Laryngopharyngeal reflux

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Laryngopharyngeal reflux in chronic obstructive pulmonary disease - a multi-centre study

Laryngopharyngeal reflux in chronic obstructive pulmonary disease - a multi-centre study

17. Jung YH, Lee DY, Kim DW, Park SS, Heo EY, Chung HS, et al. Clinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:1343 – 51. 18. Eryuksel E, Dogan M, Olgun S, Kocak I, Celikel T. Incidence and treatment

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Effect of Proton Pump inhibitors on laryngopharyngeal reflux disease: A Prospective study

Effect of Proton Pump inhibitors on laryngopharyngeal reflux disease: A Prospective study

Unlike laryngeal squamous cell carcinoma, which causes symptoms like hoarseness of voice, cough, foreign body sensation in throat even when a vocal fold lesion is miniscule, esophageal adenocarcinoma generally manifests when the esophageal lesion is so large that the patient presents with dysphagia. As a result of which, most esophageal cancers are detected at an advanced stage with a 5-year survival rate of less than 10% for a case of symptomatic esophageal adenocarcinoma. [118,119] In esophageal carcinoma, laryngopharyngeal symptoms like cough and hoarsness are better predictors than heartburn and regurgitation. Therefore an endoscopic examination of the esophagus is indicated in patients in whom symptoms of laryngopharyngeal reflux disease persists, despite the administration of antacids. This makes way for the early detection of esophageal carcinoma, if present. [112-115] Esophageal endoscopy is indicated whenever a malignancy of the digestive tract is suspected, such as in patients with significant dysphagia, weight loss or constitutional symptoms. These clinical features point towards the presence of a carcinoma.
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Clinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary disease

Clinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary disease

Methods: Prospective cohorts were established among 118 patients with COPD from March 2013 to July 2014. Thirty-two age-matched and sex-matched normal controls, who had routine health check-ups during the study period, were included. Laryngopharyngeal reflux finding scores (RFS) and reflux symptom index (RSI) for LPR were subjected to association analysis with severity and acute exacerbation of COPD during the 1-year follow-up.

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Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

8. Belafsky PC, Rees CJ. Laryngopharyngeal reflux: the value of oto- laryngology examination. Curr Gastroenterol Rep 2008;10:278-82. 9. Johnston N, Knight J, Dettmar PW, Lively MO, Koufman J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for la- ryngopharyngeal reflux disease. Laryngoscope 2004;114:2129-34. 10. Beere HM, Green DR. Stress management - heat shock protein-70

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THE EFFECT OF LARYNGOPHARYNGEAL REFLUX ON ACOUSTIC PARAMETERS IN FUNCTIONAL DYSPHONIA PATIENTS

THE EFFECT OF LARYNGOPHARYNGEAL REFLUX ON ACOUSTIC PARAMETERS IN FUNCTIONAL DYSPHONIA PATIENTS

[22] referred to multidisciplinary voice clinics (3). Many factors may contribute to the development of a functional voice disorders one of which may be laryngopharyngeal reflux (LPR). LPR is the backflow of stomach contents above the upper esophageal sphincter, into the pharynx, larynx, and upper aerodigestive system (4). So, the most common signs of LPR are posterior laryngeal edema and erythema, obliteration of the laryngeal ventricles, and interarytenoid hypertrophy. In up to 92% of cases, the most common organic symptoms of LPR are roughness/hoarseness (5) but LPR is also associated with the development of functional voice disorders like muscle tension dysphonia (6).
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High-resolution manometry in patients with and without globus pharyngeus and/or symptoms of laryngopharyngeal reflux

High-resolution manometry in patients with and without globus pharyngeus and/or symptoms of laryngopharyngeal reflux

