The application progress on diagnostic scales of laryngopharyngeal reflux disease / 临床耳鼻咽喉头颈外科杂志

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, noninvasive, 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.

Analysis on the pharyngeal microbiota in patients with laryngopharyngeal reflux disease

Abstract Objective(s): In this study, the laryngopharynx microbiome alterations were characterized after proton pump inhibitor treatment in patients with Laryngopharyngeal Reflux Disease (LPRD) and healthy people. The potential outcome-predictive biomarker was explored. Methods: Patients with LPRD and healthy controls were enrolled. The composition of their laryngopharynx microbiota was analyzed both by traditional plate count of the main bacterial groups and PCR amplification followed by denaturing gradient gel electrophoresis. Shannon-Wiener index and evenness index based on Dice index were used to assess the bacterial diversity. Droplet digital PCR was used to determine the total bacterial RNA and relative abundance of Klebsiella oxytoca. Receiver operating characteristic curve was plotted to explore the potential of Klebsiella oxytoca as an outcome-predictive biomarker. Results: A total of 29 LPRD cases and 28 healthy subjects were enrolled. The composition of the laryngopharynx microbiota was almost similar, except Klebsiella oxytoca. The cluster analysis showed that the similarity between healthy and treatment-effective groups, as well as pretreatment and treatment-invalid groups, was close. Statistical analysis showed that there were differences in the diversity index and richness among the healthy, treatment-effective, pretreatment and treatment-invalid groups. The abundance of Klebsiella oxytoca in the treatment-effective LPRD group was lower than that of the treatment-invalid LPRD group. The abundance of Klebsiella oxytoca can distinguish treatment-effective and -invalid groups (AUC = 0.859) with a sensitivity of 77.78% and specificity of 90.91%. Conclusion: There were differences in the diversity of cecal contents microbial community between treatment-invalid and treatment-effective LPRD groups. Klebsiella oxytoca has potential to distinguish treatment outcomes. Level of evidence: How common is the problem? Level 1. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 4. What will happen if we do not add a therapy? (Prognosis) Level 5. Does this intervention help? (Treatment Benefits) Level 4. What are the COMMON harms? (Treatment Harms) Level 4. What are the RARE harms? (Treatment Harms) Level 4. Is this (early detection) test worthwhile?(Screening) Level 4.

Analysis of mental state in patients with laryngopharyngeal reflux disease / 中国耳鼻咽喉头颈外科

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.

Diagnostic value of of Peptest in laryngopharyngeal reflux disease / 医学研究生学报

Objective At present,there are relatively few studies on the application of pepsin in the diagnosis of laryngopha -ryngeal reflux disease(LPRD)in China.This paper aimed to evaluate the application value of Peptest in the diagnosis of LPRD by measuring saliva/sputum pepsin in patients with chronic pharyngitis. Methods From January to June 2017,35 patients with chronic pharyngitis treated in our department were selected to undertake electronic laryngoscopy and evaluated by reflux finding score(RFS) and reflux symptom index(RSI)scoring.The patients'saliva/sputum samples were collected three times for pepsin concentration de-tection(PEPTEST).The first collection was before mouthwash in the morning,the second was 1h after lunch,and the third was the time of evident symptoms.Comparative research was carried out on the above results. Results The average RSI score and RFS score were11.31±6.21 and 5.97±1.98.The pepsin content in morning saliva/sputum[26.80(0,109.80)ng/mL]was significantly lower than that at 1 h after lunch[89.00(16.0,254.8)ng/mL]and that at the time of obvious symptoms[105.70(34.3,254.8)ng/mL](P<0.05).The area under ROC of Peptest in the morning[0.759(0.602, 0.917)],1h after lunch[0.824(0.670,0.978)], at the time of ob-vious symptoms were all greater than the combination of RSI and RFS, representing significant statistical differences(P<0.05). Conclusion Compared with traditional method(a combination of RSI and RFS),Peptest has more important clinical value in the diag-nosis of LPRD.

