The role of magnesium supplement in laryngopharyngeal reflux disease

<p class="abstract"><strong>Background:</strong> Laryngopharyngeal reflux disease (LPRD) is one of the most prevalent upper gastrointestinal disorder encountered in clinical practice and its optimal treatment is not standardized. The role of magnesium in the human body functions is often underestimated. Since magnesium (Mg) plays a major role in the regulation of smooth muscle contractionby relaxing the pyloric sphincter and enhancing gastric emptying, thereby decreasing the pressure on the LES, it was hypothesized that adding magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms. Magnesium has a neutralizing action on the gastric acid and therefore, it may be pertinent to achieve optimal Mg intakes in patients with LPRD.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done over a period of 1 year conducted in a tertiary care hospital in central India in patients presenting with LPRD of the age group 18-65 years. </p><p class="abstract"><strong>Results:</strong> The study patients were divided into two groups-one treated with esmoprazole 40 mg capsules and alginate syrup and the other with esmoprazole capsules, alginate syrup and magnesium glycinate (250 mg) supplement. Both the groups showed appreciable improvement in their mean reflux symptom index (RSI) and reflux finding score (RFS) at 1 month and 3 months follow-up. Females showed a higher preponderance than males in the disease, symptoms and the mean RSI and RFS score.</p><p class="abstract"><strong>Conclusions:</strong> Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.</p>

Effects of acids, pepsin, bile acids, and trypsin on laryngopharyngeal reflux diseases: physiopathology and therapeutic targets

Purpose Laryngopharyngeal reflux disease (LPRD) is a general term for the reflux of gastroduodenal contents into the laryngopharynx, oropharynx and even the nasopharynx, causing a series of symptoms and signs. Currently, little is known regarding the physiopathology of LPRD, and proton pump inhibitors (PPIs) are the drugs of choice for treatment. Although acid reflux plays a critical role in LPRD, PPIs fail to relieve symptoms in up to 40% of patients with LPRD. The influence of other reflux substances on LPRD, including pepsin, bile acid, and trypsin, has received increasing attention. Clarification of the substances involved in LPRD is the basis for LPRD treatment. Methods A review of the effects of acids, pepsin, bile acids, and trypsin on laryngopharyngeal reflux diseases was conducted in PubMed. Results Different reflux substances have different effects on LPRD, which will cause various symptoms, inflammatory diseases and neoplastic diseases of the laryngopharynx. For LPRD caused by different reflux substances, 24-h multichannel intraluminal impedance combined with pH-metry (MII-pH), salivary pepsin, bile acid and other tests should be established so that different drugs and treatment courses can be used to provide patients with more personalized treatment plans. Conclusion This article summarizes the research progress of different reflux substances on the pathogenesis, detection index and treatment of LPRD and lays a theoretical foundation to develop target drugs and clinical diagnosis and treatment.

Esophageal Pressure and Clinical Assessments in the Gastroesophageal Reflux Disease Patients with Laryngopharyngeal Reflux Disease

Laryngopharyngeal reflux disease (LPRD) might be associated with reflux symptoms, and its severity is correlated with the Reflux Symptoms Index. Diagnosis is often challenging because of a lack of accurate diagnostic tools. Although an association between LPRD and gastroesophageal reflux disease (GERD) exists, the extent to which esophageal pressure changes in patients with LPRD with GERD has been unknown. Therefore, this study surveys the clinical assessments and extent of esophageal pressure changes in LRPD patients with various GERD severities, and compares esophageal sphincter pressures between ages, genders, and body mass index (BMI). This observational study assessed patients with LPRD and GERD. High-resolution esophageal manometry was used to gather data pertaining to the area pressure on the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), and the correlation between such pressure and symptom severity was determined. We compared the esophageal pressure of different UES and LES levels in the following categories: gender, age, BMI, and GERD severity. We analyzed correlations between esophageal pressure and clinical assessments among 90 patients with throat globus with laryngitis with LPRD. LPRD was measured using laryngoscopy, and GERD was measured using esophagoscopy and 24 h PH monitoring. There were no significant differences in the clinical assessments among the four grades of GERD. The LPRD patients with serious GERD had a lower UES and LES pressure. The lowest pressure and longer duration of LES and UES were also observed among patients with LPRD of grade D GERD. No significant differences in UES and LES pressures among ages, genders, or BMIs were noted.

