pharyngeal complications.docVIP

PART 1 Oral cavity, pharynx and esophagus GI Motility online (2006) doi:10.1038/gimo46Published 16 May 2006 Laryngeal and pharyngeal complications of gastroesophageal reflux disease Gregory N. Postma, M.D. and?Stacey L. Halum, M.D. Key Points When reflux disease involves the larynx or pharynx, it is referred to as laryngopharyngeal reflux (LPR) or extraesophageal reflux, rather than gastroesophageal reflux disease (GERD). Laryngopharyngeal reflux and GERD are two related, yet different, disease states with different risk factors, pathophysiology, treatment, and outcomes. Patients with LPR infrequently have significant heartburn, and most commonly present with laryngeal symptoms such as hoarseness, globus sensation, throat clearing, sensation of postnasal drip, difficulty swallowing, chronic cough, and laryngospasm. Serious complications of LPR include obstructive pathology, such as laryngeal granulomas, subglottic/glottic stenosis, laryngospasm, and even laryngeal carcinoma. Although the complications of LPR may require surgical management, aggressive perioperative reflux therapy should be initiated if the patient is to achieve an optimal outcome. Top of page Laryngopharyngeal Reflux (LPR) Gastroesophageal reflux involves the backflow of stomach contents into the esophagus. In some cases the gastric refluxate reaches the larynx or pharynx, which is called laryngopharyngeal reflux (LPR). Other synonyms that have been used for LPR include extraesophageal reflux, atypical reflux, gastropharyngeal reflux, laryngeal reflux, pharyngoesophageal reflux, and supraesophageal reflux. Using prolonged pH monitoring, the diagnosis of gastroesophageal reflux disease (GERD) is typically not made unless a patient exhibits over 45 reflux episodes or has elevated acid exposure times at the esophageal probe (Table 1). Esophageal acid exposure times below this are considered normal or physiologic esophageal reflux. In contrast, one or two episodes of acid exposure (pH 4) at the proxi