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, 7 (19), 2995-3011

Treatment of Laryngopharyngeal Reflux Disease: A Systematic Review

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Treatment of Laryngopharyngeal Reflux Disease: A Systematic Review

Jerome R Lechien et al. World J Clin Cases.

Abstract

Backgroung: For a long time, laryngopharyngeal reflux disease (LPRD) has been treated by proton pump inhibitors (PPIs) with an uncertain success rate.

Aim: To shed light the current therapeutic strategies used for LPRD in order to analysis the rationale in the LPRD treatment.

Methods: Three authors conducted a PubMed search to identify papers published between January 1990 and February 2019 about the treatment of LPRD. Clinical prospective or retrospective studies had to explore the impact of medical treatment(s) on the clinical presentation of suspected or confirmed LPRD. The criteria for considering studies for the review were based on the population, intervention, comparison, and outcome framework.

Results: The search identified 1355 relevant papers, of which 76 studies met the inclusion criteria, accounting for 6457 patients. A total of 64 studies consisted of empirical therapeutic trials and 12 were studies where authors formally identified LPRD with pH-monitoring or multichannel intraluminal impedance-pH monitoring (MII-pH). The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk. The most used PPIs were omeprazole, esomeprazole, rabeprazole, lansoprazole and pantoprazole with a success rate ranging from 18% to 87%. Other composite treatments have been prescribed including PPIs, alginate, prokinetics, and H2 Receptor antagonists.

Conclusion: Regarding the development of MII-pH and the identification of LPRD subtypes (acid, nonacid, mixed), future studies are needed to improve the LPRD treatment considering all subtypes of reflux.

Keywords: Laryngitis; Laryngopharyngeal; Proton pump inhibitors; Reflux; Treatment.

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Personalized therapeutic approach for specific laryngopharyngeal reflux disease subtypes. In this algorithm, proximal reflux event was defined as an episode that reached two impedance sensors in the hypopharynx or proximal esophagus. Acidic event consisted of a gaseous or liquid reflux with a pH ≤ 4.0 while nonacidic event was a gaseous or liquid reflux with a pH > 4.0. The LPR diagnosis was based on the occurrence of ≥ 1 proximal episode. Acid reflux episode consisted of an episode with pH > 4.0. Nonacid reflux episode consisted of an episode with pH ≤ 4.0. Because there are no guidelines in the definition of acid, nonacid and mixed laryngopharyngeal reflux disease (LPRD) disease, LPRD was defined as acid when the ratio of number of acid reflux episodes/number of nonacid reflux episodes was > 2. LPRD was defined as nonacid when the ratio of number of acid reflux episodes/number of nonacid reflux episodes < 0.5. Mixed reflux consisted of a ratio ranged from 0.51 to 2.0. 1For nonacid LPR, PPIs are not necessary regarding their low efficacy.

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References

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