• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.79-83
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• 1997

The term laryngopharyngeal reflux (LPR) refers to the backflow of food or stomach acid back up into the larynx (the voice box) or the pharynx (the throat). Esophagopharyngeal reflux is suggested as an etiologic factor in laryngeal disease. To examine a possible esophageal basis for laryngopharyngeal symptoms, we studied 48 patients with persistent laryngopharyngeal symptoms, and 12 relative control subjects. Patients were evaluated for cervical symptoms by questionnaire and underwent gastrofiberoscopy, fiberoptic laryngoscopy, esophageal manometry and 24-hour ambulatory double-probe pH monitoring. We found LPR in fourteen out of 48 patients with cervical symptoms (29%). The LPR group consisted of nine men and five women. The symptoms that LPR patients complained were throat lump sensation, hoareness, sore throat, throat clearing, chronic coughing and dysphagia in order of frequency, and they were not different significantly from non-LPR patients. The laryngoscopic findings in LPR patients were posterior erythema, laryngeal edema and diffuse erythema, and there was also no significant difference between LPR group and non-LPR group. There was statistically significant correlation between LPR and gastroesophageal reflux (GER). We concluded that there is no pathognomonic symptoms or laryngoscopic findings in diagnosis of LPR, and 24-hour ambulatory double-probe pH monitoring is an essential diagnostic tool in LPR.

• Korean Journal of Bronchoesophagology
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• v.16 no.2
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• pp.97-104
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• 2010

Gastroesophageal reflux disease (GERD) is a common disorder caused by the reflux of gastric contents into the esophagus. According to the recent classification, GERD can elicit esophageal and extraesophageal syndromes. Laryngopharyngeal reflux (LPR) is defined as laryngeal symptoms with laryngeal inflammation caused by the acid reflux. The prevalence of GERD and LPR is increasing during the past decades in Korea and management of GERD and LPR is a challenging issue in clinical practice. Proton pump inhibitor is the most effective drug in the treatment of GERD. Most patients with LPR are given a 2-month trial of a proton pump inhibitor (PPI), however, there is still little evidence on the diagnosis or the treatment of LPR. During the last years concern have been raised regarding the risk of averse events related to long-term use of PPI. We review the recent update on medical treatment of GERD/LPR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.113-117
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• 2007

Although the prevalence of laryngopharyngeal reflux (LPR) is presumed to be very high, basic researches on LPR have not been active so far. This is a review of present status and prospect of researches on LPR to help readers' understanding of current trend on LPR research. In vitro and in vivo researches on acid/pepsin, intercellular junctions, bile juice, carbonic anhydrase, cytokines, and Helicobacter pylori were discussed. Considering that quality of life is getting more important in accordance with longer life span and that a fair proportion of LPR patients do not respond to conventional therapy, researches on pathogenesis and pathophysiology of treatment measures are necessary and it is anticipated for more and more researchers to concern themselves in basic research on LPR in the future.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.2
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• pp.115-127
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• 1998

Laryngopharyngeal reflux(LPR) is one firm of the gastroesophageal reflux diseases(GERD). It is known to cause various kinds of otolaryngologic symptoms such as hoarseness, foreign body sensation in throat, chronic throat clearing, chronic cough, etc. Disease entities diagnosed by otolaryngologists as posterior laryngitis, globus pharyngeus should be suspected as LPR-related diseases. In this multi-center trial, we tried to evaluate the effect of cisapride(10mg tid) on LPR-related symptoms as the part I study(CIS-KOR-051) in 19 centers, and as the part II study(CIS-KOR-052) comparative evaluation of effect between cisapride(10mg tid) and ranitidine(150mg bid) on LPR-related symptoms in 4 centers. In part I study, efficacy of cisapride on LPR-related symptoms after 4 weeks was 53.5% and that of after 8weeks was 77.9% in per protocol(PPA) analysis group. In part II study, efficacy of the cisapride was much better than that of ranitidine not only from 8 weeks trial(p<0.001) but also from 4 weeks trial(p<0.021) in PPA group. In the multiple logistic regression analysis among the parameters which affect the efficacy of the treatment, cisapride prescribed group showed 10 times greater than that of ranitidine prescribed group(p<0.0001, Odds ratio : 10) in PPA group. LPR was proved by 24Hr double probe pHmetry in 13 patients out of 19 patients tested(68.4%). Thus these results indicated that inducing the improvement of motility functions could affect the amelioration of the LPR-related symptoms much better than reducing acid secretion from the stomach. And maybe it suggests that LPR-related symptoms mainly developed by the reduced motility functions of the esophagus and/or delayed gastric emptying.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.78-83
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• 2016

