Role of Reflux Symptom Index and Reflux Finding Score in Evaluation of Treatment Outcome in Patients with Laryngopharyngeal Reflux

AbstractObjective:To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.Study design:This was a prospective, double-blind study.Subjects and methods:Fifty-five patients with either a Reflux Symptom Index of more than 13 or a Reflux Finding Score of more than 7 were enrolled. All patients underwent 24-hour, double-probe pH monitoring before commencing pantoprazole 40 mg twice daily; both investigators and patients were blinded to pH monitoring results. The Reflux Symptom Index and Reflux Finding Score were reassessed during the second, third and fourth month of follow up.Results:The sensitivity of empirical pantoprazole treatment in diagnosing laryngopharyngeal reflux was 92.5 per cent. The specificity was 14.2 per cent, the positive predictive value 86 per cent and the negative predictive value 25 per cent. There was significant reduction in the total Reflux Symptom Index and Reflux Finding Score after the second, third and fourth month of treatment. There was no correlation between laryngopharyngeal reflux and body mass index.Conclusion:Our results suggest that intensive empirical treatment with proton pump inhibitors is effective in diagnosing laryngopharyngeal reflux.

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The application of 24-hour pharyngeal pH-monitoring and Reflux Finding Score and Reflux Symptom Index questionnaires in the diagnostics of laryngopharyngeal reflux

Gastroenterology Review ◽

10.5114/pg.2019.90253 ◽

2019 ◽

Vol 14 (4) ◽

pp. 274-282

Author(s):

Elżbieta Włodarczyk ◽

Beata Miaśkiewicz ◽

Danuta Raj-Koziak ◽

Agata Szkiełkowska ◽

Piotr Skarżyński ◽

...

Keyword(s):

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index

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Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Otolaryngology ◽

10.1177/0194599816676471 ◽

2016 ◽

Vol 156 (1) ◽

pp. 144-151 ◽

Cited By ~ 15

Author(s):

Lu Wang ◽

Jia-Jie Tan ◽

Ting Wu ◽

Rui Zhang ◽

Jia-Nuan Wu ◽

...

Keyword(s):

Vocal Fold ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Healthy Controls ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Predictive Values ◽

Laryngeal Mucosa

Objective To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps’ tissues. Study Design Cross-sectional study. Setting Nanfang Hospital of Southern Medical University. Subjects and Methods The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed. Results The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%). Conclusion Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

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Deteksi pepsin pada penderita refluks laringofaring yang didiagnosis berdasarkan reflux symptom index dan reflux finding score

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v41i2.48 ◽

2011 ◽

Vol 41 (2) ◽

pp. 121

Author(s):

Yunida Andriani ◽

Muhammad Amsyar Akil ◽

Masyita Gaffar ◽

Abdul Qadar Punagi

Keyword(s):

Gold Standard ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Diagnostic Tools ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Double Probe ◽

Contact Ulcer

Background: It is estimated that more than 50% of patients with voice disorders who come fortreatment are caused by laryngopharyngeal reflux (LPR). LPR has been implicated in the etiology ofmany laryngeal disorders including subglottic stenosis, laryngeal carcinoma, laryngeal contact ulcer,laryngospasm and vocal nodule on the vocal cords. Ambulatory 24 hour double-probe (pharyngeal andesophageal) pH monitoring is the gold standard examination for diagnosing LPR, but it is still far fromideal criteria.The assessment of pepsin in airway secretions could be used as a sensitive diagnosticmarker of LPR because pepsin is not synthesized by any type of airway cells. Purpose: The aim ofthis study was to detect the presence of pepsin on laryingopharyngeal reflux patients which diagnosedbased on reflux symptom index (RSI) dan reflux finding score (RFS) at Wahidin Sudirohusodo Hospital,Makassar. Methods: This is a comparative quantitative study. We performed RSI and RFS examinationson 51 samples, followed by saliva pepsin detection using ELISA method on 48 samples, then analyzed withSpearman’s Rho test. Result: RSI score >13 was found in 48 samples (94,12%) and RFS score >7 wasin 51 samples (100%). Pepsin was detected on all sputum samples, however there was no significant relationship betwen RSI and RFS scoring with the level of pepsin in saliva (p>0.01). Conclusion: Pepsin was detected on saliva of patients with laringopharyngeal reflux who was diagnosed based on RSI andRFS. We concluded that RSI and RFS can be used as diagnostic tools for LPR. Keywords: laringopharyngeal reflux, reflux symptom index, reflux finding score, pepsin Abstrak : Latar belakang: Diperkirakan lebih dari 50% pasien dengan gangguan suara yang datang berobatke dokter THT diakibatkan oleh refluks laringofaring (RLF). Diduga RLF berperan pada patogenesissejumlah kelainan pada laring, termasuk stenosis subglotik, karsinoma laring, laryngeal contact ulcers,laringospasme dan vokal nodul pada pita suara. Pemeriksaan ambulatory 24 hour double-probe pHmonitoring merupakan gold standard untuk mendiagnosis RLF, namun pemeriksaan ini masih jauh darikriteria ideal. Menentukan adanya pepsin pada sekret saluran napas merupakan petanda diagnostik yangsensitif untuk RLF karena pepsin tidak dihasilkan oleh sel apapun dalam saluran napas. Tujuan: Penelitianini bertujuan mendeteksi keberadaan pepsin pada penderita refluks laringofaring yang didiagnosisberdasarkan refluks symptom index (RSI) dan reflux finding score (RFS). Metode: Jenis penelitian iniadalah komparatif kuantitatif. Dilakukan pemeriksaan RSI dan RFS pada 51 percontoh dan dilanjutkandengan pemeriksaan pepsin saliva menggunakan metode ELISA pada 48 percontoh lalu dilakukan ujiSpearman’s Rho. Hasil: Skor RSI >13 sebanyak 48 percontoh (94,12%) dan skor RFS >7 sebanyak 51percontoh (100%). Pepsin terdeteksi pada saliva semua percontoh. Tidak ada hubungan yang bermaknaantara skoring RSI dan RFS dengan kadar pepsin pada saliva (p>0,01). Kesimpulan: RSI dan RFS dapatdigunakan dalam menegakkan diagnosis RLF. Kata kunci: refluks laringofaring, reflux symptom index, reflux finding score, pepsin

