. 2025 Apr 8:10.14309/ajg.0000000000003482.

doi: 10.14309/ajg.0000000000003482. Online ahead of print.

The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease

Rena Yadlapati¹, Philip Weissbrod², Erin Walsh², Thomas L Carroll^{3

4}, Walter W Chan⁵, Jackie Gartner-Schmidt⁶, Livia Guadagnoli⁷, Marie Jette⁸, Jennifer C Myers⁹, Ashli O'Rourke¹⁰, Rami Sweis¹¹, Justin Wu¹², Julie M Barkmeier-Kraemer¹³, Daniel Cates², Chien-Lin Chen¹⁴, Enrique Coss-Adame¹⁵, Gregory Dion¹⁶, David Francis¹⁷, Mami Kaneko¹⁸, Jerome R Lechien¹⁹, Stephanie Misono²⁰, Anais Rameau²¹, Sabine Roman^{22

23

24}, Anne Vertigan^{25

26

27}, Yinglian Xiao²⁸, Frank Zerbib²⁹, Madeline Greytak¹, John E Pandolfino⁶, C Prakash Gyawali³⁰

Affiliations

¹ Center for Esophageal Diseases, University of California San Diego, La Jolla, California, USA.
² Department of Otolaryngology, University of California San Diego, La Jolla, California, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Carlow University, Department of Speech-Language Pathology, Pittsburgh, Pennsylvania, USA.
⁷ Kenneth C. Griffin Esophageal Center Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁸ Department of Otolaryngology-Head & Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁹ Oesophageal Function, The Queen Elizabeth Hospital & Discipline of Surgery, The University of Adelaide, Adelaide, Australia.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹¹ Division of Gastroenterology, University College London Hospital, London, UK.
¹² Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
¹³ Department of Otolaryngology-Head & Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
¹⁴ Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
¹⁵ Department of Gastroenterology, GI Motility Lab, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁷ Division of Otolaryngology, Department of Surgery, University of Wisconsin, Madison, Madison, Wisconsin, USA.
¹⁸ Department of Otolaryngology Head & Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁹ Department of Surgery, University of Mons, Mons, Belgium.
²⁰ Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
²¹ Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA.
²² Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
²³ Digestive Physiology, Lyon I University, Lyon, France.
²⁴ LabTAU, INSERM, Université Lyon 1, University of Lyon, Lyon, France.
²⁵ Speech Pathology Department, John Hunter Hospital, Newcastle, Australia.
²⁶ Centre for Asthma and Breathing, Hunter Medical Research Institute, Newcastle, Australia.
²⁷ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
²⁸ Department of Gastroenterology and Hepatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
²⁹ CHU de Bordeaux, Centre Mediochirurgical Magellan, Hopital Haut-Leveque, Department of Gastroenterology, Universite de Bordeaux, Bordeaux, France.
³⁰ Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.

PMID: 40197644
PMCID: PMC12353988 (available on 2026-04-08)
DOI: 10.14309/ajg.0000000000003482

The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease

Rena Yadlapati et al. Am J Gastroenterol. 2025.

. 2025 Apr 8:10.14309/ajg.0000000000003482.

doi: 10.14309/ajg.0000000000003482. Online ahead of print.

Authors

Affiliations

¹ Center for Esophageal Diseases, University of California San Diego, La Jolla, California, USA.
² Department of Otolaryngology, University of California San Diego, La Jolla, California, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Carlow University, Department of Speech-Language Pathology, Pittsburgh, Pennsylvania, USA.
⁷ Kenneth C. Griffin Esophageal Center Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁸ Department of Otolaryngology-Head & Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁹ Oesophageal Function, The Queen Elizabeth Hospital & Discipline of Surgery, The University of Adelaide, Adelaide, Australia.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹¹ Division of Gastroenterology, University College London Hospital, London, UK.
¹² Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
¹³ Department of Otolaryngology-Head & Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
¹⁴ Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
¹⁵ Department of Gastroenterology, GI Motility Lab, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁷ Division of Otolaryngology, Department of Surgery, University of Wisconsin, Madison, Madison, Wisconsin, USA.
¹⁸ Department of Otolaryngology Head & Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁹ Department of Surgery, University of Mons, Mons, Belgium.
²⁰ Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
²¹ Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA.
²² Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
²³ Digestive Physiology, Lyon I University, Lyon, France.
²⁴ LabTAU, INSERM, Université Lyon 1, University of Lyon, Lyon, France.
²⁵ Speech Pathology Department, John Hunter Hospital, Newcastle, Australia.
²⁶ Centre for Asthma and Breathing, Hunter Medical Research Institute, Newcastle, Australia.
²⁷ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
²⁸ Department of Gastroenterology and Hepatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
²⁹ CHU de Bordeaux, Centre Mediochirurgical Magellan, Hopital Haut-Leveque, Department of Gastroenterology, Universite de Bordeaux, Bordeaux, France.
³⁰ Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.

