CLINICAL QUESTION
Can a global definition of, and diagnostic approach for, laryngopharyngeal reflux (LPR) be devised to guide physicians in management of the disorder?
Explore This Issue
April 2024BOTTOM LINE
Via an international consensus group, a global definition for LPR now exists for otolaryngologists, gastroenterologists, surgeons, and primary care practitioners to improve detection and diagnosis, potentially allowing for greater collaborative research.
BACKGROUND: Findings of LPR are prevalent in primary care, otolaryngological, and gastroenterological consultations. The non-specificity of symptoms and findings related to LPR, however, and the poor effectiveness of empiric proton pump inhibitor therapy make diagnosis challenging. The role of additional testing, such as impedance pH-monitoring, remains poorly defined.
STUDY DESIGN: Delphi consensus study.
SETTING: Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.
SYNOPSIS: Forty-eight international experts were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Via survey, experts voted anonymously on statements written by a selected consensus committee. Consensus acceptance was a Likert rating of >8/10 by at least 80% of experts. After 24 months and three voting rounds, 79.2% of statements reached agreement on LPR definition, pathophysiology, symptoms, findings, and more. The consensus definition of LPR was “a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract.” It was agreed that pepsin is involved in the development of inflammatory reaction of the laryngopharyngeal mucosa and related LPR symptoms and findings, and that LPR is associated with recognized, non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with patient-reported outcome questionnaires and clinical instruments. Authors noted that evidence was based on expert opinion and not always from systematic reviews or randomized trials, so this work should not be considered a clinical guideline.
CITATION: Lechien JR, Vaezi MF, Chan WW, et al. The Dubai definition and diagnostic criteria of laryngopharyngeal reflux: the IFOS consensus. Laryngoscope. 2024;134:1614–1624.