Analysis of symptoms and clinical signs of laryngopharyngeal reflux depending on pepsia in saliva

Abstract

In the last fifty years, an epidemic of reflux disease has occurred as a result of poor eating habits, stress, and activities of the food industry. Part of this disease is laryngopharyngeal reflux, a disease characterized by the return of gastric contents to the throat and surrounding organs, leading to hoarseness, coughing, difficulty in swallowing and breathing, and ultimately the development of benign and malignant changes in the larynx. This study is aimed to examine the symptoms and signs of laryngopharyngeal reflux in the study group before and after therapy and to compare the concentration of pepsin in saliva with the above. The prospective longitudinal cohort study included 50 subjects, divided into two groups. The first group consisted of 25 subjects with laryngopharyngeal reflux. The second group consisted of 25 healthy subjects without symptoms and signs of laryngopharyngeal reflux. Symptoms and signs before and after therapy were collected using RSI and RFS questionnaires. Pepsin in saliva was measured with Peptest before and after therapy. The most pronounced symptoms are hoarseness, postnasal drip, and a feeling of "a lump in the throat". The median RSI score after three months of therapy was reduced from 20 to 8. From the first group, 7 subjects had measurable levels of pepsin in saliva, and none after therapy. In the control group, no subjects were found to have pepsin in their saliva. Significant improvement was observed in clinical findings (subglottic edema, posterior commissure hypertrophy, vocal cord edema, dense endolaryngeal secretion) after three months of therapy in subjects with LPR. No association of pepsin with LPR symptoms was observed but there is a significant positive association between pepsin and the clinical finding of erythema/hyperemia. In most cases, we start therapy with medication. It is, therefore, important to emphasize that laryngopharyngeal reflux treatment must always begin with a change in diet, lifestyle, and stress regulation. Treatment must be individual and should include a multidisciplinary team with a nutritionist, psychologist, and psychiatrist.