[en] [en] OBJECTIVE: The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR.
METHODS: Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician.
RESULTS: After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as 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. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h.
CONCLUSION: A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR.
LEVEL OF EVIDENCE: 5 Laryngoscope, 2023.
Disciplines :
Otolaryngology
Author, co-author :
Lechien, Jérome ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Educatio > Service de Métrologie et Sciences du langage
Vaezi, Michael F; Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Chan, Walter W ; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Allen, Jacqueline E ; Department of Otolaryngology, Head and Neck Surgery, University of Auckland, Auckland, New Zealand
Karkos, Petros D ; Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
Saussez, Sven ; Université de Mons - UMONS > Faculté de Médecine et de Pharmac > Service d'Anatomie humaine et Oncologie expérimentale ; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium
Altman, Kenneth W ; Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
Amin, Milan R; Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
Ayad, Tareck; Department of Otolaryngology-Head Neck Surgery, Montreal Hospital, Montreal, Canada
Barillari, Maria R; Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy
Belafsky, Peter C ; Department of Otolaryngology, UC Davis Medical Center, Sacramento, California, USA
Blumin, Joel H ; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Johnston, Nikki; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Bobin, Francois; Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France
Broadhurst, Matthew; Queensland Voice Centre, Brisbane, Australia
Ceccon, Fabio P ; Department of Otolaryngology-Head and Neck Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
Calvo-Henriquez, Christian ; Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
Eun, Young-Gyu ; Department of Otolaryngology Head & Neck Surgery, Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
Chiesa-Estomba, Carlos M ; Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
Crevier-Buchman, Lise; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
Clarke, John O; Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, California, USA
Dapri, Giovanni ; Université de Mons - UMONS > Faculté de Médecine et de Pharmacie > Anatomie humaine et Oncologie expérimentale ; International School Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy
Eckley, Claudia A; Divisão de Otorrinolaringologia, Fleury Medicina e Saúde Laboratórios de Diagnóstico, São Paulo, Brazil
Finck, Camille ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Educatio > Service de Métrologie et Sciences du langage ; Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Liege, Belgium
Fisichella, P Marco; Abbvie Inc., Chicago, Illinois, USA
Hamdan, Abdul-Latif ; Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Hans, Stephane; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
HUET, Kathy ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Educatio > Service de Métrologie et Sciences du langage
Imamura, Rui; Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, Sao Paulo, Brazil
Jobe, Blair A; Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
Hoppo, Toshitaka; Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
Maron, Lance P; Netcare Park Lane Hospital, Johannesburg, South Africa
Muls, Vinciane; Department of gastroenterology, CHU Saint-Pierre, Brussels
O'Rourke, Ashli K ; Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Perazzo, Paulo S; Department of Otolaryngology, School of Medicine, São Paulo Federal University, Sao Paulo, Brazil
Postma, Gregory; Department of Otolaryngology, Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
Prasad, Vyas M N ; ENT Centre and Singapore Medical Specialist Centre, Singapore, Singapore
Remacle, Marc; Department of Otolaryngology, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
Sant'Anna, Geraldo D; Disciplina de Otorrinolaringologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
Sataloff, Robert T ; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
Savarino, Edoardo V; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Schindler, Antonio; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
Siupsinskiene, Nora; Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania ; Faculty of Health Sciences, Klaipeda university, Klaipeda, Lithuania
Tseng, Ping-Huei; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Zalvan, Craig H ; Department of Otolaryngology-New York Medical College, School of Medicine, Valhalla, NY, Institute for Voice and Swallowing Disorders, Sleepy Hollow, NY, USA
Zelenik, Karol ; Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
Fraysse, Bernard; IFOS Board, Paris, France
Bock, Jonathan M ; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Akst, Lee M ; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Carroll, Thomas L ; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital and Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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