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Review
. 2019 Sep;44(5):784-800.
doi: 10.1111/coa.13395. Epub 2019 Jul 31.

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Jerome R Lechien  1   2   3   4 , Vinciane Muls  1   5 , Giovanni Dapri  1   6 , François Mouawad  4 , Pierre Eisendrath  1   5 , Antonio Schindler  1   7 , Andrea Nacci  1   8 , Maria R Barillari  1   9 , Camille Finck  3   10 , Sven Saussez  1   3 , Lee M Akst  11 , Robert T Sataloff  12
Affiliations
Free article
Review

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Jerome R Lechien et al. Clin Otolaryngol. 2019 Sep.
Free article

Abstract

Objective: To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment.

Methods: A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated.

Results: Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non-responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non-acid or mixed) or addressed personalised treatment with the addition of alginate or magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy.

Conclusion: To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non-responder LPR patients.

Level of evidence: 2a.

Keywords: failure; laryngopharyngeal; non-responder; persistent; recalcitrant; reflux; refractory; resistance; resistant; treatment.

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References

REFERENCES

    1. Lechien JR, Saussez S, Schindler A, et al. Symptoms and signs outcomes of laryngopharyngeal reflux treatment: a critical systematic review and meta-analysis. Laryngoscope. 2019;129(5):1174-1187.
    1. Habermann W, Kiesler K, Eherer A, Friedrich G. Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux. J Voice. 2002;16(3):425-432.
    1. Lechien JR, Finck C, Huet K, et al. Quality as therapeutic outcome in laryngopharyngeal reflux disease: a prospective cohort study. J Voice. 2018. https://doi.org/10.1016/j.jvoice.2018.08.018
    1. Lechien JR, Akst LM, Hamdan AL, et al. Evaluation and management of laryngopharyngeal reflux disease: state of the art review. Otolaryngol Head Neck Surg. 2019;160(5):762-782.
    1. Lechien JR, Huet K, Khalife M, et al. Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study. J Otolaryngol Head Neck Surg. 2016;45(1):59.