European clinical practice guideline: managing and treating laryngopharyngeal reflux disease

Jerome R Lechien^#^{1

2

3

4}, Carlos-Miguel Chiesa-Estomba^#^{5

6}, Stéphane Hans^{5

7}, Andrea Nacci⁸, Antonio Schindler⁹, Jorg E Bohlender¹⁰, Daniel Runggaldier¹⁰, Lise Crevier-Buchman⁷, Haldun Oguz^{11

12}, Karol Zelenik^{5

13}, Miroslav Tedla¹⁴, Nora Siupsinskiene^{15

16}, Josef Schlömicher-Thier¹⁷, Renata Taimrova¹⁸, Petros D Karkos^{5

19}, Ahmed Geneid²⁰, Giovanni Dapri²¹, Jennifer Aoun²², Vinciane Muls²², Michael Weitzendorfer²³, Edoardo V Savarino²⁴, Marc J Remacle^{7

25}, Maja Sereg-Bahar^{5

26}, Miguel Mayo-Yanez²⁷, Gianicola Iannella²⁸, Alberto M Saibene²⁹, Luigi A Vaira³⁰, Giovanni Cammaroto³¹, Antonino Maniaci^#^{5

32}, Maria R Barillari^#^{5

33}

Affiliations

¹ Research Committee of Young-Otolaryngologists of the International Federations of Oto-rhino- laryngological Societies (YO-IFOS), Paris, France. Jerome.Lechien@umons.ac.be.
² Department of Otolaryngology-Head Neck Surgery, UFR Simone Veil, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Foch Hospital, University Paris Saclay, Université Sorbonne Nouvelle/Paris3), Paris, France. Jerome.Lechien@umons.ac.be.
³ Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium. Jerome.Lechien@umons.ac.be.
⁴ Department of Surgery - Division of Laryngology and Broncho-esophagology, Department of Otolaryngology- Head & Neck Surgery, EpiCURA hospital, University of Mons, Mons, Belgium. Jerome.Lechien@umons.ac.be.
⁵ Research Committee of Young-Otolaryngologists of the International Federations of Oto-rhino- laryngological Societies (YO-IFOS), Paris, France.
⁶ Department of Otorhinolaryngology- Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
⁷ Department of Otolaryngology-Head Neck Surgery, UFR Simone Veil, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Foch Hospital, University Paris Saclay, Université Sorbonne Nouvelle/Paris3), Paris, France.
⁸ ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy.
⁹ Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, UO Otorhinolaryngology, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy.
¹⁰ Division of Phoniatrics and Speech Pathology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹¹ Fonomer Phoniatrics & Audiology Clinic, Ankara, Türkiye.
¹² Faculty of Medicine, Lokman Hekim University, Ankara, Türkiye.
¹³ Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czechia.
¹⁴ Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia.
¹⁵ Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
¹⁶ Faculty of Health Sciences, University of Klaipėda, Klaipėda, Lithuania.
¹⁷ Department of ENT, International Voice Center Austria, Salzburg University, Salzburg, Austria.
¹⁸ FortMedica ENT Private Practice, Prague, Czech Republic.
¹⁹ Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece.
²⁰ Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²¹ Minimally Invasive General & Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy.
²² Department of Gastroenterology, CHU Saint-Pierre, Brussels, Belgium.
²³ Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
²⁴ Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy.
²⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Center Hospitalier de Luxembourg, Eich, Luxembourg.
²⁶ Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.
²⁷ Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.
²⁸ Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161, Rome, Italy.
²⁹ Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20121, Milan, Italy.
³⁰ Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100, Sassari, Italy.
³¹ Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121, Forlì, Italy.
³² Faculty of Medicine and Surgery, University of Enna "Kore", Enna, Italy.
³³ Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.

^# Contributed equally.

PMID: 39719472
DOI: 10.1007/s00405-024-09181-z

European clinical practice guideline: managing and treating laryngopharyngeal reflux disease

Jerome R Lechien et al. Eur Arch Otorhinolaryngol. 2024.