Wiener et al. placed probes into the esophagus and on the top of the upper esophageal sphincter (UES) to detect pH over a course of 24 h using double- probe pH testing. They found that patients with glo- bus pharyngeus had laryngopharyngeal acid reflux. In 1989, they once again used the similar methods to monitor pH over 24 h in 32 patients with globus pharyngeus. However, this time they reported that the symptoms and the acid reflux times of these pa- tients were all different from gastroesophageal reflux disease (GERD), and esophagitis was hardly found. Since then, research on globus pharyngeus has been extensively performed [4]. Although the results were not completely consistent, laryngopharyngeal reflux (LPR) was officially adopted by the American Acad- emy of Otolaryngology-Head and Neck Surgery in 2002 [5]. However, whether there was a close rela- tionship between globus pharyngeus and laryngophar- yngeal reflux and/or gastroesophageal reflux still left some doctors feeling confused. One study showed that abnormal laryngopharyngeal or esophageal reflux was not indicated by pH-impedance monitoring in some patients with suspected LPR refractory to pro- ton pump inhibitors (PPIs) treatments. The results proved that LPR is unlikely in these patients [6]. It can be induced that globus pharyngeus patients with non-LPR (G-NR) also account for a certain propor- tion. At present, there is no report about the etiolo- gies and influence factors of these patients. This study was performed to clarify the related factors of the symptoms of globus pharyngeus refractory to PPIs treatments and to learn more about G-NR so as to improve the curative effect.
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Laryngopharyngeal reflux & vocal quality in senior population:  "mr /ms  gluttony"

Laryngopharyngeal reflux & vocal quality in senior population: "mr /ms gluttony"

i.e., a difficulty in vocal emission that precludes a natural production of voice (Dias et al., 2013; Dias et al., 2015). Regarding the process of deglutition, the larynx acts as an organ that is part of the respiratory system, operating as a sphincter-like mechanism that prevents not only aspiration of food during deglutition, as also aspiration of gastric content(s) caused by reflux (Behlau, 2001; Guimarães, 2007). Reflux can be specified as gastric orlaryngopharyngeal. The former is defined by the flow of digestive fluids to the oesophagus, in ascending direction (Burati et al., 2003; Koufman, 2014). When the gastric acid ascends to the upper aero-digestive tract (larynx, pharynx, oral and nasal cavities), we speak of Laryngopharyngeal Reflux (LPR) (Kandogan et al., 2012; Yilmaz et al., 2016; Gupta et al., 2009). Due to insufficient functioning of the first defence barrier against LPR – the upper oesophageal sphincter, formed by the cricopharyngeal muscle – the gastroduodenal content is allowed to ‘escape’, moving up to the upper aero-digestive tract (Koufman, 2014; Gupta et al., 2009; Cielo et al., 2011). When that happens, clinical manifestations of LPR occur at a physiological level, as a result of vocal and laryngeal alterations, as well as from the exposure of those structures to gastric acid (Gupta et al., 2009; Cielo et al., 2011). Such alterations also include irritation in
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Prevalence of Helicobacter pylori infection and influence of laryngopharyngeal reflux in patients with laryngeal pathologies

Prevalence of Helicobacter pylori infection and influence of laryngopharyngeal reflux in patients with laryngeal pathologies

aerodigestive tract can be an additional reservoir for this bacterium in patients with H. pylori gastritis. Rubin et al (78) and Borowski et al (79) noted a positive association between H. pylori and chronic laryngitis whereas Jaspersen et al (80) proved a negative association. Rubin et al tested for the presence of serum antibodies for H. pylori in patients with laryngeal lesions whereas Borowski et al and Jaspersen et al performed rapid urease testing for detecting the bacteria. Also Ozyurt et al (26) detected H. pylori DNA in laryngeal pathologies, nasal mucosa and nasal polyps by real time PCR method. A similar study was conducted by Siupsinskiene et al (81) to detect the presence of H. pylori in patients suffering from benign laryngeal diseases and laryngeal cancer. They performed rapid urease testing and histopathological examination of the laryngeal specimen by modified Giemsa technique for identification of the bacterium and could identify the bacterium in 45.5% of patients with chronic laryngitis and 46.2% of patients with laryngeal cancer. They concluded that H. pylori infection could be a possible risk factor for laryngeal pathologies. Cekin et al (74) also studied the association of Helicobacter pylori and laryngopharyngeal reflux in patients with laryngeal pathologies. They performed real time PCR to detect UreC gene in H. pylori and the presence of laryngopharyngeal reflux was assessed by Reflux Symptom Index and Reflux Finding Score similar to our study. They could detect H. pylori in 55.8% of subjects with laryngeal pathologies. 69.8% of subjects had significant Reflux Finding Score, but they could not find a significant association between reflux and H. pylori positivity.
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Role of Laryngopharyngeal Reflux in Eustachian Tube Dysfunction in Adults

Role of Laryngopharyngeal Reflux in Eustachian Tube Dysfunction in Adults

We have here studied the relationship between Eustachian tube dysfunction and laryngopharyngeal reflux, evaluating also the results of medical therapy in patients with such problems. Based on clinical, endoscopic and cytological investigations, we found that acid laryngopharyngeal reflux was the basis of audiological symptoms and chronic dysfunction of the Eustachian tube.

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Does laryngopharyngeal reflux disease impair nasal mucociliary transport? A case control prospective study

Does laryngopharyngeal reflux disease impair nasal mucociliary transport? A case control prospective study

Background: Laryngopharyngeal reflux disease (LPRD) is the retrograde reflux of gastro duodenal contents above the level of upper oesophageal sphincter into larynx and pharynx. LPRD can lead to upper respiratory pathology by direct contact of nasal and nasopharyngeal mucosa with the regurgitated gastric acid. Refluxate can damage the cilia, thereby prolonging the mucociliary clearance time (MCT) and consequently affecting the innate defence mechanism of upper airway. Our objective was to analyse the relationship between MCT and LPRD in patients without any nasal pathology.
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Laryngopharyngeal reflux- diagnosis and management at a tertiary care centre

Laryngopharyngeal reflux- diagnosis and management at a tertiary care centre

Laryngopharyngeal reflux (LPR) represents a controversial subject in terms of both diagnosis and treatment. The recent trends show an increased interest in understanding and managing patients of LPR. The initial description of this condition dates back to atleast four decades. 1-6 It has become one of the most common conditions presenting in an otorhinolaryngology outpatient department which is diagnosed in approximately 10% of these patients. 7,8 These patients usually present with vague symptoms such as dry cough, frequent clearing of throat, foreign body sensation in
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Original Article Anti-reflux effects of pantoprazole combined with mosapride and domperidone in the treatment of obstructive sleep apnea hypopnea syndrome and laryngopharyngeal reflux disease

Original Article Anti-reflux effects of pantoprazole combined with mosapride and domperidone in the treatment of obstructive sleep apnea hypopnea syndrome and laryngopharyngeal reflux disease

Abstract: Objective: To explore the anti-reflux effects of pantoprazole combined with mosapride and domperidone in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) and laryngopharyngeal reflux disease (LPRD). Methods: A total of 92 patients with OSAHS and LPRD were divided into the control group (n=45, treated with pantoprazole combined with mosapride and domperidone) and the observation group (n=47, pantoprazole monotherapy) according to random number tables. All patients took the medications for 8 weeks. Pulmonary func- tion parameters and sleep quality indexes before and after treatment were compared. The results of reflux symptom index (RSI), reflux finding score (RFS) and arterial blood gas (ABG) analysis before treatment and after 8 weeks of treatment were also compared. Results: The observation group had significantly higher total rate of effective treat- ment than the control group (95.74% vs. 71.11%, P=0.001). The observation group also had significantly higher vital capacity (VC), ratio of forced vital capacity compared to predicted values (FVC%), ratio of diffusing capacity divided by the alveolar volume compared to predicted values (DLCO/VA%), ratio of forced expiratory volume in one second compared to predicted values (FEV1%), total lung capacity (TLC) than the control group 8 weeks after treatment (all P<0.01). The observation group had significantly lower proportion of stage I sleep, apnea hypopnea index (AHI), and arousal index (AI) than the control group (all P<0.001). The proportion of stage III sleep for the observation group was significantly higher than that for the control group (P<0.001), and there was no statistically significant differ- ence in the proportion of stage II sleep between the two groups (P>0.05). The proportion of patients whose RSI was above 13 and RFS above 7 in both groups decreased significantly after 8 weeks of treatment (both P<0.05), and the drop was more noticeable in the observation group (P<0.001). Both groups showed improvements in the results of ABG analysis after treatment (both P<0.05), but there was no statistically significant difference between the two groups (P>0.05). Conclusions: Pantoprazole combined with mosapride and domperidone can significantly improve lung function, sleep quality and acid reflux symptoms for patients with OSAHS and LPRD.
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Role of proton Pump Inhibitors in the Management of Laryngopharyngeal Reflux