Voice Quality Measurement as an Indicator of Efficiency of Treatment in Laryngopharyngeal Reflux Disease

Introduction Laryngopharyngeal reflux disease can alter the structural and functional integrity of the vocal fold. Objectives of the study was to determine the effect of Laryngopharyngeal Reflux Disease (LPRD) on selected Acoustic, Aerodynamic and perceptual parameters of voice and to establish its effectiveness in therapeutic outcome. Materials and Methods The number of patients enrolled for this prospective observational study was 65, all with Reflux symptom index (RSI) more than 13. Quality of life was evaluated using voice handicap index (VHI). Perceptual evaluation of voice done by Grade Roughness Breathiness Asthenia Strain score (GRBAS) followed by acoustic and aerodynamic analysis. Patients were started on a once daily proton pump inhibitor therapy for 3 months along with vocal hygiene measures and RSI, VHI and voice analysis repeated after the treatment. Results There was significant improvement in the RSI score after treatment. Percent jitter and shimmer showed significant improvement in males post treatment (p value:<0.05). Harmonic to noise ratio improved 3 months post treatment in both sexes. Improvement noted in Maximum phonation time and GRBAS score except asthenia and strain post treatment. Conclusion Measurement of voice quality can be used as an effective tool to monitor the efficiency of treatment of LPRD.

708 A NEW DIAGNOSTIC PARADIGM FOR LARYNGOPHARYNGEAL REFLUX DISEASE: CORRELATION OF IMPEDANCE-PH MONITORING AND DIGITAL REFLUX SCINTIGRAPHY RESULTS

No gold-standard investigation exists for laryngopharyngeal reflux (LPR). Multichannel intraluminal impedance (MII)-pH testing has uncertain utility in LPR. Meanwhile, reflux scintigraphy allows immediate and delayed visualisation of tracer reflux in the esophagus, pharynx, and lungs. The present study aimed to correlate MII-pH and scintigraphic reflux results in patients with primary LPR. Methods Consecutive patients with LPR underwent MII-pH and scintigraphic reflux studies. Abnormal values for MII-pH results were defined from existing literature. MII-pH and scintigraphic data were correlated. Results 105 patients with LPR (31 males (29.5%), median age 60 years (range: 20–87)) were studied. Scintigraphic reflux was seen in the pharynx in 94 (90.4%), and in the proximal esophagus in 94 (90.4%). Delayed scintigraphic contamination of the pharynx was seen in 101 patients (96.2%) and in the lungs of 56 patients (53.3%). Abnormal reflux was seen in the distal esophagus in 12.4%, proximal esophagus in 25.7%, and in the pharynx in 82.9%. Patients with poor scintigraphic clearance had higher Demeester scores (p = 0.043), more proximal reflux episodes (p = 0.046), more distal acid reflux episodes (p = 0.023), and longer bolus clearance times (p = 0.002). Conclusion Reflux scintigraphy has a high yield in LPR patients. Scintigraphic time-activity curves correlated with validated MII-pH results. A high rate of pulmonary microaspiration was found in LPR patients. This study demonstrated a high level of pharyngeal contamination by scintigraphy and MII-pH, which supports the use of digital reflux scintigraphy in diagnosing LPR.

719 REDUCED MEAN NOCTURNAL BASELINE IMPEDANCE AIDS DIAGNOSIS OF GASTRO-ESOPHAGEAL REFLUX DISEASE AND LARYNGOPHARYNGEAL REFLUX DISEASE

Laryngopharyngeal reflux disease (LPR) and gastro-esophageal reflux disease (GERD) occur due to acidic gastric refluxate causing symptoms. Baseline esophageal impedance has been shown to be reduced with prolonged acid exposure. Mean nocturnal baseline impedance (MNBI) is a novel measure that has shown promise in GERD but has not been evaluated in LPR. This study aimed to assess the role of MNBI in LPR and GERD patients. Methods Off-therapy impedance-pH tracings were blindly reviewed for 187 patients previously prospectively allocated clinical diagnoses of LPR (n = 105) or GERD (n = 82). Conventional impedance-pH measures and MNBI were analysed for the two groups. Results MNBI was significantly lower in the distal esophagus in GERD patients compared with LPR (1679 ± 914 vs. 2109 ± 863; p = 0.001). Similarly, in the proximal esophagus, MNBI was lower in GERD than LPR (2289 ± 579 vs. 2541 ± 471; p = 0.001). In the pharynx, MNBI was similar between the two groups (2116 ± 699 vs. 2133 ± 770; p = 0.878). Distal acid exposure time (AET) and the number of distal acid reflux episodes negatively correlated with distal esophageal MNBI (r = −0.195; p = 0.007) and (r = −0.330; p &lt; 0.001) respectively. Conclusion Baseline impedance was reduced in both LPR and GERD at both distal and proximal esophageal measurements, and more severely reduced in GERD. Baseline impedance is strongly and inversely related to acid exposure in the esophagus. Pharyngeal MNBI was not reduced or different between groups. Distal and proximal esophageal MNBI may be useful in diagnosis of LPR as well as GERD.