PMID: 40197644
PMCID: PMC12353988 (available on 2026-04-08)
DOI: 10.14309/ajg.0000000000003482

Abstract

Introduction: The term laryngopharyngeal reflux (LPR) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. The aim of this initiative was to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.

Methods: A 28-member international interdisciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations.

Results: The term laryngopharyngeal symptoms (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. Laryngopharyngeal reflux disease (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for nonreflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive antireflux management. The two recommended ambulatory reflux monitoring modalities, 24-hour pH-impedance and 96-hour wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators.

Discussion: The San Diego Consensus represents the formal modern-day interdisciplinary care paradigm to evaluate and manage LPS and LPRD.

Keywords: ambulatory reflux monitoring; gastroesophageal reflux disease; laryngopharyngeal reflux disease; laryngopharyngeal symptoms; laryngoscopy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest:

Rena Yadlapati: Institutional Consulting Agreement: Medtronic, StatLink MD; Consultant: Phathom Pharmaceuticals; Braintree Pharmaceuticals, Reckitt Benckiser Healthcare Ltd; Advisory Board: RJS Mediagnostix

Philip Weissbrod: Founder, Channel Robotics; Consultant, FemtoVox

Erin Walsh: Royalties, Plural Publishing

Thomas L. Carroll: Consultant: Pentax, GSK, Ambu; Scientific Advisory Board and stock options: N-Zyme Medical, Sofregen Medical; Royalties: Plural Publishing

Ashli O’Rourke: Consultant: Laborie Medical Inc, Mectron Inc, Patheous Inc. Scientific Advisory Board: Inovio Pharmaceuticals

Walter W. Chan: Advisory Board: Regeneron, Sanofi.

Justin Wu: Advisory board of Laborie Medical Inc.

Rami Sweis: honoraria for lectures and symposia from Medtronic, Falk, Johnson and Johnson and Endogastric Solutions; consult for Medtronic, Falk and Johnson & Johnson.

Frank Zerbib: Consultant: Medtronic, Reckitt, Sanofi, Dr Falk Pharma, Bristol Myers Squibb, Bioprojet, AstraZeneca, Coloplast

Anais Rameau: Equity: Perceptron Health Inc., Consulting fees: Pentax Medical, Equity: Sound Health Systems, Inc.

Enrique Coss-Adame: Consultant and speaker for Medtronic México. Speaker: Medtronic Mexico

C. Prakash Gyawali: Consultant: Medtronic, Diversatek, Phathom, Braintree; Speaker: Carnot

John Pandolfino: IP/Patent: Medtronic; Consultant/Advisory Board: Medtronic, EndoGastric Solutions, Phathom, Speaker: Medtronic, EndoGastric Solutions, Phathom

Jennifer C Myers: Education/ Proctoring agreement: Medtronic Australasia.

Jackie Gartner-Schmidt: Royalties MedBridge, Inc.

Sabine Roman: consultant for Dr Falk Pharma, Sanofi; Research Support from Medtronic, Diversatek Healthcare

None to disclose: Marie Jette, Livia Guadagnoli, Mami Kaneko, Anne Vertigan, Chien-Lin Chen, Yinglian Xiao, Jerome R. Lechien, Julie Barkmeier-Kraemer, Daniel Cates, Gregory Dion, Stephanie Misono, Madeline Greytak

References

1. Koufman JA, Aviv JE, Casiano RR, et al. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2002;127:32–5. - PubMed
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;160:762–782. - PubMed
1. Yadlapati R, Katzka DA. Laryngopharyngeal Reflux Is an Eternally Rolling Boulder. Clin Gastroenterol Hepatol 2020;18:1431–1432. - PubMed
1. Francis DO, Rymer JA, Slaughter JC, et al. High economic burden of caring for patients with suspected extraesophageal reflux. Am J Gastroenterol 2013;108:905–11. - PubMed
1. Gong EJ, Choi KD, Jung HK, et al. Quality of life, patient satisfaction, and disease burden in patients with gastroesophageal reflux disease with or without laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol 2017;32:1336–1340. - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wolters Kluwer

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease

Affiliations

The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources