Results of the study of conservative treatment of laryngeal manifestations of laryngopharyngeal reflux

Gastroesophageal reflux disease (GERD) is a disease of the gastrointestinal tract caused by the discharge of stomach contents into the esophagus. In GERD, both esophageal and extraesophageal manifestations are widespread, but, unfortunately, the latter are less well known. About one third of GERD patients have extraesophageal symptoms, which can occur even in the absence of the usual esophageal symptoms of GERD, which makes diagnosis difficult. The most common of these is laryngitis. In addition to reflux laryngitis, laryngopharyngeal reflux (LFR) can cause the development of contact granulomas, laryngeal stenosis, functional dysphonia, vocal fold nodules, Reinecke's edema, and laryngeal neoplasms. These symptoms disappear after taking antireflux therapy, but there is still no consensus on its duration.

Aim. To evaluate the results of treatment of laryngeal manifestations of LFR with omeprasole 20 mg 30 minutes before meals in the morning.

Methods. The study involved 531 patients with complaints of hoarseness, of which women 337 - 63.5%, men 194 - 36.5%. We prescribed omeprasole 20 mg 30 minutes before meals in the morning for 6 weeks. Patients were questioned using the Reflux Symptom Index (RSI) questionnaire and indirect laryngoscopy with an assessment of laryngeal changes according to the Reflux Signs Scale (RSS).

Results. There was a statistically significant decrease in hoarseness 1 week after treatment, which continues to decrease 6 weeks after the initiation of treatment when evaluating the data on the RSI questionnaire. There was no statistically significant difference in the laryngoscopic picture before the start of treatment and after 1 week of treatment according to RSS; a statistically significant decrease in the quantitative assessment of RSS was revealed 6 weeks after the initiation of treatment.

Conclusions. Omeprasole at a dose of 20 mg in 30 minutes reduces the symptoms of LFR already after 1 week, the decrease in the severity of symptoms continues by 6 weeks of its use. Improvement of the laryngoscopic picture with the appointment of omeprazole 20 mg 30 minutes before meals occurs by the 6th week of its use. A positive correlation was found between the severity of LFR symptoms, including hoarseness, and the severity of changes in the laryngoscopic picture.

1. Durazzo M., Lupi G., Cicerchia F., Ferro A., Barutta F., Beccuti G. et al. Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update. J Clin Med. 2020;9(8):2559. https://doi.org/10.3390/jcm9082559.

2. Koufman J.A., Cummins M.M. The prevalence and spectrum of reflux in laryngology: a prospective study of 132 consecutive patients with laryngeal and voice disorders. 1994. Available at: https://www.industrydocuments.ucsf.edu/tobacco/docs/#id=pkpw0094.

3. Napierkowski J., Wong R.K.H. Extraesophageal manifestations of GERD. Am J Med Sci. 2003;326(5):285-299. https://doi.org/10.1097/00000441-200311000-00005.

4. Koufman J.A. 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 (53 Suppl.):1-78. https://doi.org/10.1002/lary.1991.101.s53.1.

5. Nostrant T.T. Gastroesophageal reflux and laryngitis: a skeptic's view. Am J Med. 2000;108(4a Suppl.):149S-152S. https//doi.org/10.1016/s0002-9343(99)00355-1.

6. De Bortoli N., Nacci A., Savarino E., Martinucci I., Bellini M., Fattori B. et al. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related? World J Gastroenterol. 2012;18(32):4363-4370. https://doi.org/10.3748/wjg.v18.i32.4363.

7. Kambic V., Radsel Z. Acid posterior laryngitis. Aetiology, histology, diagnosis and treatment. J Laryngol Otol. 1984;98(12):1237-1240. https//doi.org/10.1017/s0022215100148340.

8. Maronian N.C., Azadeh H., Waugh P., Hillel A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol. 2001;110(7 Pt 1): 606-612. https//doi.org/10.1177/000348940111000703.

