The Dreaded Diagnosis of Laryngopharyngeal Reflux Disease

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Laryngopharyngeal Reflux: What Does It Mean?

Acid reflux creates a burning pain in the lower chest area, often after eating. Exact figures vary, but diseases resulting from acid reflux are the most common gut complaint seen by hospital departments in the United States.

The uniform presence of histological esophagitis with intraepithelial eosinophils, basal cell hyperplasia, and papillary lengthening strongly implicates GERD in the pathogenesis of the adult ringed esophagus. In addition to a series of gradual esophageal dilations, we suggest using a proton pump inhibitor to provide acid suppression.

1 Castell in 1985 described GERD and pressed it as an “iceberg”, 2 thereafter the apparent part of the “iceberg” has been growing con- tinually. Extra-esophageal symptoms may be a consequence of GERD but there is substantial overlap with other etiologies. Patients with documented GERD and prominent symptoms such as chest pain, cough, hoarseness or wheezing do not always realize any benefits in these extra-esophageal symptoms after antireflux surgery.

New studies have also made clear, for the first time, that endoscopy-negative acid reflux disease has a measurable and substantial impact on the patients’ general well-being and quality of life. Patients with endoscopy-negative disease have quality-of-life scores that are similar to those found in patients with oesophagitis.

A recent study suggests that dietary choices may be as effective as using proton pump inhibitors (PPIs) in treating acid reflux. The prevalence rate of reflux esophagitis (RE) in Asia, including Taiwan, has increased dramatically in recent years. However, few studies have discussed on its relationship with metabolic syndrome (MetS). This study aimed to evaluate the correlation between RE and MetS and its components. [6, 21,23].

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  • Recent clinical trials have yielded important new information about endoscopy-negative acid reflux disease.
  • The non-PPI responder is the worst patient to send to an antireflux surgeon.
  • Some patients have persistence of symptoms that were part of their GERD presentation, raising the concern that they are suffering from an ineffective or failing fundoplication.
  • Learn more about heartburn here.
  • Oesophageal pH monitoring is therefore of limited value in patients with endoscopy-negative reflux disease, unless the test focuses on analysis of the correlation between symptoms and episodes of reflux.

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MacGill, Markus. “What is acid reflux?.” Medical News Today.

In prospective randomized controlled trials, some findings were more likely to be evidence of GERD, such as the changes in the arytenoid and the interarytenoid area, with granularity/granuloma and a cobblestone appearance of the interarytenoid area in the larynx. However, these findings were not predictive of laryngopharyngeal disease, and these patients were treated with anti-GERD therapy. The studies that have looked at this have used high-dose, twice-daily therapy, and there was no response after 3 months of therapy. Even though they had GERD, it didn’t predict which patients would have beneficial outcomes.

On the long term, tolerability and safety of proton pump inhibitors are excellent. Refractory esophagitis may be related to poor adherence to therapy and/or insufficient acid secretion inhibition and represents a potential indication for anti-reflux surgery (laparoscopic fundoplication) which provides excellent functional results, but may have side effects. Erosive esophagitis is a risk factor for Barrett’s esophagus and esophageal adenocarcinoma, thus justifying screening strategy in patients with gastroesophageal reflux and surveillance program if Barrett’s esophagus is present.

Patients who are unresponsive to 4-8 weeks’ treatment with PPIs twice daily might have so-called refractory GERD. The first investigation these patients should undergo is upper endoscopy to exclude a diagnosis of peptic ulcer disease or cancer and identify the presence of esophagitis. The presence of esophagitis in these patients is suggestive of a pill-induced injury, an autoimmune skin disease involving the esophagus, eosinophilic esophagitis or, less likely, a hypersecretory syndrome or a genotype that confers altered metabolism of PPIs.

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January 8, 2015

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