Laryngopharyngeal reflux (LPR) disease is an extraoesophageal variant of gastro-esophageal reflux disease that can affect the larynx and pharynx. LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.67-74
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• 2003

Larygopharyngeal reflux(LPR) is one form of the Gastroesophageal Reflux Diseases(GERD). It is known to cause various kinds of otolaryngologic symptoms such as hoarseness, globus sensation in throat, chronic throat clearing, and chronic cough, Disease entities diagnosed by otolaryngologists as posterior laryngitis, globus pharyngeus and reflux laryngitis should be suspected as LPR-related diseases. The nizatidine(AXID), as a Histamine H2-receptor antagonist, reduces gastric acid secretion and improves gastric motility function. Objectives : The effect of nizatidine using 150mg b.i.d was evaluated for symptom relief and improvement of laryngoscopic findings in patients with LPR. Materials and Methods : In 30 multicenter, observational trial performed nationalwidely in Korea. 308 patients with LPR symptom were observed to evaluate their symptoms and larygnoscopic findings after 4weeks, 8weeks, 12weeks of treatment with nizatidine. Results : The symptoms of LPR including globus sensation, chronic throat clearing and hoarseness, are reduced significantly after 4 weeks, 8weeks, and 12weeks of treatment(p<0.05). The laryngoscopic findings including diffuse erythema, edema and granulation are improved after nizatidine treatment(p<0.05). and the efficacy of nizatidine on LPR-related sympoms after 4 weeks is 88.6%, and those of after 8 weeks and 12weeks were 92.6%, and 99.1% in ITT(Intent To Treatment) group(p<0.05). And PPA(Per Protocol Analysis)group showed 93.7%, 97.3%, and 99.1% of efficacy after 4, 8, and 12 weeks of nizatidine treatment(p<0.05). Conclusion : These results indicate that in patient with LPR, nizatidine 150mg b.i.d treatment very effectively reduces LPR symptoms and improves laryngoscopic findings as well as reduces gastric acid secretion and improves gastric motility function.

• Korean Journal of Bronchoesophagology
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• v.10 no.2
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• pp.22-27
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• 2004

Background : LPRD(Laryngopharyngeal reflux disease) gives rise to inflammatory change in the pharyngolaryngeal tissue with various otolaryngologic symptoms. Ranitidine, histamine H2receptor antagonists, are currently used as therapeutic medications. However, the efficacy of Ranitidine on LPRD has not been proven yet. Objectives : We intended to analyze the efficacy of the Ranitidine on LPRD. Materials :md Methods : In 20 multicenter, 607 patients with LPR(laryngopharyngeal reflux) symptom were observed to evaluate their symptoms and laryngoscopic findings after 4 weeks, 8 weeks, and 12 weeks of treatment of Ranitidine. Results : The symptom of LPR including globus sensation, sore throat hoarseness, regurgitatioin are improved after 4 weeks $86.2\%,\;8 weeks\;91.5\%,\;12 weeks\;92.9\%$ of Ranitidine treatment and improved after 4 weeks $91.5\%,\;8 weeks\;94.5\%,\;12 weeks\; 97.2\%$ of Ranitidine combined with prokinetics. The rates of sore throat, chronic cough, globus sensation improvement at 8 weeks after treatment are $26.7\%,\;16.7\%,\;16\%$. Conclusion : In patient with LPR, Ranitidine treatment reduces LPR symptoms very effectively.

• Journal of Acupuncture Research
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• v.40 no.3
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• pp.188-200
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• 2023

Laryngopharyngeal reflux (LPR) disease is a condition in which the stomach contents return to the larynx and pharynx via the esophagus, causing mucosal injury. While conventional treatments, such as proton pump inhibitors, have limitations, acupuncture has been shown to reduce LPR symptoms. However, its effectiveness has not been systematically assessed. This study aimed to systematically evaluate the effectiveness of acupuncture in treating LPR. We review 10 electronic databases with a consistent search strategy, and 2 independent reviewers screened the articles based on the inclusion and exclusion criteria. This study selected and analyzed 7 randomized controlled trials after the screening to assess primary outcomes, including reflux symptom index and reflux finding score, and secondary outcomes, including upper and lower esophageal sphincter pressure. The results revealed the statistically significant effectiveness of acupuncture in combination with conventional treatment in reducing LPR symptoms compared with conventional treatment alone. The most commonly used acupuncture points were CV22, ST36, and LR3. However, the meta-analysis demonstrated low reliability, as assessed using the GRADE Tool. Further research is needed to improve the evidence and draw clear conclusions regarding the clinical use of acupuncture for treating LPR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.2
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• pp.81-86
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• 2004

Background and Objectives : In general, ambulatory 24-hour pH monitoring is considered the current gold standard for larynogopharyngeal reflux(LPR). There is no validated instrument whose purpose is to document the physical finding and severity of laryngopharyngeal reflux. The purposes of this study are to revaluate the validity and reliability of the reflux finding score(RFS) and to quantify laryngoscopic findings using reflux finding score. Material and Methods : Thirty-three LPR patients confirmed by dual-probe pH monitoring and thirty patients of control were selected. The RFS was documented for each patient with telescopic laryngoscopy before treatment. For test-retest intraobserver reliability assessment, a blinded laryngologists determined the RFS on two separate occasions. To evaluate interobserver reliability assessment, the RFS was determined by t재 different blinded laryngologists. Results : The mean age of the cohort with pH-documented LPR was 45.8 years and the mean RFS was 11.4. The mean age of cotrol subjects was 52 years and the mean RFS was 5.4. The mean RFS for laryngologist no. 1 was 10.8 at the initial screening and 10.9 at the repeat evaluation. The mean FRS for laryngologist no.2 was 11.1 at the intial test and 10.9 at the repeat evaluation. The correlation coefficient for interobserver variability was 0.93 and intraobserver variability was 0.94. Conclusion : The RFS demonstrates excellent inter-and introaobserver reproducibility and is helpful for quantifying laryngeal finding in LPR. We can be 95% certain that an individual with a RFS greater than 7 has LPR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.108-112
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• 2007

Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms ; and the constellation of symptoms has been called laryngopharyngeal reflux (LPR). In the absence of definite diagnostic criteria, LPR disease remains a subjective entity. A diagnosis of LPR is usually based on response of symptoms to empirical treatment. Investigative modalities such as pH monitoring and, more recently, impedance studies are generally reserved for treatment failures. LPR usually requires more aggressive and prolonged treatment to achieve regression of both symptoms and laryngeal findings. The suppression of gastric acid and secretion with anti-secretary agents has been the mainstay of medical treatment for patients with acid-related disorders. The suppression of gastric acid secretion achieved with Hz-receptor antagonist $(H_2RA)$ has proved suboptimal for relief of reflux symptoms. The rapid development of tolerance and rebound acid hypersecretion after the with-drawal of $H_2RA$ limit their clinical use. Proton pump inhibitors (PPI) have been proved to be very effective for suppressing intragastric acidity, but the optimal dose and duration is unknown. Current evidence indicates that pharmacologic intervention should include, at a minimum, a 3 month trial of twice daily PPI. Symptoms of LPR improve over 2 months of therapy. The physical findings of LPR resolve more slowly than the symptoms and this continues through out at least 6 months of treatment. For most patients with LPR, twice daily dosing with a PPI is usually recommended for an initial treatment for a period of no less than 6 months treatment, and lifetime treatment may be required.