Role of proton Pump Inhibitors in the Management of Laryngopharyngeal Reflux

Results: The mean age group was 43.5 years. Foreign body sensation in the throat and frequent clearing of throat were most common presenting symptoms and Erythema of the arytenoids along with posterior commisure hypertrophy and ventricular obliteration were the common finding in videolaryngoscopy in patients of Laryngopharyngeal reflux. There was a significant improvement in the reflux symptom index and reflux finding score following treatment with proton pump inhibitors.

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Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study

Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study

Laryngopharyngeal reflux (LPR) is the back flow of gastric contents into the laryngopharynx where it comes in contact with the tissues of the upper aerodi- gestive tract [1]. It concerns 4 to 10 % of patients who seek Ear Nose Throat (ENT) consultation and 1 % of patients in primary care practice [2–4]. The most common symptoms reported are globus sensation (88 %), throat clearing (82 %), and voice disorders such as hoarseness (79 %) [5, 6]. Heartburn accounts for less than 40 % of cases, whereas esophagitis concerns only 25 % of LPR patients [7, 8]. The major etiologic factor for hoarseness of more than 3 months duration is LPR, with a prevalence of 55 to 79 % in hoarse pa- tients [9–11]. In comparison with healthy subjects, LPR patients often reported abnormal subjective voice characteristics such as musculoskeletal tension, hard glottal attack, glottal fry, vocal forcing, forcing sensa- tions, clamping, vocal fatigue, prolonged voice warm- up time, and restricted tone placement [12–14]. LPR signs include posterior commissure hypertrophy (89 %), vocal fold edema (79 %), hyperemia (79 %), and diffuse laryngeal edema (76 %) 5 . This clinical entity considerably affects patients’ quality of life by reducing the speaker’s communicative effectiveness [2, 15]. Specifically, LPR is related to 50 to 78 % of the popula- tion with voice complaints and 91 % of voice disorders in the elderly [16–18]. Based on these voice disorders, many authors have used acoustic parameters as out- comes of medical treatment efficacy in LPR patients or in LPR patients with hoarseness, but results are mixed and controversial among studies [19–21]. Undoubt- edly, some observe improvements of some acoustic parameters values [20, 21], and others refute these results [22, 23]. These varied results do not help the understanding of the pathophysiological mechanisms underlying hoarseness in LPR patients. Specifically, some authors suggested that vocal fold edema may be the main sign responsible for irregular vocal fold vibration leading to hoarseness [13], whereas other suspected mechanisms include dryness, keratosis, thickening of the epithelium, ulcerative lesions and alterations of the Reinke space [24].
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Aerodynamic Analysis Of Voice In Persons With Laryngopharyngeal Reflux

Aerodynamic Analysis Of Voice In Persons With Laryngopharyngeal Reflux

Objectives of the study: The individuals with laryngopharyngeal reflux are prone for aspiration of refluxed contents and so there is a need for aerodynamic evaluation in these individuals. Hence, the present study investigated the aerodynamic characteristics in individuals with Laryngopharyngeal reflux. Study design: Prospective control group design. Method: Thirty laryngopharyngeal reflux subjects and 30 normal subjects participated in the study. Aerodynamic parameters such as vital capacity, mean air flow rate, maximum phonation duration and phonation quotient were measured using Aero Phone Instrument ((Model 6800). Independent t test was employed for statistical inference. Results: The results revealed that the vital capacity and maximum phonation duration values were lower for laryngopharyngeal reflux subjects when compared to normal controls. No significant differences were observed for mean air flow rate and phonation quotient. Conclusions: The results revealed that the laryngopharyngeal reflux individuals showed significant deviations in aerodynamic parameters when compared to normal individuals. Thus study confirms aerodynamic abnormalities in laryngopharyngeal reflux subjects.
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Management of laryngopharyngeal reflux with proton pump inhibitors

