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Clinical Challenges in Otolaryngology |

GERD-Related Chronic Laryngitis: Pro

Charles N. Ford, MD
Arch Otolaryngol Head Neck Surg. 2010;136(9):910-913. doi:10.1001/archoto.2010.152.
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Hypothesis:Gastric acid blockade with PPIs is effective in treating LPR.

I searched the PubMed database and the OVID Database of Systematic Reviews for laryngopharyngeal reflux, laryngopharyngeal reflux PPI treatment, and gastroesophageal reflux AND laryngitis. I also searched the Cochrane Database of Systemic Reviews using keyword combinations of laryngitisand reflux. In addition, I accessed the 58 references included in my earlier article1and also hand searched pertinent subject matter journals and reference lists of key research articles for articles relevant to the present analysis.

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Charles N. Ford, MD

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Figure 1.

Diagrammatic representation of established and evolving factors (X factors) building the case for a more refined definition of laryngopharyngeal reflux. The probability of precision in diagnosis increases from generic factors that might be associated with laryngitis to specific symptoms, findings, and anatomic and physiologic findings more likely applicable to laryngopharyngeal reflux. A number of factors may provide more reliable objective findings and future targets for treatment, including measurements of pepsin, CA-III, CD81, CD1d, Helicobacter pylori, total Eubacteria, and salivary epidermal growth factor (EGF). EtOH indicates excessive ethanol consumption; FEESST, functional endoscopic evaluation of swallowing and sensory testing; RFS, reflux finding score; and TVF, true vocal fold.

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Figure 2.

The probability of proton pump inhibitor (PPI) treatment success. Likelihood of PPI treatment success is predictable based on building the case that gastric acid is the key factor producing the clinical condition. Success of PPI treatment is least likely when the symptoms and findings are most generic. Logic and current data support the high probability of success in those patients exhibiting a positive response to adequate PPI trials and those with coexistent gastroesophageal reflux disease (GERD) and increased laryngopharyngeal acid exposure time (AET). Other factors listed are stacked to indicate the order of relative specificity in predicting probability of PPI efficacy. FEESST indicates functional endoscopic evaluation of swallowing and sensory testing; IA, interarytenoid; LES, weak lower esophageal sphincter; RFS, reflux finding score; RSI, Reflux Symptom Index; and TVF, true vocal fold.

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