Setting the rules for diagnosis and management of laryngopharyngeal reflux disease

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Abstract

Objectives: To  study  how  to  evaluate  Laryngopharyngeal  Reflux(LPR),  and  to  formulate  management  strategy. 
Study design: Prospective study. Material and methods: A total of 112patients were studied and followed for a period of at least six months. The study was conducted under the following headings: (1) establish the diagnosis of LPR by using Reflux Finding Score (RFS) and Reflux Symptom Index (RSI), (2) establish diagnosis of GERD by history  and endoscopy, (3) treat LPR by lifestyle modification and medical management using proton pump inhibitors (PPI) or surgical management.
Results: Majority of patients were females (53.3%) and in the age group of 20-50 years. RSI was used to study symptoms and median RSI score was (17). The common symptoms were clearing of throat (97.1%), lump in
throat (96.2%), excess throat mucus (93.3%) and heartburn (62.9%). The signs of LPR were studied by using RFS and median  RFS  was  (11)  .The  common  findings  were  vocal  cord  edema  (97.1%)  and  erythema  (93.3%). Symptoms  of GERD were present in less than half of patients (47.6%). EGD was found to be normal in (64.8%). The most common
finding on EGD was esophagitis (17.1%) followed by gastritis (14.3%) and hiatus hernia (8.6%). Majority of patients responded to medical management only (96.2%). RSI improved from a mean score of 17.6% at initiation of treatment to 3.9 at 6 months follow up. RFS improved from a mean score of 11.9 at pre-treatment to (1.7) at 6 months follow up.
Symptoms of GERD improved completely in all patients at 4 months only. Conclusion: LPR is common and RFS and RSI were used to evaluate LPR and they were reproducible and effective. GERD was present in less than half of the patients. Medical management using twice daily PPI was effective.

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