The role of pepsin in the laryngopharyngeal reflux

2017 ◽  
Vol 71 (6) ◽  
pp. 7-13 ◽  
Author(s):  
Katarzyna Kowalik ◽  
Antoni Krzeski
Keyword(s):  
Differential Diagnosis ◽  
Laryngopharyngeal Reflux ◽  
Upper Respiratory Tract ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Upper Respiratory ◽  
Inflammatory Changes ◽  
Common Defect

Laryngopharyngeal reflux (LPR) is a common defect among laryngological and phoniatric patients. Although LPR is categorized as a superficial gastroesophageal reflux disease (GERD), differential diagnosis should treat these two diseases separately. LPR symptoms can be assessed in the interview using as a tool the reflux symptom index (RSI). In addition, changes in the larynx that occur during LPR might be seen during laryngoscopy and classified according to the reflux finding score (RFS). One of the main mucosal irritants in LPR is pepsin which digests proteins and impairs the functions of the upper respiratory tract cells by affecting carbonate anhydrase (CAIII) and the Sep 70 protein. Pepsin initiates inflammatory changes within the larynx, nasopharynx and nasal cavity. The use of pepsin detection in upper and lower throat secretions is a new direction in LPR diagnostics.

scholarly journals Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints?

2017 ◽  
Vol 7 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Rajesh Vishwakarma ◽  
Ruta V Shah
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Female Ratio ◽  
The Real ◽  
Body Sensation ◽  
Male Female Ratio ◽  
The Mean ◽  
Nose And Throat

ABSTRACT Aim The aim of this study is to evaluate the role of laryngopharyngeal reflux (LPR) in patients with laryngeal complaints and study the correlation between reflux symptom index (RSI) and reflux finding score (RFS). Materials and methods This is a study of 104 patients, who presented in the ear, nose, and throat outpatient department at the Civil Hospital, Ahmedabad, India, from April 2015 to April 2016, with complaints like change of voice, chronic cough, foreign body sensation, throat clearing, difficulty swallowing, and regurgitation. All the patients were examined with 90° endoscope by a single examiner, and an RSI ≥13 was considered as indicative of reflux. Observation and discussion The mean age of the 104 patients was 47.2 years. The male-female ratio was 1:1.8. The RSI ranged from 5 to 44, with a mean of 22.99 and standard deviation (SD) of 7.43. The RFS ranged from 4 to 22, with a mean of 11.04 and SD of 3.07. Both the parameters showed high correlation (correlation coefficient 0.98). Conclusion The LPR plays an important contributory role in patients with laryngeal complaints. The RFS and RSI can be used as routine parameters in establishing the diagnosis of reflux. How to cite this article Shah RV, Vishwakarma R. Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints? Int J Phonosurg Laryngol 2017; 7(1):6-9.

scholarly journals Correlation between reflux symptom index and reflux finding score in patients with laryngopharyngeal reflux: Our experience

2016 ◽  
Vol 3 ◽  
pp. 13-17
Author(s):  
Deepthi Satish ◽  
H. C. Badari Datta ◽  
B. V. Manjula ◽  
Brinda A. Poojari ◽  
Bhaskar Reddy Molluru
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Reflux Symptom ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Symptom Index

scholarly journals The role of magnesium supplement in laryngopharyngeal reflux disease

2021 ◽  
Vol 8 (1) ◽  
pp. 47
Author(s):  
Adhira Gobind
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Care Hospital ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Regular Treatment ◽  
Laryngopharyngeal Reflux Disease

<p class="abstract"><strong>Background:</strong> Laryngopharyngeal reflux disease (LPRD) is one of the most prevalent upper gastrointestinal disorder encountered in clinical practice and its optimal treatment is not standardized. The role of magnesium in the human body functions is often underestimated. Since magnesium (Mg) plays a major role in the regulation of smooth muscle contractionby relaxing the pyloric sphincter and enhancing gastric emptying, thereby decreasing the pressure on the LES, it was hypothesized that adding magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms. Magnesium has a neutralizing action on the gastric acid and therefore, it may be pertinent to achieve optimal Mg intakes in patients with LPRD.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done over a period of 1 year conducted in a tertiary care hospital in central India in patients presenting with LPRD of the age group 18-65 years.  </p><p class="abstract"><strong>Results:</strong> The study patients were divided into two groups-one treated with esmoprazole 40 mg capsules and alginate syrup and the other with esmoprazole capsules, alginate syrup and magnesium glycinate (250 mg) supplement. Both the groups showed appreciable improvement in their mean reflux symptom index (RSI) and reflux finding score (RFS) at 1 month and 3 months follow-up. Females showed a higher preponderance than males in the disease, symptoms and the mean RSI and RFS score.</p><p class="abstract"><strong>Conclusions:</strong> Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.</p>

scholarly journals Aggravation of Reflux Finding Score (RFS) after thyroidectomy

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254235
Author(s):  
Hyung-Joon Yoon ◽  
Hee Ryung Kim ◽  
Chang Myeon Song ◽  
Ji Young Lee ◽  
You Hern Ahn ◽  
...  
Keyword(s):  
Esophageal Manometry ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Central Neck Dissection ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Preoperative Level ◽  
Symptom Index ◽  
Before And After ◽  
Possible Cause

Laryngopharyngeal reflux (LPR) has been suggested as a possible cause of post-thyroidectomy syndrome. However, the pathophysiology and relationship between thyroidectomy and LPR have not been well investigated. We aimed to evaluate the correlation between thyroidectomy and LPR by assessing changes in LPR-related symptoms and laryngoscopic findings before and after thyroidectomy. Ninety-five patients who underwent thyroidectomy with or without central neck dissection were included. The reflux finding score (RFS) and reflux symptom index (RSI) were investigated one day before surgery and two, four, six, and twelve months after surgery. The RFS scores increased significantly after thyroidectomy and decreased to the preoperative level 12 months after surgery. The RSI scores increased after surgery and decreased gradually by 12 months postoperatively, although it was not statistically significant. The RSI and RFS scores improved with the administration of proton pump inhibitors. In conclusion, LPR-related laryngoscopic findings were exacerbated after uncomplicated thyroidectomy. Further studies using pH-monitoring and esophageal manometry are required to investigate the possible deterioration of LPR itself and the UES pressure after thyroidectomy.

Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux

2011 ◽  
Vol 125 (5) ◽  
pp. 502-508 ◽  
Author(s):  
M Masaany ◽  
M B Marina ◽  
W P Sharifa Ezat ◽  
A Sani
Keyword(s):  
Predictive Value ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Reflux Symptom ◽  
Empirical Treatment ◽  
Double Blind Study ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Double Blind ◽  
Symptom Index

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.

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

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

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

2016 ◽  
Vol 156 (1) ◽  
pp. 144-151 ◽  
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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