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At present, objective methods for diagnosing laryngopharyngeal reflux disease(LPRD) are not minimally invasive, effective, and economical. Diagnostic scales are widely used worldwide due to the advantages of inexpensive, noninvasive, and easy to operate. The reflux symptom index(RSI) and the reflux finding score(RFS) are preferred to use in clinical diagnosis. However, many controversies have appeared in the application of RSI and RFS in recent years, causing many troubles to clinical diagnosis. Therefore, this review briefly discusses the problems of RSI and RFS in clinical applications to provide reference for diagnosing LPRD accurately.
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Humans , Laryngopharyngeal Reflux/diagnosisABSTRACT
Objective@#The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. @*Method@#From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-<40 years, n=86）, group B （40-<60 years, n=107） and group C （≥60 years, n=65）. The diagnosis was confirmed by 24 h pH-metry. The diagnostic rate, RSI and RFS scores were compared among the three groups. ROC curve was used to analyze the optimal thresholds for the diagnosis of LPR by RSI and RFS scores. @*Result@#Among the three groups, group C had the highest diagnostic rate（93.85%）. There was no significant difference in RFS score among the three groups （P>0.05）, RSI score was significantly different （P<0.05）, RSI score of group A and group B was higher than that of group C （P<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. @*Conclusion@#The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.
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The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-0.05）, RSI score was significantly different （<0.05）, RSI score of group A and group B was higher than that of group C （<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.
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Background: Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the throat, that is, into the hypopharynx. LPR is different from classical gastroesophageal reflux disease. Majority of such patients present with globus pharyngeus, cough, foreign body sensation in throat, and hoarseness. Objectives: Conflicting results appear in literature for the role of proton-pump inhibitors (PPIs) in LPR. Our aim in this study is to evaluate the role of PPI based on their effect on reflux finding score (RFS) and reflux symptom index (RSI). Materials and Methods: This prospective observational study was conducted in the Department of ENT and HNS of Government Medical College, Srinagar, for 3 years from 2015 to 2018. The materials for the present study were 70 patients of different age groups attending the ENT Outpatient Department (OPD) having different symptoms of LPR diagnosed on the basis of RFS >7 and RSI >13. Of them, 20 lost to follow up, and finally, 50 patients were followed as per the protocol. Patients were divided into different age groups. Results: A total number of patients included in the study were 50; 35 (70%) cases were females and 15 (30%) were males. A maximum number of patients were in the age group 31–40 years forming about 40% of the study group. Mean RSI of all patients was 24.4 before treatment with PPIs. Significant change in RSI occurred after the first 8 weeks of therapy, and no further significant change occurred in the next 16 weeks. Mean RFS of the patients was 13.2 before treatment with PPIs. There was a slight response after 8 weeks of therapy in physical findings and significant response after 16 weeks of therapy. Conclusion: PPIs are treatment of choice in patients with LPR and treatment should be continued for at least 4 months.
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BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux (LPR) is a prevalent condition with an increasing incidence, and several recent studies have reported the association of LPR with chronic rhinosinusitis (CRS). In this study, we studied the effect of proton-pump inhibitors (PPIs) on symptom improvement for LPR and comorbid CRS. SUBJECTS AND METHOD: Enrolled in the study from January 2017 to December 2017 were 164 patients (54 male, 110 female, mean age 48.8 years) who were diagnosed as LPR by reflux symptom index (RSI) or reflux finding scores (RFS) and comorbid CRS. Sino-Nasal Outcome Test (SNOT)-20 and Lund-Kennedy endoscopic scores were evaluated for CRS severity. The study group was divided into PPI treatment group (Ilaprazole 20 mg, once a day for 8 weeks) and non-treatment group. The RSI, RFS, SNOT-20, and Lund-Kennedy endoscopic scores were repeated at the end of treatment. RESULTS: Ninety-two patients were prescribed PPI and 72 patients were not. Initial RSI, RFS, SNOT-20, and Lund-Kennedy score did not differ between the two groups. RSI and RFS decreased significantly after eight weeks of PPI medication (p=0.002 and p<0.001, respectively). In the non-treatment group, only RFS showed statistically significant decrease. SNOT-20 and Lund-Kennedy endoscopic scores decreased significantly in the treatment group (p=0.005 and p<0.001, respectively) compared to the non-treatment group. CONCLUSION: The results of our study suggest that PPI treatment for 8 weeks was effective in reducing signs and symptoms of both LPR and CRS.
