Clin Exp Otorhinolaryngol.  2020 Aug;13(3):299-307. 10.21053/ceo.2019.01669.

Management of Laryngopharyngeal Reflux in Asia

• Kim SI
• Lechien JR
• Ayad T
• Jia H
• Khoddami SM
• Enver N
• Raghunandhan SK
• Hamdan AL
• Eun YG

• KMID: 2504926
• DOI: http://doi.org/10.21053/ceo.2019.01669

Abstract

Objectives
. This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR).
Methods
. An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.
Results
. Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR.
Conclusion
. Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

Keyword

Laryngopharyngeal Reflux; Otolaryngologist; Disease Management; Therapeutics; Surveys and Questionnaires

Figure

• 

  Fig. 1. Clinical findings associated with reflux in the development of upper aerodigestive tract diseases (Western vs. Eastern Asian otolaryngologists). The Y-axis corresponds to the number of otolaryngologists who agreed or not with a certain association. NS, not significant; LPR, laryngopharyngeal reflux.

• 

  Fig. 2. The main reasons why Western and Eastern Asian otolaryngologists prescribed gastrointestinal (GI) endoscopy. The Y-axis corresponds to the number of otolaryngologists who endorsed a certain reason for prescribing GI endoscopy (each otolaryngologist could select multiple reasons). PPI, proton pump inhibitor; LPR, laryngopharyngeal reflux.

• 

  Fig. 3. Anti-reflux treatment options used by Western and Eastern Asian otolaryngologists. The Y-axis corresponds to the number of otolaryngologists who prescribed each drug (each otolaryngologist could select multiple options). Eastern Asian otolaryngologists more frequently used once-daily proton pump inhibitors (PPIs; 64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025).

• 

  Fig. 4. Treatment duration differences between Western and Eastern Asian otolaryngologists. Western Asian otolaryngologists prescribed treatments with a longer duration than did Eastern Asian otolaryngologists (P=0.048).

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  Fig. 5. The main reasons for therapeutic failure according to Western and Eastern Asian otolaryngologists. More than 50% of Western and Eastern Asian otolaryngologists believed that patients’ poor dietary habits are the main cause of therapeutic failure (56% and 52%, respectively).

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  Fig. 6. Therapeutic management of recalcitrant reflux by Western and Eastern Asian otolaryngologists. For the management of recalcitrant laryngopharyngeal reflux, more than 40% of Western and Eastern Asian otolaryngologists referred the patient to a gastroenterologist (46% and 41%, respectively) and more than 25% of them performed an additional examination (35% and 26%, respectively).

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