Pitfalls in the Treatment of Laryngopharyngeal Reflux Disease

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  • Sato Kiminori
    Sato Clinic & Hospital Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine

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  • 咽喉頭逆流症 (LPRD) —診療のピットフォール—
  • 咽喉頭逆流症(LPRD) : 診療のピットフォール
  • インコウトウ ギャクリュウショウ(LPRD) : シンリョウ ノ ピットフォール

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There is no clear consensus on the findings or clinical manifestations of laryngopharyngeal reflux disease (LPRD). Furthermore, there are no ideal diagnostic procedures for evaluating LPRD, and the diagnostic outcome criteria and treatment are ambiguous. The pitfalls of diagnosis and treatment for LPRD were discussed.<br>1) The symptoms of LPRD are protean and not specific for LPRD. 2) Transnasal videolaryngoscopy shows the suspected LPRD. However, it is difficult to evaluate the relationship between laryngopharyngeal acid reflux and LPRD with/without organic diseases. 3) Transnasal videoesophagoscopy often reveals the endoscopy-negative gastroesophageal reflux diseases (GERD) and LPRD. The pathological change at the gastroesophageal junction is not specific for LPRD. 4) 24-hour pH monitoring is both highly sensitive and specific for LPRD. Although, it remains a gold standard for the diagnosis of LPRD, there is no consensus with respect to the number of pH sensors, their location, or the interpretation of results from them. It is valid to use a pH level of 5 rather than 4 as indicative of laryngopharyngeal reflux. 5) Regarding the proton pump inhibitor (PPI) test, there are false negative LPRD cases. Examples include, in cases of LPRD being resistant to antacid therapy and LPRD with nocturnal gastric acid breakthrough on PPI therapy.<br>Pitfalls of LPRD should be taken into consideration when the diagnosis and treatment of LPRD are performed.

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