The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Jerome R Lechien^{1

2

3

4}, Michael F Vaezi⁵, Walter W Chan⁶, Jacqueline E Allen⁷, Petros D Karkos⁸, Sven Saussez^{1

2}, Kenneth W Altman⁹, Milan R Amin¹⁰, Tareck Ayad¹¹, Maria R Barillari¹², Peter C Belafsky¹³, Joel H Blumin¹⁴, Nikki Johnston¹⁴, Francois Bobin⁴, Matthew Broadhurst¹⁵, Fabio P Ceccon¹⁶, Christian Calvo-Henriquez¹⁷, Young-Gyu Eun¹⁸, Carlos M Chiesa-Estomba¹⁹, Lise Crevier-Buchman³, John O Clarke²⁰, Giovanni Dapri²¹, Claudia A Eckley²², Camille Finck²³, P Marco Fisichella²⁴, Abdul-Latif Hamdan²⁵, Stephane Hans³, Kathy Huet²⁶, Rui Imamura²⁷, Blair A Jobe²⁸, Toshitaka Hoppo²⁸, Lance P Maron²⁹, Vinciane Muls³⁰, Ashli K O'Rourke³¹, Paulo S Perazzo³², Gregory Postma³³, Vyas M N Prasad³⁴, Marc Remacle³⁵, Geraldo D Sant'Anna³⁶, Robert T Sataloff³⁷, Edoardo V Savarino³⁸, Antonio Schindler³⁹, Nora Siupsinskiene^{40

41}, Ping-Huei Tseng⁴², Craig H Zalvan⁴³, Karol Zelenik⁴⁴, Bernard Fraysse⁴⁵, Jonathan M Bock¹⁴, Lee M Akst⁴⁶, Thomas L Carroll⁴⁷

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.
² Department of Laryngology and Broncho-Esophagology (Anatomy Department), EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
³ Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
⁴ Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France.
⁵ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Otolaryngology, Head and Neck Surgery, University of Auckland, Auckland, New Zealand.
⁸ Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece.
⁹ Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA.
¹¹ Department of Otolaryngology-Head Neck Surgery, Montreal Hospital, Montreal, Canada.
¹² Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy.
¹³ Department of Otolaryngology, UC Davis Medical Center, Sacramento, California, USA.
¹⁴ Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁵ Queensland Voice Centre, Brisbane, Australia.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
¹⁷ Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
¹⁸ Department of Otolaryngology Head & Neck Surgery, Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.
¹⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
²⁰ Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, California, USA.
²¹ International School Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy.
²² Divisão de Otorrinolaringologia, Fleury Medicina e Saúde Laboratórios de Diagnóstico, São Paulo, Brazil.
²³ Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Liege, Belgium.
²⁴ Abbvie Inc., Chicago, Illinois, USA.
²⁵ Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
²⁶ Department of Metrology and Langage Science, University of Mons, Mons, Belgium.
²⁷ Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, Sao Paulo, Brazil.
²⁸ Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA.
²⁹ Netcare Park Lane Hospital, Johannesburg, South Africa.
³⁰ Department of gastroenterology, CHU Saint-Pierre, Brussels.
³¹ Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³² Department of Otolaryngology, School of Medicine, São Paulo Federal University, Sao Paulo, Brazil.
³³ Department of Otolaryngology, Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
³⁴ ENT Centre and Singapore Medical Specialist Centre, Singapore, Singapore.
³⁵ Department of Otolaryngology, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg.
³⁶ Disciplina de Otorrinolaringologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
³⁷ Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
³⁸ Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
³⁹ Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
⁴⁰ Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁴¹ Faculty of Health Sciences, Klaipeda university, Klaipeda, Lithuania.
⁴² Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴³ Department of Otolaryngology-New York Medical College, School of Medicine, Valhalla, NY; Institute for Voice and Swallowing Disorders, Sleepy Hollow, NY, USA.
⁴⁴ Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
⁴⁵ IFOS Board, Paris, France.
⁴⁶ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁴⁷ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital and Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 37929860
DOI: 10.1002/lary.31134

Free article

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Jerome R Lechien et al. Laryngoscope. 2024 Apr.

Free article

. 2024 Apr;134(4):1614-1624.

doi: 10.1002/lary.31134. Epub 2023 Nov 6.

Authors

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.
² Department of Laryngology and Broncho-Esophagology (Anatomy Department), EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
³ Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
⁴ Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France.
⁵ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Otolaryngology, Head and Neck Surgery, University of Auckland, Auckland, New Zealand.
⁸ Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece.
⁹ Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA.
¹¹ Department of Otolaryngology-Head Neck Surgery, Montreal Hospital, Montreal, Canada.
¹² Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy.
¹³ Department of Otolaryngology, UC Davis Medical Center, Sacramento, California, USA.
¹⁴ Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁵ Queensland Voice Centre, Brisbane, Australia.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
¹⁷ Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
¹⁸ Department of Otolaryngology Head & Neck Surgery, Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.
¹⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
²⁰ Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, California, USA.
²¹ International School Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy.
²² Divisão de Otorrinolaringologia, Fleury Medicina e Saúde Laboratórios de Diagnóstico, São Paulo, Brazil.
²³ Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Liege, Belgium.
²⁴ Abbvie Inc., Chicago, Illinois, USA.
²⁵ Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
²⁶ Department of Metrology and Langage Science, University of Mons, Mons, Belgium.
²⁷ Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, Sao Paulo, Brazil.
²⁸ Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA.
²⁹ Netcare Park Lane Hospital, Johannesburg, South Africa.
³⁰ Department of gastroenterology, CHU Saint-Pierre, Brussels.
³¹ Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³² Department of Otolaryngology, School of Medicine, São Paulo Federal University, Sao Paulo, Brazil.
³³ Department of Otolaryngology, Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
³⁴ ENT Centre and Singapore Medical Specialist Centre, Singapore, Singapore.
³⁵ Department of Otolaryngology, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg.
³⁶ Disciplina de Otorrinolaringologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
³⁷ Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
³⁸ Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
³⁹ Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
⁴⁰ Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁴¹ Faculty of Health Sciences, Klaipeda university, Klaipeda, Lithuania.
⁴² Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴³ Department of Otolaryngology-New York Medical College, School of Medicine, Valhalla, NY; Institute for Voice and Swallowing Disorders, Sleepy Hollow, NY, USA.
⁴⁴ Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
⁴⁵ IFOS Board, Paris, France.
⁴⁶ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁴⁷ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital and Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 37929860
DOI: 10.1002/lary.31134

Abstract

Objective: The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR.

Methods: Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician.

Results: After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h.

Conclusion: A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR.

Level of evidence: 5 Laryngoscope, 134:1614-1624, 2024.

Keywords: consensus; definition; diagnostic; gastroesophageal; guidelines; laryngitis; laryngopharyngeal; reflux.

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References

BIBLIOGRAPHY

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The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Affiliations

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

Authors

Affiliations

Abstract

References

BIBLIOGRAPHY

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials