LARYNGOPHARYNGEAL REFLUX

Ankara Üniversitesi Tıp Fakültesi, KBB Anabilim Dalı, Ankara, Türkiye Laryngopharyngeal reflux (LPR), an atypical form of gastroesophageal reflux (GER), is defined as the backflow of gastric contents into the esophagus, severe enough to reach the structures above the upper esophageal sphincter, without associated belching or vomiting. The contact of gastric acid and pepsin, with the mucosa of the larynx, trachea, pharynx and oral cavity may cause non-specific symptoms of upper aerodigestive system irritation and mucosal ulcerative lesions. Patients who see an otolaryngologist for their LFR-associated symptoms and disorders, infrequently have the typical symptoms of GER, such as heartburn and regurgitation. A meticulous synthesis of the information gathered from a detailed history, complete otolaryngologic examination focusing on the larynx, diagnostic laboratory tests that detect and evaluate reflux, and response to treatment is essential for the diagnosis for LFR. Esophageal endoscopy and barium esophagograms can be considered in patients with esophageal symptoms; otherwise, esophagitis is rare in patients with LFR-associated otolaryngologic disorders and the role of these diagnostic methods are limited. 24-hour, double channel pH monitoring study of the esophagus is the most sensitive and specific test for the diagnosis of LFR. Interpretation of the pH monitoring data should consider the technical difficulties of the test and the different characteristics of reflux events in otolaryngologic patients. pH monitoring may not detect reflux in all petients, due to the intermittant nature of laryngopharyngeal reflux. The presence of different reflux patterns and the lack of an ideal diagnostic test, justifiy the use of improvement in the signs and symptoms with an empirical trial of treatment as a diagnostic tool. Medical treatment of LFR consists of life-style modifications and acid supressive agents. Proton pump inhibitors provide a better success rate in patients with LFR, compared to H2 blockers; the duration of the treatment should not be less than three months and the standart dos should be doubled (i.e. lansoprazole 30 mgr BID, or omeprazole 20 mgr BID). Patients who do not respond to medications, develop frequent relapses and have LFR-related complications of the upper respiraory system are candidates for the surgical treatment of reflux. Nissen fundoplication, that can also be performed laparoscopically, is the most commonly used surgical procedure, with high success rates. Keywords : reflü larenjiti