What are the areas of agreement and controversy in clinical practice guidelines for reflux disease, and is it feasible to create a clinical protocol for otolaryngologists?
Explore this issue:April 2011
Background: With the movement in health care toward evidence-based medicine, is it important to identify best practice guidelines for reflux disease, including gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR)? Because gastroenterologists and otolaryngologists often collaborate on these conditions, it would be beneficial to establish a framework for disseminating evidence-based clinical practice guidelines.
Study design: Literature review with discussion.
Setting: Department of Otolaryngology, Mount Sinai School of Medicine, New York, and Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville.
Synopsis: After a PubMed search of 570 articles on GERD or LPR, 13 key studies were identified, with 11 of those from gastroenterology literature and none from otolaryngology literature. The reviewers found a consensus on empiric medication trial as a first-line therapy for presumed uncomplicated GERD and on prioritizing early identification of patients with severe disease complications.
Areas of controversy include the definitions of GERD and LPR and the long-term management of medical therapy. The most controversial issues surrounding LPR/GERD involve the role of diagnostic testing and the continued role of acid/peptic reflux in those who remain symptomatic despite aggressive dosing and duration of acid suppression.
Bottom line: Evidence-based clinical practice guidelines exist in the literature to support the routine care of GERD patients, and these may be applicable to patients with LPR. The authors said there is enough literature to support a rudimentary clinical protocol.
Citation: Altman KW, Prufer N, Vaezi MF. A review of clinical practice guidelines for reflux disease: toward creating a clinical protocol for the otolaryngologist. Laryngoscope. 2011;121(4):717-723.
—Reviewed by Sue Pondrom