Gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is a common condition in ILO/VCD where stomach contents, including acid and digestive enzymes, reflux and cause symptoms or complications. This reflux can reach the larynx and pharynx beyond the oesophagus, causing laryngopharyngeal reflux. laryngopharyngeal reflux may cause an inflammatory reaction associated with ILO/VCD and could be the main link between reflux disease and ILO/VCD.

The incidence and prevalence of GORD, especially laryngopharyngeal reflux, remain unknown due to a lack of standardised diagnostic criteria and the absence of a gold standard test, although it is estimated to affect up to 30% of outpatients [Stabenau et al., 2021]. Previous studies found that 56–61 % of people with ILO/VCD had GERD/laryngopharyngeal reflux.

Although the precise mechanisms linking GORD/laryngopharyngeal reflux are not well established, the underlying pathophysiology could be complex. laryngopharyngeal reflux is an inflammatory condition caused by the backflow of stomach contents, including gastric acid and digestive enzymes such as pepsin, bile, and trypsin, into the pharynx and larynx. This reflux is thought to directly damage the mucosal tissue of the larynx and vocal cords, resulting in laryngeal hyper-responsiveness that may trigger ILO/VCD [Kenn et al., 2011; Cui et al., 2024].

GORD is diagnosed with a combination of symptoms, treatment responses, and objective tests, including upper endoscopy and reflux monitoring [Katz et al., 2022]. As there is no gold standard for diagnosing LPRD, a comprehensive approach using various diagnostic modalities is essential to assess laryngopharyngeal reflux. Questionnaires, including the Reflux Symptom Index (RSI), are available for assessing symptom severity and treatment response. While not a diagnostic tool for laryngopharyngeal reflux, laryngoscopy is useful for excluding other laryngeal conditions and identifying signs potentially suggestive of laryngopharyngeal reflux. The reflux finding score (RFS) is used to quantify the presence and severity of laryngoscopic abnormalities. Another test available is hypopharyngeal-oesophageal multichannel intraluminal impedance-pH monitoring to identify both acidic and non-acid reflux events in the hypopharynx. Salivary biomarkers tests for pepsin detection are potential diagnostic tools for laryngopharyngeal reflux.

GORD/ laryngopharyngeal reflux can be managed with a variety of approaches, including dietary and lifestyle modifications, medications, speech therapy and behavioural therapy. Dietary and lifestyle modifications include elevating the head of the bed during sleep, smoking cessation, and dietary changes, such as reduction of fat, chocolate, alcohol, citrus fruits, tomato, coffee, tea, and soda intake. Avoiding late evening meals and losing weight are also recommended. Proton pump inhibitors (PPIs) are commonly used to treat GORD/LPRD, while they are not effective for all people with GORD/LPRD, especially those with predominantly non-acid reflux. PPIs are reasonable for people with typical reflux symptoms, including heartburn or regurgitation [Cui et al., 2024; Katz et al., 2022].