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Female , Humans , Male , Incidence , Laryngopharyngeal Reflux , Methods , Proton Pumps , ProtonsABSTRACT
OBJECTIVE: To observe the curative effect of acupuncture stimulation of the back segment (10 spots below the spinous processes from T3 to T12) of the Governor Vessel in the treatment of gastroesophageal reflux cough (GERC). METHODS: A total of 60 cases of GERC patients were randomly divided into acupuncture and medication groups (n＝30 in each). For patients of the acupuncture group, the depression spots below the spinous processes from T3 to T12, including acupoints Shenzhu (GV12), Shendao (GV11), Lingtai (GV10), Zhiyang (GV9), Jinsuo (GV8) and non-acupoints (T4, T8, T12) were punctured with filiform needles, once every other day for 8 weeks. Patients of the medication group were ordered to take omeprazole capsules (20 mg/time), twice a day for 8 weeks. The therapeutic effect was assessed by using "Reflux Diagnostic Questionnaire"(RDQ, scores of symptoms of heartburn, retrosternal pain, acid regurgitation and food regurgitation, 0－40 points), cough symptom score (0－3 points) and "Leicester Cough Questionnaire" (LCQ, scores of physiological, psychological and social functions, 0－21 points), respectively. RESULTS: Following the treatment, RDQ score and cough symptom scores during both daytime and night were significantly decreased in both groups (P<0.05)，and the scores of physiological status, psychological health and social function of LCQ were significantly increased in both acupuncture and medication groups in comparison with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture was markedly superior to that of medication in lowering RDQ score and cough symptom scores of daytime and night, and in raising LCQ scores of the physiological status, psychological health and social function (P<0.05). CONCLUSION: Acupuncture stimulation of the dorsal segment of the Governor Vessel is effective in improving clinical symptoms and living quality of GERC patients.
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OBJECTIVE To identify the mental state of laryngopharyngeal reflux disease (LPRD) patients by analyzing anxiety scale and depression scale. METHODS The LPRD patients who received treatment in Fuzhou General Hospital were studied. The healthy volunteers were recruited as control group. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to get the individual scores. Mental states of LPRD patients were finally studied through statistical analysis. RESULTS The scores of anxiety and depression in patients with LPRD were significantly higher than those in control group (anxiety score 50.59±7.24 vs 38.76±7.70, depression score 52.90±7.14 vs 40.63±8.17). The incidence of anxiety and depression in patients with LPRD were significantly higher than that in control group (anxiety rate 56.68％ vs 9.80％, depression rate 50.98％ vs 11.76％). Significant association was detected between ref lux symptom index score and anxiety or depression score in patients with LPRD(r =0.786, r =0.736, P ＜0.05). Significant association between LPRD and anxiety and depression were concluded. CONCLUSION The results showed that the patients with LPRD are more prone to be anxiety and depression mental state than healthy control group, and the severity of LPRD symptoms is significantly correlated with the anxiety and depression. This suggests that the patient's mental state should also be emphasized as well as antacids treatment.
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Objective To study the correlation between laryngopharyngeal reflux (LPR) and secretory otitis media (SOM).Methods A total of 294 adult patients with reflux-related symptoms were recruited in this study.The patients were evaluated with reflux symptom index (RSI) and reflux finding score (RFS).Tympanometry was conducted to all the patients.The 54 patients with the otitis media effusion with type B tympanograms were tested by auripuncture.Results Among the 294 patients,168 cases showed RSI＜13,in which 128 cases,31 cases and 9 cases had type A,type C,and type B tympanograms,respectively.The other 126 patients showed RSI＞13 in which 52 cases,29 cases and 45 cases had type A,type C,and type B tympanograms,respectively.Among the 294 patiems,172 patients showed RFS＜7,in which 131,32 and 9 cases had type A,type C,and type B tympanograms,respectively.The left 122 patients showed RFS＞7,in which 49,28 and 45 cases had type A,type C,and type B tympanograms,respectively.The ratio of type B tympanograms in the patients with RSI＞13 and RFS＞7 were both significantly higher than those in the patients with RSI＜13 and RFS＜7 (P＜0.05).The RSI scores of patients with type A,C,and B tympanogram were 8.6± 3.8,15.9±7.5,and 23.9±8.6,respectively,and the RFS score were 5.6±2.6,9.6±4.7,and 15.3±6.6,respectively.Compared with type A and C,the patients with type B tympanogram had significantly higher RSI and RFS score (P＜ 0.05).Among the 54 patients of type B tympanograms,those with RSI＜13 were found to have serous fluid,grume fluid,glue fluid as in 6 cases,2 cases,and 1 case,while the patient of the RSI＞ 13 had serous fluid,grume fluid,glue fluid in 13 cases,23 cases,and 9 cases,respectively.The otitis media effusion of the patients with the RSI＜13 were mainly serous,while those with the RSI＞13 were mainly sticky.Conclusion The correlation between LPR and SOM was significant.LPRmay accelerate the progress of SOM.
