Evaluation and Management of Laryngopharyngeal Reflux Disease: An Updated State of the Art Review

OBJECTIVE: To review the updated literature about epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux disease (LPRD) and to provide a practical management for clinical practice. DATA SOURCES: PubMED, Cochrane Library, and Scopus. REVIEW METHOD: Four authors conducted the literature review on LPRD epidemiology, clinical presentation, diagnosis, and treatment according to the PRISMA statement. A critical analysis of the literature and a related management algorithm for clinical practice were provided. CONCLUSIONS: Studies from the last 5 years provided increased evidence about the gaseous and alkaline profile of LPRD at 24-hour hypopharyngeal-esophageal impedance-pH monitoring, and the presence of alkaline-activated enzymes in the upper aerodigestive tract mucosa. Three consensuses emerged, emphasizing the importance of objective testing to demonstrate LPRD in patients with laryngopharyngeal symptoms. The recent literature suggested that LPRD may be associated with atypical presentations, including posterior nasal inflammation, dry eyes, and middle ear disorders. The predominantly alkaline nature of LPRD has prompted clinical studies supporting alginate and magaldrate over proton pump inhibitors (PPIs), which only target gastric acidity, for managing acid, weakly acid, and alkaline pharyngeal reflux events. Despite a growing literature, there was no randomized controlled trial comparing alginate, magaldrate, diet, and PPIs conducted in the last 5 years. IMPLICATIONS FOR PRACTICE: The increased evidence about alkalinity of pharyngeal reflux events and the detection of alkaline-activated enzymes in saliva may shift the current PPI-based therapy to alginate therapy. Multicenter international randomized controlled studies with standardized protocols could improve the scientific knowledge about LPRD.