awareness; laryngitis; laryngopharyngeal; practice; reflux; trend; Europe; Female; General Practitioners/standards; Humans; Laryngopharyngeal Reflux/diagnosis; Male; Middle Aged; Otolaryngologists/standards; Practice Patterns, Physicians'/trends; Surveys and Questionnaires; Awareness; Disease Management; Otolaryngology; General Practitioners; Laryngopharyngeal Reflux; Otolaryngologists; Practice Patterns, Physicians'; Otorhinolaryngology; General Medicine
Abstract :
[en] [en] OBJECTIVES: To investigate the current trends in management of laryngopharyngeal reflux (LPR) among young European otolaryngologists and general practitioners (GP).
METHODS: An international survey was sent to European general practitioners and all otolaryngologists under 45 years old from the 2017 IFOS meeting. This survey was conducted by the LPR Study Group of YO-IFOS (Young Otolaryngologists of the International Federation of Otolaryngological Societies).
RESULTS: Among the 2500 attendees, 230 European otolaryngologists (response rate = 9%) completed the survey; an additional 70 GPs also completed the survey. GPs did not differentiate between gastroeosophageal reflux disease (GERD) and LPR, overstating GERD-related symptoms (ie, heartburn and regurgitations) in LPR clinical presentation and relying on gastrointestinal endoscopy for LPR diagnosis. Otolaryngologists also believe that GERD-related symptoms are prevalent in LPR. Knowledge of nonacid and mixed LPR and use of multichannel intraluminal impedance-pH monitoring are still limited in both groups. A therapeutic dichotomy exists between groups: GPs mainly use a 4-week once daily empiric proton pump inhibitors (PPIs) trial, while otolaryngologists use PPIs twice daily for a longer therapeutic period ranging from 8 to 12 weeks. More than 50% of GPs and otolaryngologists believe that they are not adequately knowledgeable and skilled about LPR.
CONCLUSION: The majority of GPs and otolaryngologists do not believe themselves to be sufficiently informed about LPR, leading to different practice patterns and grey areas. The elaboration of international recommendations in the management of reflux is needed to improve practices.
Disciplines :
Otolaryngology
Author, co-author :
Lechien, Jerome R ; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium ; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium ; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
Mouawad, Francois; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Lille, Université de Lille, Lille, France
Mortuaire, Geoffrey; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Lille, Université de Lille, Lille, France
Remacle, Marc; Department of Otorhinolaryngology and Head and Neck Surgery, CH Luxembourg, Lille, Luxembourg
Bobin, Francois; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinique de Poitiers, Poitiers, France
Huet, Kathy ; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
Nacci, Andrea; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
Barillari, Maria Rosaria; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy
Crevier-Buchman, Lise; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
Hans, Stéphane; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
Finck, Camille ; Université de Liège - ULiège > Département des sciences cliniques > Phoniatrie ; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS
Akst, Lee M; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Karkos, Petros D ; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS ; Department of Otolaryngology-Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
Prof. Dominique Chevalier for the diffusion to the French ENT Society. Prof. Hans Edmund Eckel for the diffusion to European Confederation of Otorhinolaryngological Societies. Tareck Ayad for the professional access to SurveyMonkey. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Lechien JR, Saussez S, Schindler A,. Symptoms and signs outcomes of laryngopharyngeal reflux treatment: a critical systematic review and meta-analysis. Laryngoscope. 2019 May;129(5):1174-1187.
Koufman JA., The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2 suppl 53):1-78.
Gaynor EB., Otolaryngologic manifestations of gastroesophageal reflux. Am J Gastroenterol. 1991;86(7):80180-8.
Karkos PD, Benton J, Leong SC,. Trends in laryngopharyngeal reflux: a British ENT survey. Eur Arch Otorhinolaryngol. 2007;264(5):513-517.
Gooi Z, Ishman SL, Bock JM, Blumin JH, Akst LM., Laryngopharyngeal reflux: paradigms for evaluation, diagnosis, and treatment. Ann Otol Rhinol Laryngol. 2014;123(10):677-685.
Gooi Z, Ishman SL, Bock JM, Blumin JH, Akst LM., Changing patterns in reflux care: 10-year comparison of ABEA members. Ann Otol Rhinol Laryngol. 2015;124(12):940-946.
Ahmed TF, Khandwala F, Abelson TI,. Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am J Gastroenterol. 2006;101(3):470-408.
Book DT, Rhee JS, Toohill RJ, Smith TL., Perspectives in laryngopharyngeal reflux: an international survey. Laryngoscope. 2002;112(8 Pt 1):1399-1406.
Lechien JR, Akst LM, Hamdan AL,. Evaluation and management of laryngopharyngeal reflux disease: state of the art review. Otolaryngol Head Neck Surg. 2019;160(5):762-782.
Lechien JR, Schindler A, Hamdan AL,. The development of new clinical instruments in laryngopharyngeal reflux disease: the international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(5S):S85-S91.
Ayad T, Stephenson K, AL Smit D,. Young Otolaryngologists of International Federation of Oto-rhino-laryngological Societies (YO-IFOS) committees. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(5S):S61-S65.
Lechien JR, Saussez S, Karkos PD., Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018. Curr Opin Otolaryngol Head Neck Surg. 2018;26(6):392-402.
Aldhahrani A, Powell J, Ladak S,. The potential role of bile acids in acquired laryngotracheal stenosis. Laryngoscope. 2018;128(9):2029-2033.
Terra RM, de Medeiros IL, Minamoto H, Nasi A, Pego-Fernandes PM, Jatene FB., Idiopathic tracheal stenosis: successful outcome with antigastroesophageal reflux disease therapy. Ann Thorac Surg. 2008;85(4):1438-1439.
Lorenz RR., Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg. 2003;11(6):467-472.
Toohill RJ, Ulualp SO, Shaker R., Evaluation of gastroesophageal reflux in patients with laryngotracheal stenosis. Ann Otol Rhinol Laryngol. 1998;107(12):1010-1014.
Miura MS, Mascaro M, Rosenfeld RM., Association between otitis media and gastroesophageal reflux: a systematic review. Otolaryngol Head Neck Surg. 2012;146(3):345-352.
Al-Saab F, Manoukian JJ, Al-Sabah B,. Linking laryngopharyngeal reflux to otitis media with effusion: pepsinogen study of adenoid tissue and middle ear fluid. J Otolaryngol Head Neck Surg. 2008;37(4):565-571.
Lechien JR, Saussez S, Nacci A,. Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review [published online March 20, 2019]. Laryngoscope. Doi:10.1002/lary.27932
Khoshoo V, Mohnot S, Haydel R, Jr Saturno E, Edell D, Kobernick A., Bronchial hyperreactivity in non-atopic children with asthma and reflux: effect of anti-reflux treatment. Pediatr Pulmonol. 2009;44(11):1070-1074.
Hancox RJ, Poulton R, Taylor DR,. Associations between respiratory symptoms, lung function and gastro-oesophageal reflux symptoms in a population-based birth cohort. Respir Res. 2006;7:142.
Jiang SP, Liang RY, Zeng ZY, Liu QL, Liang YK, Li JG., Effects of antireflux treatment on bronchial hyper-responsiveness and lung function in asthmatic patients with gastroesophageal reflux disease. World J Gastroenterol. 2003;9(5):1123-1125.
Wang J, Yu Z, Ren J,. Effects of pepsin A on heat shock protein 70 response in laryngopharyngeal reflux patients with chronic rhinosinusitis. Acta Otolaryngol. 2017;137(12):1253-1259.
Loehrl TA, Samuels TL, Poetker DM, Toohill RJ, Blumin JH, Johnston N., The role of extraesophageal reflux in medically and surgically refractory rhinosinusitis. Laryngoscope. 2012;122(7):1425-1430.
Ozmen S, Yücel OT, Sinici I,. Nasal pepsin assay and pH monitoring in chronic rhinosinusitis. Laryngoscope. 2008;118(5):890-894.
Wise SK, Wise JC, DelGaudio JM., Association of nasopharyngeal and laryngopharyngeal reflux with postnasal drip symptomatology in patients with and without rhinosinusitis. Am J Rhinol. 2006;20(3):283-289.
Belafsky PC, Postma GN, Koufman JA., Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274-277.
Lechien JR, Bobin F, Muls V,. Validity and reliability of the reflux symptom score [published online April 4, 2019]. Laryngoscope. doi:10.1002/lary.28017
Jaspersen D, Kulig M, Labenz J,. Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD Study. Aliment Pharmacol Ther. 2003;17(12):1515-1520.
Ford CN., Evaluation and management of laryngopharyngeal reflux. JAMA. 2005;294(12):1534-1540.
Gupta N, Green RW, Megwalu UC., Evaluation of a laryngopharyngeal reflux management protocol. Am J Otolaryngol. 2016;37(3):245-250.
Lechien JR, Finck C, Khalife M,. Change of signs, symptoms and voice quality evaluations throughout a 3- to 6-month empirical treatment for laryngopharyngeal reflux disease. Clin Otolaryngol. 2018;43(5):1273-1282.
Park W, Hicks DM, Khandwala F,. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope. 2005;115(7):1230-1238.
Postma GN, Johnson LF, Koufman JA., Treatment of laryngopharyngeal reflux. Ear Nose Throat J. 2002;81(9 Suppl 2):24-26.
Koufman JA, Aviv JE, Casiano RR, Shaw GY., 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(1):32-35.
Jin BJ, Lee YS, Jeong SW, Jeong JH, Lee SH, Tae K., Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients. Laryngoscope. 2008;118(5):938-941.
Pisegna JM, Yang S, Purcell A, Rubio A., A mixed-methods study of patient views on reflux symptoms and medication routines. J Voice. 2017;31(3):381.e15-381.e25.
Lechien JR, Khalife M, Finck C,. Alkaline, protein and low fat diet in laryngopharyngeal reflux disease: our experience on 65 patients. Clin Otolaryngol. 2019;44(3):379-384.
Yang J, Dehom S, Sanders S, Murry T, Krishna P, Crawley BK., Treating laryngopharyngeal reflux: evaluation of an anti-reflux program with comparison to medications. Am J Otolaryngol. 2018;39(1):50-55.
