LPR2002LPR2002.doc

Laryngopharyngeal reflux 2002: a new paradigm of airway disease. (Introduction). Our purpose in writing this supplement is to provide an overview of laryngopharyngeal reflux (LPR). This supplement is not all-encompassing; some of the material presented is controversial; and we recognize that it does represent the bias of physicians at the Center for Voice Disorders of Wake Forest University. Furthermore, we understand that we raise as many questions as we answer. Still, we hope that this supplement will serve as a useful summary of LPR for clinicians, and that it will stimulate others in the research arena. Background It is likely that gastroesophageal reflux disease (GERD) was recognized in antiquity. In 1618, Fabricius described the gastroesophageal junction, which he referred to as cardia, a term he attributed to Galen (ca. 200 AD). (1) Galen had coined the term because symptoms arising from the gastroesophageal junction could mimic those arising from the heart. (1) It was not until the 20th century, however, that the relationship between symptoms and gastroesophageal reflux (GER) was established. (2,3) Even though the distally lighted esophagoscope had been invented by Chevalier Jackson in 1890, (1) for the first half of the 20th century he and his contemporaries did not understand GER. For example, they thought that esophageal strictures were caused by inflammatory diseases (e.g., tuberculosis) that arose in the mediastinum or below the diaphragm. In 1935, Winkelstein first described peptic esophagitis in adults. (2) It was not until 1950 that GERD was first described in children. (3) In 1968, laryngopharyngeal reflux (LPR)--that is, GERD that affects the larynx and pharynx--was described in relationship to contact ulcers and granulomas of the larynx. (4,5) However, relatively few reports of LPR/ GERD were published in the otolaryngology literature between 1970 and the mid-1980s. (6-20) GERD patients who did not have heartburn were considered to have a