Clinical analysis of patients with Laryngopharyngeal reflux disease / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the changes of symptoms and signs of laryngopharyngeal reflux diseases(LPRD) after treatment with esomeprazole.METHODS The suspected LPRD patients were treated with esomeprazole for 8 weeks.Reflux finding score(RFS) and reflux symptoms index(RSI) score were evaluated before and after treatment.RESULTS In RSI,84％ of the patients had the symptom of hoarseness or a problem with voice,87％ had clearing of throat,71％had excess throat mucus,58％ had difficulty swallowing food,52％ had coughing after eat or after lying down,68％ had breathing difficulties or chocking episodes,79％ had troublesome or annoying cough,92％ had lump in your throat or sensation of something sticking in throat,and 32％ had heartburn,chest pain,indigestion or stomach acid coming up.In the RFS,45％ of the patients had pseudosulcus,57％ had ventricular obliteration,94％ had erythema/hyperemia,85％ had vocal cord edema,82％ had diffuse laryngeal edema,83％ had posterior commissure hypertrophy,10％ had granuloma/granulation,and 58％ had thick endolaryngeal mucus.The RSI and RFS score had statistical difference before and after treatment(P＜0.001).CONCLUSION The main symptoms of LPRD were lump in throat or sensation of something sticking in throat,clearing of throat and hoarseness or a problem with voice.The main signs of LPRD were erythema/hyperemia,vocal cord edema and posterior commissure hypertrophy.The PPI has marked improved in symptoms and signs of LPRD.

Analysis the risk factors and the prevalence of Laryngopharyngeal reflux disease in Fuzhou area / 中国耳鼻咽喉头颈外科

OBJECTIVE To assess the prevalence and analyze the influence factors of laryngopharyngeal reflux disease(LPRD) in the Fuzhou region, in order to provide a theoretical basis for the development of prevention and control measures for LPRD. METHODS A questionnaire survey in residents in Fuzhou by a random cluster sampling was carried out. Individual information, reflux symptom index(RSI) of Belafsky and risk factors were included. Patients more than 13 scores of RSI were defined as LPRD. Data were statistically analyzed. RESULTS A total of 4100 residents were investigated, 4063 of them were available. The prevalence of LPRD was 5.00%. Often eating too much, often drinking strong tea, menolipsis, rhinitis, tonsillitis were closely related to LPRD. CONCLUSION The prevalence of LPRD in Fuzhou region were closely related to many factors.

A Case of Esophageal Achalasia Misconceived as Laryngopharyngeal Reflux Disease

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.

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

PURPOSE: We tried to evaluate the difference in the expression of carbonic anhydrase (CA) III and heat shock protein (Hsp) 70 between laryngopharyngeal reflux disease (LPRD) and non-LPRD patients. MATERIALS AND METHODS: The study involved 28 patients who underwent laryngeal microsurgery due to benign laryngeal disease from March to August 2008. Reflux symptom index (RSI) and reflux finding score (RFS) were measured for each person, and they were assigned either to the LPRD group (n=10) or non-LPRD group (n=18). Tissue samples were obtained from the mucosa of posterior commissure, and immunohistochemistry (IHC) staining of CAIII and Hsp70 was performed. The IHC scores were measured and compared with clinical features including RSI and RFS. RESULTS: Total 10 patients were assigned as LPRD group, and 18 patients were as control group. The mean IHC score of CAIII and Hsp70 was 1.70+/-1.06 and 1.90+/-0.88, respectively, in LPRD patients, whereas the mean IHC score of CAIII and Hsp70 was 0.78+/-0.73 and 0.94+/-0.87, respectively, in non-LPRD patients. The difference between two groups was statistically significant (p<0.05). CONCLUSION: CAIII and Hsp70 expressions were higher in LPRD patients that in non-LPRD patients, suggesting the possibility as one of biomomarker in LPRD diagnosis.

