• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.2
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• pp.124-128
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• 2012

Background and Objectives : There are many diagnostic modalities to evaluate laryngopharyngeal reflux. However, ideal diagnostic methods have not been established yet. The purpose of this study is to evaluate the effectiveness of Water-Siphon test as a diagnostic test of laryngopharyngeal reflux. Subjects and Methods : From November 2006 to September 2007, we performed esophagography with Water-Siphon test and questionnaire, physical examination for 227 patients with laryngopharyngeal reflux symptoms. The results of Water-Siphon test were classified according to the degree of reflux, the number of reflux, the retention time and analyzed about the relationship with the reflux symptom index (RSI), reflux finding score (RFS). Results : The degree of reflux was related with pseudosulcus, thick endolaryngeal mucus. The number of reflux was related with thick endolaryngeal mucus. A positive predictive value of Water-Siphon test was 82.7% and sensitivity was 91.5%. Conclusion : Water-Siphon test is a reliable diagnostic test for laryngopharyngeal reflux.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.2
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• pp.56-63
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• 2021

Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition of the upper aerodigestive tract mucosa induced by reflux content from stomach. Some of vocal cord diseases are associated with laryngopharyngeal reflux. Because of the pathophysiological features, proton pump inhibitor shows therapeutic effect on some vocal cord diseases. As like that, the gastric reflux contents can make macroscopic or microscopic morphological changes in the upper aerodigestive tract mucosa. Although the pathophysiology of LPRD is relatively clear, clinical diagnosis is still difficult. The diagnosis of LPRD includes objective tests such as 24-hours multichannel intraluminal impedance-pH metry and subjective tests such as questionnaire method. However, the objective verification of reflux is difficult due to invasiveness of the method, and the questionnaire methods have limitations because many symptoms are not specific for LPRD. Moreover, most methods are not fully standardized until now. Despite these limitations, many researchers are struggling to standardize diagnosis and treatment of LPRD, and there are several new achievements recently. Therefore, the purpose of this article is to review the recent literature on the clinical presentation, diagnosis, and treatment of LPRD, and to systematize our knowledge.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.84-86
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• 2016

Globus pharyngeus or globus sensation is the painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling. It is often associated with persistent clearing of the throat, chronic cough, hoarseness, and catarrh. Its etiology remains unclear ; however, laryngopharyngeal reflux may play a role in a subset of patients. Psychogenic problems have often been thought to cause or trigger the globus sensation. Personality studies have found higher levels of alexithymia, neuroticism, and psychological distress (including anxiety, low mood, and somatic concerns) and lower levels of extraversion in patients presenting with globus. Globus patients with laryngopharyngeal reflux exhibited weaker psychological symptoms than non- laryngopharyngeal reflux globus patients, and globus patients who did not respond to proton pump inhibitor had significantly higher anxiety scores. In cases with negative clinical investigations and consistent globus symptom, other treatment strategies, including speech therapy, antidepressants, and cognitive-behavioral therapy, should be considered.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.79-83
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• 1997

The term laryngopharyngeal reflux (LPR) refers to the backflow of food or stomach acid back up into the larynx (the voice box) or the pharynx (the throat). Esophagopharyngeal reflux is suggested as an etiologic factor in laryngeal disease. To examine a possible esophageal basis for laryngopharyngeal symptoms, we studied 48 patients with persistent laryngopharyngeal symptoms, and 12 relative control subjects. Patients were evaluated for cervical symptoms by questionnaire and underwent gastrofiberoscopy, fiberoptic laryngoscopy, esophageal manometry and 24-hour ambulatory double-probe pH monitoring. We found LPR in fourteen out of 48 patients with cervical symptoms (29%). The LPR group consisted of nine men and five women. The symptoms that LPR patients complained were throat lump sensation, hoareness, sore throat, throat clearing, chronic coughing and dysphagia in order of frequency, and they were not different significantly from non-LPR patients. The laryngoscopic findings in LPR patients were posterior erythema, laryngeal edema and diffuse erythema, and there was also no significant difference between LPR group and non-LPR group. There was statistically significant correlation between LPR and gastroesophageal reflux (GER). We concluded that there is no pathognomonic symptoms or laryngoscopic findings in diagnosis of LPR, and 24-hour ambulatory double-probe pH monitoring is an essential diagnostic tool in LPR.

• Korean Journal of Bronchoesophagology
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• v.15 no.1
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• pp.41-49
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• 2009

Background and Objectives : Proton pump inhibitors(PPIs) improve the symptoms of laryngopharyngeal reflux(LPR). But there is little reports about the changes of each items in reflux symptom index (RSI) and reflux finding score (RFS) after PPIstreatment. The purpose of this study is to analyze the changes of pre- and post-treatment score in each RSI and RFS items after 8 weeks medication with proton pump inhibitors in laryngopharyngeal reflux patients. Methods : Prospective study. Among the patients who had visited the department of otolaryngology from January 2007 to December 2008, 91 patients who had shown scores greater than 13 on the RSI and/or 7 on the RFS were studied. All patients received PPIs once daily before breakfast for 8 weeks. RSI and RFS were assessed at initial, four weeks and eight weeks after medication. Result: All RSI items were improved (p < 0.05). The globus sense followed by throat clearing, heartburns and hoarseness showed high initial RSI score than other items. And globus sense, throat clearing, hoarseness and heartburn were improved significantly more than others items. But only posterior commissure hypertrophy of RFS was improved significantly more than others items. Conclusion: Empiric PPIs therapy reduced the RSI scores and more effective for symptoms such as globus sense, throat clearing, hoarseness and heartburn among suspected LPR patients. In RFS, only posterior commissure hypertrophy has improved significantly. However, the changes of each categories of RFS were minimal (average: 0.16), therefore clinical significance is restricted in RFS.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.60-66
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• 2003

Although there is a wide range of diseases caused by gastric acid reflux and the number of cases is on the rise, it is difficult for the laryngologist to make the correct diagnosis. The treatment for laryngopharyngeal reflux can be grouped into 3 categories - changes in lifestyle, medication, and surgery. The medication used to treat laryngopharyngeal reflux are prokinetic agents and acid supressive agents such as antacids, H2 blockers, and PPIs(Proton pump inhibitor). Rabeprazole sodium($Pariet^{\circledR}$) is a newly developed agent belonging to the PPI group, but in contrast with the existing drugs such as omeprazole, lansoprazole, pantoprazole, has a low dependency on CYP2C19 during the metabolic cycle. Thus, it is known to have a quick but fixed antiacid effect and less individual differences. We analyzed 2166 patients from 32 hospitals who were prescribed $Pariet^{\circledR}$ from May, 2001 to April, 2002. The patients were divided into 4 groups according to the duration of treatment - Group 1: 1-14 days, Group 2: 15-28 days, group 3: 29-56 days, Group 4: more than 56 days. The cases were then analyzed for improvement of 8 symptoms(heart bum, regurgitation, chronic cough, hoarseness, globus sensation, chronic throat clearing, sore throat, and dysphagia), improvement on laryngoscope, usefulness to the doctor, and complication development. Of the total of 2116 patients, 1627(75.1%) cases showed at least 50% improvement of symptoms and the amount of improvement increased according to the duration of medical treatment. Most of the patients showed objective improvement on the laryngoscope, with 32.9% showing significant improvement and 38.7% showing moderate improvement. 37.6% of the doctors questioned replied that $Pariet^{\circledR}$ was very useful and 50.3% said it was useful, showing that most were satisfied with the treatment results. The complications known to develop after taking PPI are headache, nausea, diarrhea, abdominal pain, constipation, dizziness, fatigue, and of these, only a small percentage of the patients complained of mild headache. $Pariet^{\circledR}$ has shown to be a relatively safe and effective drug for the treatment of laryngopharyngeal reflux.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.73-77
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• 2016