Management of laryngopharyngeal reflux with proton pump inhibitors

Abstract: There is a lack of consistent guidelines and consensus for the diagnosis of laryngopharyngeal refl ux (LPR). A therapeutic trial with a proton pump inhibitor (PPI) has been suggested to identify patients with LPR. This review focuses on the current diffi culties in diagnosing the disease and examines the evidence for the effectiveness of PPI therapy in sus- pected refl ux-related laryngeal symptoms. Additionally, mode of action, safety, and tolerability of PPIs are described. A total of 7 placebo-controlled trials were identifi ed and included in the review. All studies evaluated the effect of a PPI on symptoms and objective laryngoscopic fi nd- ings in suspected LPR. Data from these trials show that PPI therapy is no more effective than placebo in producing symptom relief in patients suspected of LPR. Symptoms, laryngoscopic fi ndings, or abnormal fi ndings on pH monitoring will not predict response to PPI therapy. High placebo response levels suggest a much more complex and multifactorial pathophysiology of LPR than simple acid refl ux. Further studies are needed to characterize subgroups of patients with refl ux-associated laryngeal symptoms that might benefi t from treatment with PPI. Future studies should use validated patient reported outcome measures with endpoints that represent a predefi ned clinically meaningful change in symptom scores.
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Laryngopharengeal Reflux in Gastroesophageal Reflux Disease: Does “Silent Laryngopharengeal Reflux” Really Exist?

Laryngopharengeal Reflux in Gastroesophageal Reflux Disease: Does “Silent Laryngopharengeal Reflux” Really Exist?

Gastroesophageal reflux disease (GERD) is diagnosed clinically or histologically due to abnormal exposure of the oesophagus to gastric contents [1]. Extraesophageal manifestations are the complicated GERD primarily in- volving the neighboring organs [2]. Laryngopharyngeal reflux (LPR) is common, but its diagnosis may be diffi- cult, for its symptoms are nonspecific and its laryngoscopic signs are not always correlated with symptom sever- ity [3]. Little gastric content can induce laryngitis as laryngeal tissue is more vulnerable to such injury than oe- sophageal one [4]. There is neither pathognomonic symptom nor sign for LPR, but both reflux symptoms index (RSI) and reflux finding score (RFS) were validated for its diagnosis [5].
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Erosive esophageal reflux vs. non erosive esophageal reflux: oral findings in 71 patients

Erosive esophageal reflux vs. non erosive esophageal reflux: oral findings in 71 patients

It has been demonstrated histopathologically in the rat model that reflux affects the soft palate, which suggests that these pathological changes may reflect the relation- ship between laryngopharyngeal reflux and airway ob- struction [5]. One clinical large case-controlled study observed a significant association of GERD with ery- thema of the palatal mucosa and uvula [7]. In another study, histologic examination of palatal mucosa found a greater prevalence of epithelial atrophy, deepening of epithelial crests in connective tissue and a higher preva- lence of fibroblasts in 31 GERD patients compared with 14 control subjects [6]. But, these changes were not vis- ible to the naked eye, unlike the mucosal changes that may be more readily observed in esophagitis and laryngi- tis where the pH of the gastric reflux at these sites is lower than in the mouth [31, 32]. Other studies have not found any abnormal appearances of the oral mucosa or associated oral symptoms in patients with confirmed GERD [8, 11].
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Combination drug therapy for laryngopharyngeal reflex

Combination drug therapy for laryngopharyngeal reflex

Background: We sought to evaluate the combination of high-dose prebreakfast proton pump inhibitors (PPIs) (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing as a surrogate and rational regimen for LPR. Methods: 60 subjects that presented to ENT and HNS OPD with symptoms of laryngopharyngeal reflux (LPR) were prospectively evaluated and underwent a comprehensive otolaryngological examination. All subjects were treated sequentially and outcomes recorded using reflux finding score (RFS) and reflux symptom index (RSI).

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Gastroesophageal Reflux and Pulmonary Disease

Gastroesophageal Reflux and Pulmonary Disease

Jolley SG, Herbst JJ, Johnson DG, et al: Mean duration of gastroesophageal reflux identifies children -with reflux-in- duced respiratory symptoms. Heyman S, Kirkpatrick JA, Winter HS, et[r]

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