The data emerging from these studies explain the role of biomarkers not only in mucosal defense mechanisms but also in tumor progression. Data from controlled studies demonstrate that the outcomes of PPI therapy are comparable to those of placebo treatment. Nevertheless, empirical treatment with PPIs for 2 to 3 months continues to be recommended in the medical literature as a cost-effective and useful therapy for the initial diagnosis of LPR.
The result would be an unreal increase in the diagnosis of LPR in patients who do not respond to acid suppression therapy. Controlled studies have shown low response rates and no significant differences between PPI and placebo treatment, a fact suggesting that patients without typical symptoms of GERD heartburn or burning sensation will not benefit from treatment with PPIs.
LPR is a disease commonly diagnosed in otorhinolaryngologic practice in the presence of a set of nonspecific laryngeal signs and symptoms. The cause of laryngeal damage is uncertain but is likely to comprise a combination of acid and reflux components, particularly pepsin. Pepsin is associated with nonacid or weakly acid reflux. This enzyme remains stable in laryngeal tissues and is reactivated by subsequent reflux or by dietary acids.
There is no specific test for LPR. Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of this condition. Other treatment options include lifestyle and dietary changes quitting smoking and drinking, weight loss, avoiding caffeine, etc.
Molecular studies have been conducted in an attempt to identify biomarkers of reflux, such as ILs, carbonic anhydrase, E-cadherin, and mucins. However, further investigation is needed to establish a definitive diagnostic test for LPR and to determine the mechanism underlying mucosal damage, which would contribute to the development of new treatments and the understanding of the physiopathology of LPR.
National Center for Biotechnology Information , U. Journal List Int Arch Otorhinolaryngol v. Int Arch Otorhinolaryngol. Published online Nov 5. Author information Article notes Copyright and License information Disclaimer. Received Dec 14; Accepted Jun 6. This article has been cited by other articles in PMC. Keywords: laryngopharyngeal reflux, laryngoscopy, esophageal pH monitoring, proton pump inhibitors, biomarkers, pharmacologic. Introduction Laryngopharyngeal reflux LPR is defined as the retrograde flow of stomach content to the larynx and pharynx whereby this material comes in contact with the upper aerodigestive tract.
Literature Review Harmful Events Physiological Barriers The physiological barriers to LPR include the lower esophageal sphincter, esophageal clearance influenced by esophageal peristalsis, saliva and gravity, and the upper esophageal sphincter. Acid The pH of the pharynx is neutral pH 7 , whereas stomach acids range in pH from 1. Bile Acids The reflux of duodenal-gastric juices contains bile acids and pancreatic secretions and can reach the larynx.
How did the problems listed below affect you since the last month? Hoarseness or voice problems 0 1 2 3 4 5 2. Throat clearing 0 1 2 3 4 5 3. Excess mucus or postnasal drip descends behind the nose to the throat 0 1 2 3 4 5 4. Difficulty in swallowing solids, fluids or tablets 0 1 2 3 4 5 5.
Coughing after eating or lying down 0 1 2 3 4 5 6. Breathing difficulties or choking episodes 0 1 2 3 4 5 7. Annoying cough 0 1 2 3 4 5 8. Sensation of a lump or foreign body in the throat 0 1 2 3 4 5 9.
Burning, heartburn, chest pain, indigestion, or stomach acid coming up reflux 0 1 2 3 4 5 Total. Open in a separate window. Diagnostic Methods Laryngoscopy The laryngoscopic findings used for the diagnosis of reflux are nonspecific signs of laryngeal irritation and inflammation.
Table 2 Reflux Finding Score. Empirical Treatment In view of the controversial diagnostic criteria for LPR, empirical treatment with PPIs has been used as an alternative diagnostic modality in which a favorable response is defined as diagnostic confirmation. Treatment Treatment of LPR consists of dietary changes and changes in habits such as weight loss, quitting smoking, avoiding alcohol, and not eating immediately before bedtime.
Surgery Laparoscopic or Nissen fundoplication is a well-established surgical treatment for GERD and produces reliable and reproducible results. Latest Research Nonacid Diet and Alkaline Water Koufman suggested that pepsin, which is deposited in laryngeal tissue, can be activated by exogenous hydrogen ions derived from any source, including diet.