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[ABSTRACT]OBJECTIVETo diagnose laryngopharyngeal reflux (LPR) by using two methods: 24h pH monitoring and RSI combined with RFS scales. To research the voice characteristics of patients with LPR and changes of voice parameters before and after PPIs therapy, and to use voice parameters to help diagnosing and evaluating treatment effect of LPR.METHODSThe patients visited department of Otolaryngology head & neck surgery of Peking University Third Hospital from August 2012 to August 2013 were included in this study. There were 26 LPR patients diagnosed by 24 hr pH-MII monitoring (pH group) and 26 LPR patients diagnosed by RSI combined with RFS (questionnaire group). Another 52 subjects without laryngeal or pharyngeal symptoms were as control group. All subjects underwent MDVP examination. The patients from pH group and questionnaire group took esomeprazole 20 mg bid for one month, afterwards MDVP was examined again. The voice related parameters were compared before and after medication therapy.RESULTSComparing data between LPR patients and normal subjects, Jitter, Shimmer, NHR had significant difference (P0.05) before treatment. After PPIs therapy there was no significant difference between each group (P>0.05).CONCLUSIONAbnormal voice parameters were existed in LPR patients. After PPIs treatment, voice related parameters improved apparently.
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[ABSTRACT]OBJECTIVETo assess the clinical effects of proton pump inhibitor(PPI) combined with traditional Chinese medicine for laryngopharyngeal reflux disease(LPRD).METHODSA total of 74 LPRD patients with laryngopharyngeal signs and symptoms confirmed by reflux symptom index(RSI) and reflux finding score(RFS) were enrolled. All patients received PPI combined with traditional Chinese medicine therapy. Effect evaluation was conducted at 2, 6, 12, and 18 months after the beginning of therapy.RESULTSThe relief rate was 74.3%, 90.5%, 87.8%, and 86.5% at the 2, 6, 12, and 18 months after the beginning of treatment respectively.CONCLUSIONPPI combined with traditional Chinese medicine therapy is safe and effective for LPRD and worthy of wide application.
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BACKGROUND AND OBJECTIVES: Various drugs can be used for treatment of laryngopharyngeal reflux disease (LPRD). However, the optimal medical treatment regimen is still controversial. This study was performed to determine the optimal medical treatment regimen and duration for LPRD. SUBJECTS AND METHOD: We studied 172 patients who were diagnosed as LPRD by reflux symptom index (RSI) or reflux finding scores (RFS). The study group was divided into 4 groups according to the medication regimen: proton pump inhibitor (PPI), PPI and prokinetics, PPI and H2 blocker, and double dose PPI groups. All patients took medicines for 3 months or more. Clinical remission was defined as 70% improvement of initial RSI scores. RESULTS: 36 (20.9%) patients were prescribed PPI only, 65 (37.8%) patients PPI with prokinetics, 51 (29.6%) patients PPI with H2 blocker, 20 (11.6%) patients double dose PPI. Pretreatment with RSI and RFS did not differ among the four groups. RSI was improved after one month of medication in all of the groups. RSI and RFS tended to decrease during the treatment in all groups (p for trend <0.001). The mean clinical remission time was 2.3 months in patients receiving PPI alone, 2.6 months in PPI and prokinetics group, 2.5 months in the PPI and H2 blocker group and 1.8 months in the double dose PPI group. About 70% of patients reached clinical remission within 3 months. CONCLUSION: PPI with or without prokinetics or H2 blocker is effective treatment for LPRD, and the appropriate duration of medication seems to be about 3 months. Double dose PPI can be used for those whom normal dose PPI is ineffective.
Subject(s)
Humans , Laryngopharyngeal Reflux , Proton PumpsABSTRACT
BACKGROUND/AIMS: Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis. METHODS: A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90. RESULTS: Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis. CONCLUSIONS: IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis.
Subject(s)
Humans , Male , Anxiety , Checklist , Colonoscopy , Endoscopy, Digestive System , Esophagitis , Gastroesophageal Reflux , Heartburn , Hernia, Hiatal , Hostility , Irritable Bowel Syndrome , Surveys and Questionnaires , Risk FactorsABSTRACT
Objective To investigate the effect of autonomic nervous dysfunction on pathogenesis of gastro-esophageal reflux disease(GERD).Methods Autonomic nervous function(ANF) was assessed by cardiovascular reflex tests in healthy volunteers and patients with GERD;Based on the ANF test results,the relationship between the impairment degree of autonomic nerve and the esophageal motility or the reflux esophagitis or the score of reflux symptoms was investigated.Results ① 59.5% of patients with GERD have abnormal ANF and the rate in GERD patients is much higher than that in healthy volunteers,parasympathetic nerve impairment is predominant.② The score of reflux symptoms in patients with normal ANF is significantly lower than that in patients with abnormal ANF(6(2,7.6)vs 9(4.1,17),P