. 2024 Dec 24.

doi: 10.1007/s00405-024-09181-z. Online ahead of print.

Authors

Affiliations

¹ Research Committee of Young-Otolaryngologists of the International Federations of Oto-rhino- laryngological Societies (YO-IFOS), Paris, France. Jerome.Lechien@umons.ac.be.
² Department of Otolaryngology-Head Neck Surgery, UFR Simone Veil, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Foch Hospital, University Paris Saclay, Université Sorbonne Nouvelle/Paris3), Paris, France. Jerome.Lechien@umons.ac.be.
³ Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium. Jerome.Lechien@umons.ac.be.
⁴ Department of Surgery - Division of Laryngology and Broncho-esophagology, Department of Otolaryngology- Head & Neck Surgery, EpiCURA hospital, University of Mons, Mons, Belgium. Jerome.Lechien@umons.ac.be.
⁵ Research Committee of Young-Otolaryngologists of the International Federations of Oto-rhino- laryngological Societies (YO-IFOS), Paris, France.
⁶ Department of Otorhinolaryngology- Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
⁷ Department of Otolaryngology-Head Neck Surgery, UFR Simone Veil, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Foch Hospital, University Paris Saclay, Université Sorbonne Nouvelle/Paris3), Paris, France.
⁸ ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy.
⁹ Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, UO Otorhinolaryngology, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy.
¹⁰ Division of Phoniatrics and Speech Pathology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹¹ Fonomer Phoniatrics & Audiology Clinic, Ankara, Türkiye.
¹² Faculty of Medicine, Lokman Hekim University, Ankara, Türkiye.
¹³ Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czechia.
¹⁴ Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia.
¹⁵ Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
¹⁶ Faculty of Health Sciences, University of Klaipėda, Klaipėda, Lithuania.
¹⁷ Department of ENT, International Voice Center Austria, Salzburg University, Salzburg, Austria.
¹⁸ FortMedica ENT Private Practice, Prague, Czech Republic.
¹⁹ Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece.
²⁰ Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²¹ Minimally Invasive General & Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy.
²² Department of Gastroenterology, CHU Saint-Pierre, Brussels, Belgium.
²³ Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
²⁴ Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy.
²⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Center Hospitalier de Luxembourg, Eich, Luxembourg.
²⁶ Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.
²⁷ Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.
²⁸ Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161, Rome, Italy.
²⁹ Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20121, Milan, Italy.
³⁰ Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100, Sassari, Italy.
³¹ Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121, Forlì, Italy.
³² Faculty of Medicine and Surgery, University of Enna "Kore", Enna, Italy.
³³ Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.

^# Contributed equally.

PMID: 39719472
DOI: 10.1007/s00405-024-09181-z

Erratum in

Correction: European clinical practice guideline: managing and treating laryngopharyngeal reflux disease.
Lechien JR, Chiesa-Estomba CM, Hans S, Nacci A, Schindler A, Bohlender JE, Runggaldier D, Crevier-Buchman L, Oguz H, Zelenik K, Tedla M, Siupsinskiene N, Schlömicher-Thier J, Taimrova R, Karkos PD, Geneid A, Dapri G, Aoun J, Muls V, Weitzendorfer M, Savarino EV, Remacle MJ, Sereg-Bahar M, Mayo-Yanez M, Iannella G, Saibene AM, Vaira LA, Cammaroto G, Maniaci A, Barillari MR. Lechien JR, et al. Eur Arch Otorhinolaryngol. 2025 Mar 27. doi: 10.1007/s00405-025-09307-x. Online ahead of print. Eur Arch Otorhinolaryngol. 2025. PMID: 40148590 No abstract available.

Abstract

Objective: To propose a European consensus for managing and treating laryngopharyngeal reflux disease (LPRD) to guide primary care and specialist physicians.