Biomarkers of Reflux Inflammatory Cytokines Multiple markers have been implicated in inflammation of the esophageal mucosa caused by reflux. Carbonic Anhydrase Carbonic anhydrase is a defense component of the mucosa that catalyzes the hydration of carbon dioxide, producing bicarbonate, which neutralizes acid reflux in the extracellular space. E-Cadherin E-cadherin plays an important role in the maintenance of integrity and barrier function of the epithelium.
Mucins Mucins are glycoproteins expressed by different types of epithelial cells at sites exposed to oscillations in pH, ion concentration, hydration, and oxygenation. Discussion LPR has become a frequent disease in the otorhinolaryngologist's office. Conclusion LPR is a disease commonly diagnosed in otorhinolaryngologic practice in the presence of a set of nonspecific laryngeal signs and symptoms.
References 1. Ford C N. Evaluation and management of laryngopharyngeal reflux. El-Serag H B. Stomach juices are made up of strong digestive acids, containing enzymes to break down our food and bile from the gall bladder to emulsify fats.
The stomach lining is designed to cope with these juices but sometimes they travel upwards from the stomach into the gullet oesophagus which was not designed to accommodate powerful digestive juices and the oesphageal lining becomes irritated causing symptoms of indigestion heartburn.
This process is referred to as gastro-oesophageal reflux GOR. However, in some people, small amounts of stomach juice can spill back into the upper throat pharynx affecting the back of the voice box larynx causing irritation and hoarseness. This is known as laryngo-pharyngeal reflux LPR. It is often called 'silent reflux' because many people do not experience any of the classic symptoms of heartburn or indigestion.
LPR can occur during the day or night, even if a person hasn't eaten anything. Usually, however, LPR occurs at night. The term reflux comes from a Greek word meaning 'backflow'.
Normally, the things we eat and drink stay in the stomach to be digested and do not spill back up into the oesophagus.
However, if the valve at the lower end of the oesophagus the oesophageal sphincter is weak or disco-ordinate reflux may occur. Some people with LPR also experience heartburn. Others rarely notice heartburn or never experience it at all hence the term 'silent reflux'. This is because the material that refluxes refluxate does not stay in the oesophagus for long.
As a result, the contents do not have enough time to irritate the oesophagus and cause heartburn. However, if even small amounts of reflux come all the way up into the pharynx and larynx, other problems can occur. This is because the tissue lining the larynx and pharynx is more sensitive to injury and irritation from stomach juices than the lining of the oesophagus.
Damage to the larynx from stomach refluxate will affect a person's voice and can sometimes affect their lungs and breathing. In this capacity he works closely with sales and marketing to provide clinical support, manages clinical studies, and provides clinical perspectives on business development.
Jeff has over 30 years of experience in the medical device industry and previously worked in sales at companies such as Encision Inc. He has been working as the VP of Sales for Mederi Therapeutics since and now brings his extensive expertise to Restech. Jeff was part of the team that bridged the Mederi asset sale to Restech. His clinical knowledge of the Stretta and Secca technologies is invaluable.
Jeff has three decades of physician relations experience that he brings to Restech as part of the leadership team. He has been in the medical device, and specifically in the GERD space for more than 18 years.
Starting in sales at Sandhill Scientific pH diagnostics, he moved on to Curon Medical when Stretta and Secca were first introduced to the market. He then worked for Given Imaging when Curon closed operations. Ray was instrumental in keeping Stretta alive and the customer based informed when Mederi ceased operation and assets were purchased by Restech. He is part of the leadership team directing all product sales for Restech.
Mark is a seasoned professional and Certified Public Accountant in Texas who brings a unique blend of creative vision and financial expertise to any leadership team. Mark currently serves as a Chief Financial Officer and consulting CFO seven years providing in-house and outsourced CFO and transactional services to the middle market.
He is a software architect specializing in remote patient monitoring, medical sensors, and clinical trial software. Silent reflux damages the mucous membranes, and they need time to heal. The time that it takes is very individual. Some patients see great improvements within weeks of adopting lifestyle changes. However, a time horizon of a few months is more realistic for a more complete recovery, particularly if treatment is started slowly rather than making sudden large changes to lifestyle and diet.
Damage to the mucous membranes is caused by pepsin. Pepsin is a stomach enzyme that gets carried along with the reflux acid and thereby reaches the throat and airways. Exactly how long it takes for the symptoms to improve or disappear is very individual. Treatment does not usually immediately eliminate all reflux events; it just reduces them.
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