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Correlation between Reflux Symptom Index and Reflux Finding Score in Laryngopharyngeal Reflux

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i2.38898 ◽

2021 ◽

Vol 18 (2) ◽

pp. 51-54

Author(s):

Anshu Sharma ◽

Dhundi Raj Paudel

Keyword(s):

Laryngopharyngeal Reflux ◽

Cost Effective ◽

Reflux Symptom ◽

Moderate Correlation ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Combined Use ◽

Clearance Mechanism ◽

Significant Disease

Introduction: Laryngopharyngeal reflux is an extra esophageal variant of gastro esophageal reflux disease and is characterized by change in voice, recurrent throat clearing, chronic cough, discomfort in throat, globus. The larynx and pharynx are devoid of the normal acid clearance mechanism even three episodes of reflux per week seems to be associated with a significant disease. Aims: The aim of the study was to evaluate the correlation between the reflux symptom index and reflux finding score in patients with Laryngopharyngeal reflux. Methods: This prospective analytical study was conducted from November 2019 to October 2020 in total of 65 patients presented in department of Otorhinolaryngology, Nepalgunj Medcial College and Teaching Hospital, Nepalgunj. Reflux symptom index questionnaire with nine Questions were answered by patients on a 5 point scale. Reflux symptom index of more than 13 out of total score of 45 was considered to indicate Laryngopharyngeal reflux were as, reflux finding score was based on laryngoscopic findings after evaluating 8 items. Score more than 7 out of 26 was taken as an indicator for presence of Laryngopharyngeal reflux. Results: The reflux symptom index was more than 13 on 22 patients withmean11.85±3.48 and reflux finding score was more than 7 on 11 patients with mean 5.02±3.23 with statistically moderate correlation between reflux symptom index and reflux finding score (p=0.000,r=0.595). Conclusion: There is moderate correlation between the reflux symptom index and reflux finding score. The combined use of these questionnaires and laryngoscopic findings can be more precise, practical and cost effective in the diagnosis of laryngopharyngeal reflux.

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Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in Management of Laryngopharyngeal Reflux in Indian Scenario

International Journal of Clinical & Experimental Otolaryngology ◽

10.19070/2572-732x-2000020 ◽

2020 ◽

pp. 108-113 ◽

Cited By ~ 1

Author(s):

Shahul Hameed Poondiyar Sirajuddin ◽

Keyword(s):

Laryngopharyngeal Reflux ◽

Reflux Symptom ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Indian Scenario

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Prevalence and Symptomatology of Laryngopharyngeal Reflux Disease in a Medical College Hospital in Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/457 ◽

2021 ◽

Vol 8 (27) ◽

pp. 2467-2471

Author(s):

Binu Raju George ◽

Ajayan P.V ◽

Saify Samad

Keyword(s):

Reflux Disease ◽

Laryngopharyngeal Reflux ◽

Reflux Symptom ◽

Common Symptom ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Female Ratio ◽

Medical College ◽

Laryngopharyngeal Reflux Disease

BACKGROUND Laryngopharyngeal reflux is a common clinical condition encountered in Otolaryngology practice. It is one of the major causes of laryngeal inflammation. It presents with a constellation of symptoms making the diagnosis difficult. Reflux Symptom Index and Reflux Finding Score are two tools which aid in diagnosis of Laryngopharyngeal reflux. The main objective of this study was to study the agent, host and environment factors of epidemiology of patients with laryngopharyngeal reflux disease using Reflux Symptom Index and Reflux Finding Score. METHODS A descriptive study was conducted on 100 patients attending the Department of Otorhinolaryngology, Government Medical College and Hospital, Thrissur, Kerala. The study period was for one year from December 2017 to December 2018. Demographic data of the patients was recorded, and patients were evaluated for Laryngopharyngeal reflux disease using Reflux Symptom Index and Reflux Finding Score using 70 degree / flexible nasopharyngolaryngoscopy. The clinical data collected was then tabulated and analysed. RESULTS From the study conducted in 100 patients, 59 % were females and 41 % males. Most common symptom noted was frequent clearing of throat which was present in 88 % cases. Least frequent symptom was choking episode (in 5 %). CONCLUSIONS The prevalence of Laryngopharyngeal Reflux Disease was commonest in the 31 to 40 years age group with mean age was 37.8 ± 2.35 years. The male to female ratio were 1:1.43. The disease was common in labourers and housewives. Risk factors were consumption of tea/coffee, inadequate sleep of less than 6 hrs. Lower socioeconomic group populations were more vulnerable than higher income group. The RSI score was between 13 and 15 in 53 % of the patients. KEYWORDS Laryngopharyngeal Reflux, Reflux Symptom Index, Reflux Finding Score

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