Laryngopharyngeal reflux disease (LPRD) is different with gastroesophageal reflux disease (GERD). The lower esophageal sphincter (LES) possesses an intrinsic nervous plexus that allows the LES to have a considerable degree of independent neural control. Sympathetic control of the LES and stomach stems from cholinergic preganglionic neurons in the intermediolateral column of the thoracic spinal cord (T6 through T9 divisions), which impinge on postganglionic neurons in the celiac ganglion, of which the catecholaminergic neurons provide the LES and stomach with most of its sympathetic supply. Sympathetic regulation of motility primarily involves inhibitory presynaptic modulation of vagal cholinergic input to postganglionic neurons in the enteric plexus. The magnitude of sympathetic inhibition of motility is directly proportional to the level of background vagal efferent input. Recognizing that the LES is under the dual control of the sympathetic and parasympathetic nervous systems, we refer the reader to other comprehensive reviews on the role of the sympathetic and parasympatetic control of LES and gastric function. The present review focuses on the functionally dominant parasympathetic control of the LES and stomach via the dorsal motor nucleus of the vagus.

• Journal of Acupuncture Research
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• v.40 no.3
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• pp.188-200
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• 2023

Laryngopharyngeal reflux (LPR) disease is a condition in which the stomach contents return to the larynx and pharynx via the esophagus, causing mucosal injury. While conventional treatments, such as proton pump inhibitors, have limitations, acupuncture has been shown to reduce LPR symptoms. However, its effectiveness has not been systematically assessed. This study aimed to systematically evaluate the effectiveness of acupuncture in treating LPR. We review 10 electronic databases with a consistent search strategy, and 2 independent reviewers screened the articles based on the inclusion and exclusion criteria. This study selected and analyzed 7 randomized controlled trials after the screening to assess primary outcomes, including reflux symptom index and reflux finding score, and secondary outcomes, including upper and lower esophageal sphincter pressure. The results revealed the statistically significant effectiveness of acupuncture in combination with conventional treatment in reducing LPR symptoms compared with conventional treatment alone. The most commonly used acupuncture points were CV22, ST36, and LR3. However, the meta-analysis demonstrated low reliability, as assessed using the GRADE Tool. Further research is needed to improve the evidence and draw clear conclusions regarding the clinical use of acupuncture for treating LPR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.113-117
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• 2007

Although the prevalence of laryngopharyngeal reflux (LPR) is presumed to be very high, basic researches on LPR have not been active so far. This is a review of present status and prospect of researches on LPR to help readers' understanding of current trend on LPR research. In vitro and in vivo researches on acid/pepsin, intercellular junctions, bile juice, carbonic anhydrase, cytokines, and Helicobacter pylori were discussed. Considering that quality of life is getting more important in accordance with longer life span and that a fair proportion of LPR patients do not respond to conventional therapy, researches on pathogenesis and pathophysiology of treatment measures are necessary and it is anticipated for more and more researchers to concern themselves in basic research on LPR in the future.

• Korean Journal of Bronchoesophagology
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• v.16 no.2
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• pp.97-104
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• 2010

Gastroesophageal reflux disease (GERD) is a common disorder caused by the reflux of gastric contents into the esophagus. According to the recent classification, GERD can elicit esophageal and extraesophageal syndromes. Laryngopharyngeal reflux (LPR) is defined as laryngeal symptoms with laryngeal inflammation caused by the acid reflux. The prevalence of GERD and LPR is increasing during the past decades in Korea and management of GERD and LPR is a challenging issue in clinical practice. Proton pump inhibitor is the most effective drug in the treatment of GERD. Most patients with LPR are given a 2-month trial of a proton pump inhibitor (PPI), however, there is still little evidence on the diagnosis or the treatment of LPR. During the last years concern have been raised regarding the risk of averse events related to long-term use of PPI. We review the recent update on medical treatment of GERD/LPR.