Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-year Case-Series

Version 1 : Received: 13 April 2021 / Approved: 15 April 2021 / Online: 15 April 2021 (12:08:19 CEST)

A peer-reviewed article of this Preprint also exists.

Lechien, J.R.; Hans, S.; Bobin, F.; Calvo-Henriquez, C.; Saussez, S.; Karkos, P.D. Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series. J. Clin. Med. 2021, 10, 2439. Lechien, J.R.; Hans, S.; Bobin, F.; Calvo-Henriquez, C.; Saussez, S.; Karkos, P.D. Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series. J. Clin. Med. 2021, 10, 2439.

Journal reference: J. Clin. Med. 2021, 10, 2439
DOI: 10.3390/jcm10112439

Abstract

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as etiological or favoring factor of laryngeal, oral, sinonasal or otological diseases. In this case-series, we reported atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with 24-hour hypopharyngeal-esophageal impedance pH-study and patients were treated with a combination of diet, proton pump inhibitors and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N=9), recurrent burps and abdominal disorders (N=2), posterior nasal obstruction (N=2), recurrent acute suppurative otitis media (N=2), severe vocal fold dysplasia (N=2), and recurrent acute rhinopharyngitis (N=1), tearing (N=1), aspirations (N=1) or tracheobronchitis (N=1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate anti-reflux treatment. Conclusion: LPR may present with various clinical presentations including mouth, eye, tracheobronchial, nasal or laryngeal findings, which may all regress with an adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzyme in the enflamed tissue.

Keywords

Reflux; Laryngopharyngeal; Clinical; Atypical; Nasal; Otological; Respiratory; Management; Treatment; Diagnosis

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