Laryngopharyngeal Reflux Disease: Diagnosis and Treatment in 2021

Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition of the upper aerodigestive tract mucosa induced by reflux content from stomach. Some of vocal cord diseases are associated with laryngopharyngeal reflux. Because of the pathophysiological features, proton pump inhibitor shows therapeutic effect on some vocal cord diseases. As like that, the gastric reflux contents can make macroscopic or microscopic morphological changes in the upper aerodigestive tract mucosa. Although the pathophysiology of LPRD is relatively clear, clinical diagnosis is still difficult. The diagnosis of LPRD includes objective tests such as 24-hours multichannel intraluminal impedance-pH metry and subjective tests such as questionnaire method. However, the objective verification of reflux is difficult due to invasiveness of the method, and the questionnaire methods have limitations because many symptoms are not specific for LPRD. Moreover, most methods are not fully standardized until now. Despite these limitations, many researchers are struggling to standardize diagnosis and treatment of LPRD, and there are several new achievements recently. Therefore, the purpose of this article is to review the recent literature on the clinical presentation, diagnosis, and treatment of LPRD, and to systematize our knowledge.

Usefulness of matrix metalloproteinase-7 in saliva as a diagnostic biomarker for laryngopharyngeal reflux disease

Several diagnostic methods are currently being used to diagnose LPRD (laryngopharyngeal reflux disease), but have the disadvantage of being invasive, subjective, or expensive. Our purpose in this study was to investigate the correlation between pepsin and MMP-7 (Matrix Metalloproteinase-7) in pharyngeal secretions of subjects according to RSI (Reflux Symptom Index) score to find out the diagnostic value of MMP-7. We recruited 173 subjects aged between 19 and 85 years who completed the RSI scale. All samples were taken after waking up, and the amount of the pepsin and MMP-7 in saliva were measured by means of an enzyme activity assay. There was a significant increase of pepsin and MMP-7 activity in the study group with an RSI score of 13 or higher. The sensitivity and specificity of MMP-7 for predicting the possibility of an RSI of 13 or more was higher than that of pepsin. When MMP-7 and pepsin were combined, this sensitivity and specificity increased. An enzyme assay of MMP-7 in saliva may be a noninvasive and easy technique for diagnosing LPRD.

Pendekatan Diagnostik Refluks Laring Faring

Lifestyle and behavior changes can have bad impacts on our health. One of the diseases that can be caused by lifestyle changes is pharyngeal larynx reflux. Pharyngeal laryngeal reflux is a state of return of the contents of the stomach to the larynx and pharynx causing an inflammatory reaction to the mucous membranes of the larynx and pharynx. In an attempt to diagnose pharyngeal larynx reflux, a follow-up examination is required. In this case there are several examinations that can be done to confirm the diagnosis of pharyngeal larynx reflux. This study was aimed to obtain the diagnostic approaches in laringopharyngeal reflux cases. This was a literature review study using two databases namely PubMed and ClinicalKey. The keywords used were laringophaingeal reflux and laryngopharyngeal reflux disease. After being selected based on inclusion and exclusion criteria, nine literatures using experimental research methods. were obtained. The results showed that several examinations that could be performed in diagnosing laringofaringeal reflux, as follows: anamnesis, physical examination, pH-monitoring, reflux findings score, reflux symptom score, PEP-test, reflux sign assessment, reflux symptom score, immunohistochemistry, and fiber-optic laryngoscopy. In conclusion, supporting examinations are needed to confirm the diagnosis of pharyngeal larynx reflux.Keywords: refluks laring faring; laryngopharyngeal reflux disease. Abstrak: Perubahan gaya hidup dan perilaku dapat berdampak pada kesehatan tubuh. Salah satu penyakit yang dapat diakibatkan oleh perubahan gaya hidup yaitu refluks laring faring. Refluks laring faring merupakan keadaan kembalinya isi lambung ke laring dan faring sehingga menyebabkan reaksi inflamasi pada selaput lendir laring dan faring. Untuk menegakkan diagnosis refluks laring faring dibutuhkan pemeriksaan lanjutan. Penelitian ini bertujuan untuk mengetahui pendekatan diagnosis yang dapat dilakukan dalam pemeriksaan kasus refluks laring faring. Jenis penelitian ialah literature review dengan pencarian data menggunakan dua database yaitu PubMed dan ClinicalKey. Kata kunci yang digunakan yaitu refluks laring faring and laryngopharyngeal reflux disease. Setelah diseleksi berdasarkan kriteria inklusi dan eksklusi, didapatkan sembilan literatur yang menggunakan metode penelitian eksperimental. Hasil peneli-tian mendapatkan pemeriksaan-pemeriksaan yang dilakukan dalam menegakkan diagnosis refluks laring faring ialah: anamnesis, pemeriksaan fisik, pH-monitoring, skor temuan refluks, skor gejala refluks, PEP-test, reflux sign assessment, reflux symptom score, immunohistochemistry, dan fiber-optic laryngoscopy. Simpulan penelitian ini ialah pemeriksaan penunjang perlu dilakukan untuk menegakkan diagnosis refluks laring faring.Kata kunci: refluks laring faring; laryngopharyngeal reflux disease