9. Wendl B., Pfeiffer A., Pehl C., Schmidt T., Kaess H. Effect of decaffeination of coffee or tea on gastrooesophageal reflux. Aliment Pharmacol Ther. 1994;8(3):283-287. https://doi.org/10.1111/j.1365-2036.1994.tb00289.x.

10. Karkos P.D., Yates P.D., Carding P.N., Wilson J.A. Is laryngopharyngeal reflux related to functional dysphonia? Ann Otol Rhinol Laryngol. 2007;116(1):24-29. https://doi.org/10.1177/000348940711600105.

11. Amirlak B., Mudd P.A. Reflux Laryngitis. Medscape. 2020. Available at: http://emedicine.medscape.com/article/864864-overview.

12. Cherry J., Margulies S.I. Contact ulcer of the larynx. Laryngoscope. 1968;78(11):1937-1340. https://doi.org/10.1288/00005537-196811000-00007.

13. Hanson D.G., Kamel P.L., Kahrilas P.J. Outcomes of antireflux therapy for the treatment of chronic laryngitis. Ann Otol Rhinol Laryngol. 1995;104(7):550-555. https://doi.org/10.1177/000348949510400709.

14. Kamel P.L., Hanson D., Kahrilas P.J. Omeprazole for the treatment of posterior laryngitis. Am J Med. 1994;96(4):321-326. https://doi.org/10.1016/0002-9343(94)90061-2.

15. Ulualp S.O., Toohill R.J., Shaker R. Outcomes of acid suppressive therapy in patients with posterior laryngitis. Otolaryngol Head Neck Surg. 2001;124(1):16-22. https://doi.org/10.1067/mhn.2001.112200.

16. Lindstrom D.R., Wallace J., Loehrl T.A., Merati A.L., Toohill R.J. Nissen fundoplication surgery for extraesophageal manifestations of gastroesophageal reflux (EER). Laryngoscope. 2002;112(10):1762-1765. https://doi.org/10.1097/00005537-200210000-00010.

17. El-Serag H.B., Lee P., Buchner A., Inadomi J.M., Gavin M., McCarthy D.M. Lansoprazole treatment of patients with chronic idiopathic laryngitis: a placebo-controlled trial. Am J Gastroenterol. 2001;96(4):979-983. https://doi.org/10.1111/j.1572-0241.2001.03681.x.

18. Lechien J.R., Mouawad F., Mortuaire G., Remacle M., Bobin F., Huet K. et at. Awareness of European Otolaryngologists and General Practitioners Toward Laryngopharyngeal Reflux. Ann Otol Rhinol Laryngol. 2019;128(11):1030-1040. https://doi.org/10.1177/0003489419858090.

19. Lechien J.R., Allen J., Mouawad F., Ayad T., Barillari M.R., Huet K. et al. Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently? Laryngoscope. 2020;130(10):E539-E547. https://doi.org/10.1002/lary.28484.

20. Belafsky P.C., Postma G.N., Koufman J.A. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274-277. https://doi.org/10.1016/s0892-1997(02)00097-8.

21. Pasechnikov V.D., Goguev R.K., Pasechnikov D.V. Comparison of the acid-suppressive effect generates omeprazole. Klinicheskiye perspektivy gastroenterologii, gepatologii = Clinical Perspectives of Gastroenterology, Hepatology. 2010;(5):10-15. (In Russ.) Available at: https://medi.ru/info/8068/.

22. Koufman J.A., Aviv J.E., Casiano R.R., Shaw G.Y. 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. https://doi.org/10.1067/mhn.2002.125760.

23. Silva C.E., Niedermeier B.T., Portinho F. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy. Int Arch Otorhinolaryngol. 2015;19(3):234-237. https://doi.org/10.1055/s-0034-1399794.

24. Lechien J.R., Bobin F., Muls V., Mouawad F., Dapri G., Dequanter D. et al. Changes of Laryngeal and Extralaryngeal Symptoms and Findings in Laryngopharyngeal Reflux Patients. Laryngoscope. 2021;131(6):1332-1342. https://doi.org/10.1002/lary.28962.