Methods: Twenty-three European experts (otolaryngologists, gastroenterologists, surgeons) participated in a modified Delphi process to revise 38 statements about the definition, clinical management, and treatment of LPRD. Three voting rounds were conducted on a 5-point scale and a consensus was defined a priori as agreement by 80% of the experts.

Results: After the third round, 36 statements composed the first European Consensus Report on the definition, diagnosis, and treatment of LPRD. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring is the gold standard for diagnosing LPRD (> 1 pharyngeal reflux event) and treating the LPRD with personalized therapy. The empirical treatment needs to be based on diet, stress reduction, and alginates or antiacids to address the acidic and alkaline reflux events. Proton pump inhibitors are kept for patients with acidic LPRD and gastroesophageal reflux disease (GERD) findings. The treatment needs to be as short as possible (minimum two months). The medication can be progressively reduced for patients with relief of symptoms. Changing medication class can be considered for refractory LPRD rather than an increase in drug doses.

Conclusion: A consensus endorsed by the Confederation of European Otorhinolaryngology-Head and Neck Surgery Societies is presented to improve the management and treatment of LPRD. The approved statements could improve collaborative research through the adoption of common management approaches to LPRD.

Keywords: Consensus; Europe; European; Gastroesophageal; Guidelines; Head neck surgery; Laryngopharyngeal; Otolaryngology; Reflux.

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Conflict of interest statement

Declarations. Ethic committee: No IRB approval was required for this study protocol. Informed consent: Participants consented to the study. Competing interests: The author Jerome R. Lechien was not involved with the peer review process of this article.

References

1. Lechien JR, Vaezi MF, Chan WW, Allen JE, Karkos PD, Saussez S, Altman KW, Amin MR, Ayad T, Barillari MR, Belafsky PC, Blumin JH, Johnston N, Bobin F, Broadhurst M, Ceccon FP, Calvo-Henriquez C, Eun YG, Chiesa-Estomba CM, Crevier-Buchman L, Clarke JO, Dapri G, Eckley CA, Finck C, Fisichella PM, Hamdan AL, Hans S, Huet K, Imamura R, Jobe BA, Hoppo T, Maron LP, Muls V, O’Rourke AK, Perazzo PS, Postma G, Prasad VMN, Remacle M, Sant’Anna GD, Sataloff RT, Savarino EV, Schindler A, Siupsinskiene N, Tseng PH, Zalvan CH, Zelenik K, Fraysse B, Bock JM, Akst LM, Carroll TL (2024) The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: the IFOS Consensus. Laryngoscope 134(4):1614–1624. https://doi.org/10.1002/lary.31134 - DOI - PubMed
1. Kotby MN, Hassan O, El-Makhzangy AM, Farahat M, Shadi M, Milad P (2010) Gastroesophageal reflux/laryngopharyngeal reflux disease: a critical analysis of the literature. Eur Arch Otorhinolaryngol 267(2):171–179. https://doi.org/10.1007/s00405-009-1176-4 - DOI - PubMed
1. Lee YS, Choi SH, Son YI, Park YH, Kim SY, Nam SY (2011) Prospective, observational study using rabeprazole in 455 patients with laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 268(6):863–869. https://doi.org/10.1007/s00405-010-1475-9 - DOI - PubMed
1. Lechien JR, Saussez S, Hopkins C (2023) Association between laryngopharyngeal reflux, gastroesophageal reflux and recalcitrant chronic rhinosinusitis: a systematic review. Clin Otolaryngol 48(4):501–514. https://doi.org/10.1111/coa.14047 - DOI - PubMed
1. Eren E, Arslanoğlu S, Aktaş A, Kopar A, Ciğer E, Önal K, Katılmiş H (2014) Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings. Eur Arch Otorhinolaryngol 271(4):743–747. https://doi.org/10.1007/s00405-013-2682-y - DOI - PubMed

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European clinical practice guideline: managing and treating laryngopharyngeal reflux disease

Affiliations

European clinical practice guideline: managing and treating laryngopharyngeal reflux disease

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources