Multicenter international studies with a standardized protocol could improve scientific knowledge about LPR.

24-Hour Multichannel Intraluminal Impedance–pH in Proton Pump Inhibitor Nonresponders vs Responders in Patients With Laryngopharyngeal Reflux

2021 ◽  
pp. 019459982110268
Author(s):  
Su Il Kim ◽  
Su Jin Jeong ◽  
Oh Eun Kwon ◽  
Jung Min Park ◽  
Young Chan Lee ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Tertiary Care ◽  
High Dose ◽  
Multichannel Intraluminal Impedance ◽  
Reflux Time ◽  
Intraluminal Impedance ◽  
Multichannel Intraluminal Impedance Ph

Objective This study aimed to evaluate the characteristics of reflux in proton pump inhibitor (PPI) nonresponders vs responders in patients with laryngopharyngeal reflux (LPR) by using 24-hour multichannel intraluminal impedance–pH (MII-pH) monitoring. Study Design Prospective cohort study. Setting A tertiary care otolaryngology clinic. Methods Patients with typical LPR symptoms showing >1 proximal reflux episode were considered to have LPR and investigated prospectively. Patients were prescribed high-dose PPI twice daily and followed up for at least 2 months. Patients with LPR showing a ≥50% decrease in the follow-up reflux symptom index score during treatment periods as compared with pretreatment were defined as responders; others were defined as nonresponders. Various parameters in 24-hour MII-pH monitoring between nonresponders and responders with LPR were compared with Student’s t test and receiver operating characteristic curve. Results Eighty patients were diagnosed with LPR and categorized as nonresponders (n = 19) and responders (n = 61). Proximal all reflux time and proximal longest reflux time in various MII parameters were higher in responders than in nonresponders ( P = .0040 and .0216, respectively). Proximal all reflux time >0.000517% was a better cutoff value to predict responders with LPR as compared with the proximal longest reflux time >0.61 minutes (sensitivity + specificity: 1.317 vs 1.291). Conclusion Proximal all reflux time in various 24-hour MII-pH monitoring parameters can be helpful to predict the response to PPI therapy in patients with LPR. These findings will help establish a personalized therapeutic scheme for patients with LPR.

Awareness of European Otolaryngologists and General Practitioners Toward Laryngopharyngeal Reflux

2019 ◽  
Vol 128 (11) ◽  
pp. 1030-1040 ◽  
Author(s):  
Jerome R. Lechien ◽  
Francois Mouawad ◽  
Geoffrey Mortuaire ◽  
Marc Remacle ◽  
Francois Bobin ◽  
...  
Keyword(s):  
General Practitioners ◽  
Gastrointestinal Endoscopy ◽  
Clinical Presentation ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Multichannel Intraluminal Impedance ◽  
Once Daily ◽  
Current Trends ◽  
Intraluminal Impedance ◽  
Multichannel Intraluminal Impedance Ph

Objectives: To investigate the current trends in management of laryngopharyngeal reflux (LPR) among young European otolaryngologists and general practitioners (GP). Methods: An international survey was sent to European general practitioners and all otolaryngologists under 45 years old from the 2017 IFOS meeting. This survey was conducted by the LPR Study Group of YO-IFOS (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Results: Among the 2500 attendees, 230 European otolaryngologists (response rate = 9%) completed the survey; an additional 70 GPs also completed the survey. GPs did not differentiate between gastroeosophageal reflux disease (GERD) and LPR, overstating GERD-related symptoms (ie, heartburn and regurgitations) in LPR clinical presentation and relying on gastrointestinal endoscopy for LPR diagnosis. Otolaryngologists also believe that GERD-related symptoms are prevalent in LPR. Knowledge of nonacid and mixed LPR and use of multichannel intraluminal impedance-pH monitoring are still limited in both groups. A therapeutic dichotomy exists between groups: GPs mainly use a 4-week once daily empiric proton pump inhibitors (PPIs) trial, while otolaryngologists use PPIs twice daily for a longer therapeutic period ranging from 8 to 12 weeks. More than 50% of GPs and otolaryngologists believe that they are not adequately knowledgeable and skilled about LPR. Conclusion: The majority of GPs and otolaryngologists do not believe themselves to be sufficiently informed about LPR, leading to different practice patterns and grey areas. The elaboration of international recommendations in the management of reflux is needed to improve practices.

Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review

2020 ◽  
pp. 019459982093320 ◽  
Author(s):  
Jerome R. Lechien ◽  
Lee M. Akst ◽  
Sven Saussez ◽  
Lise Crevier-Buchman ◽  
Stéphane Hans ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Outcome Evaluation ◽  
Laryngotracheal Stenosis ◽  
Multichannel Intraluminal Impedance ◽  
Laryngeal Papillomatosis ◽  
Laryngeal Diseases ◽  
Intraluminal Impedance ◽  
Multichannel Intraluminal Impedance Ph

Objectives To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections Data Sources PubMed, Cochrane Library, and Scopus. Review Methods A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Results Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance–pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance–pH monitoring. Conclusion The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.

Comparison Between Manual and Automated Analyses in Multichannel Intraluminal Impedance: pH Monitoring for Laryngopharyngeal Reflux

2021 ◽  
pp. 019459982110069
Author(s):  
Hee Jin Kang ◽  
Jung Min Park ◽  
Soo Young Choi ◽  
Su Il Kim ◽  
Young Chan Lee ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Automated Analysis ◽  
Acid Reflux ◽  
Multichannel Intraluminal Impedance ◽  
Symptom Index ◽  
Manual Analysis ◽  
Intraluminal Impedance ◽  
Symptom Association Probability ◽  
Multichannel Intraluminal Impedance Ph

Objective To evaluate differences between manual and automated analyses of 24-hour multichannel intraluminal impedance–pH monitoring for diagnosis of laryngopharyngeal reflux. Study Design Case series with planned data collection. Setting Academic center outpatient clinic. Methods The study group comprised 127 patients with symptoms suspicious of laryngopharyngeal reflux, who underwent 24-hour multichannel intraluminal impedance–pH monitoring. Automated and manual analyses were performed for each patient. The following parameters were compared between analyses: number of proximal reflux episodes, proximal exposure time, symptom index, and symptom association probability. Results The number of proximal reflux episodes detected by manual analysis was significantly lower than that detected by automated analysis, except in acid reflux cases. The false positive of automated analysis was 39.8%. In addition, the proximal exposure time for manual analysis was significantly lower than that for automated analysis, except in cases of acid reflux. Symptom index and symptom association probability values based on manual analysis were significantly lower than in automated analysis, except in heartburn cases. Conclusions Automated analysis demonstrated a tendency of excessive reflux measurement when compared with manual analysis. It is necessary to increase the accuracy of laryngopharyngeal reflux diagnosis through manual analysis.

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