Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Version 1 : Received: 15 October 2020 / Approved: 19 October 2020 / Online: 19 October 2020 (10:32:33 CEST)

A peer-reviewed article of this Preprint also exists.

Lechien, J.R.; Saussez, S.; Muls, V.; Barillari, M.R.; Chiesa-Estomba, C.M.; Hans, S.; Karkos, P.D. Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians. J. Clin. Med. 2020, 9, 3618. Lechien, J.R.; Saussez, S.; Muls, V.; Barillari, M.R.; Chiesa-Estomba, C.M.; Hans, S.; Karkos, P.D. Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians. J. Clin. Med. 2020, 9, 3618.

Journal reference: J. Clin. Med. 2020, 9, 3618
DOI: 10.3390/jcm9113618

Abstract

Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

Subject Areas

Reflux; Laryngopharyngeal; Gastroesophageal; Primary Care; Physician; Mangement; General; Treatment; Diagnosis.

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