Clinical observation and esophageal dynamical analysis of esomeprazole combined with itopride in the treatment of gastroesophageal relfux disease / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo study the changes of symptoms, signs and esophageal dynamics characteristics of laryngopharyngeal reflux diseases(LPRD) before and after treatment with esomeprazole and itopride.METHODS The suspected LPRD patients were took the diagnostic treatment with esomeprazole and itopride. Reflux finding score(RFS), reflux symptoms index(RSI) score and high-resolution esophageal pressure were evaluated before and after treatment. The patients were divided into pure LPRD group and LPRD with GERD group according to gastroesophageal reflux disease(GERD) questionnaire scores.RESULTS There were 38 patients confirmed with LPRD(pure LPRD group:12 cases, LPRD with GERD group:26 cases). The BMI, age, gender ratio had no statistical difference between the two groups(P>0.05). In LPRD group, RSI had significant difference before and after treatment(Z=-3.009,P0.976). In LPRD with GERD group, the RSI and RFS had significant difference before and after treatment(P0.05), but in LPRD with GERD group, esophageal dynamic parameters of UESP, LESP, DCI, DL had significant difference before and after treatment(P<0.05).CONCLUSIONIn pure LPRD group, the reflux symptoms improved obviously after treatment, but the signs may need treatment for more time. Esomeprazole combined with itopride can improve the esophageal dynamics in LPRD with GERD group, but can not improve that in pure LPRD group. The results suggested that the LPRD and GERD have different pathogenesis.

Laryngopharyngeal reflux disease treated by combination of Chinese and western medicine / 中国耳鼻咽喉头颈外科

[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.

Clinical Analysis of High Resolution Manometry (HRM) in Patients with Laryngopharyngeal Reflux Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High resolution manometry (HRM), a newly developed device that uses 36 channels to plot pressure topography of esophagus, has recently been applied to evaluate the esophageal and upper esophageal sphincter (UES) status; however, its definite role in laryngopharyngeal reflux disease (LPRD) is not well elucidated. The aim of this study was to evaluate clinical usefulness of HRM and to elucidate the association between HRM findings and dysphasia in LPRD patients. SUBJECTS AND METHOD: A total of 56 patients who had been diagnosed LPRD from July 2010 to July 2011 were prospectively enrolled in this study. Patients consisted of 20 men and 36 women, with the mean age of 51.4 years. Every patient performed the questionnaire and HRM examination. A comparative analysis was performed to evaluate the correlation between the HRM results and LPRD. RESULTS: Of 30 patients (53.6%), there were 11 peristaltic dysfunction (19.7%), 6 relaxation impairment of lower esophageal sphincter (LES)(10.7%), 4 diffuse esophageal spasm (7.1%), 4 hypotensive LES (7.1%), 3 Nutcracker esophagus (5.4%), and 2 relaxation impairment of UES (3.6%). The mean distance of UES from the nostril was 17.88+/-2.17 cm and the mean UES basal pressure was 63.10+/-24.49 mm Hg. Differences between the prevalence of abnormal findings shown by HRM and dysphasia symptoms were not statistically significant. CONCLUSION: In this study, a considerable amount of abnormalities in esophageal function were observed using HRM, and thus we think that HRM could provide useful information about esophagus dysfunction in LPRD patients.

Effect of laryngopharyngeal reflux on premalignant lesion and cancer of the larynx / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the effect of laryngopharyngeal and gastroesophageal reflux on the development of the laryngeal precancerous lesion and cancer.METHODS Twelve patients with vocal fold precancerous lesions and one patient with laryngeal cancer proved pathologically underwent 24-hour dual probe pH monitoring.All patients had been operated on and follow-up.RESULTS Seven of 13 patients(53.85%)showed positive pH monitoring in laryngopharynx,8 of 13(61.53%)patients showed positive pH monitoring in esophagus.Positive pH monitoring in both sites was found in 6 patients(46.15%).Among 7 patients with laryngopharyngeal reflux and 8 patients with gastroesophageal reflux,positive RSI was found in 5 cases and positive RFS was found in 6 cases.CONCLUSION The laryngopharyngeal reflux may be a risk factor in the development of the laryngeal precancerous lesion laryngeal cancer.