Laryngopharyngeal reflux disease (LPRD) by Dr Sagar Gujrathi.ppt

Laryngopharyngeal reflux disease (LPRD)

1. Laryngopharyngeal Reflux
Disease
DR SAGAR GUJRATHI

2. Introduction
REFLUX(Greek) word meaning “backflow,” of gastric
contents
1
st
described by Koufmannin 1991
GERD: an abnormal reflux up through the LES and into the
esophagus,
Occurs in supine position
LPRD: when the reflux passes through the UES reaching the
larynx and pharynx
Occurs in upright position
2

3. 3

4. 4
Etiopathogenesis
Lining epithelium
Oesophagus –
Stratified squamous epithelium (more resilient)
Larynx and pharynx –
Squamous and respiratory epithelium (less resilient)
LES –physiological sphincter
UES –anatomical sphincter

5. 5
Anti
Reflux
Barriers
Epithelium
lining
Oesophageal
Acid
Clearance
Mucus
support

6. Pathophysiology
Gastric refluxate(acid, pepsin, bile and food particles)
LES
Backflows
UES
Laryngeal mucosa (post glottis)
Persistent and chronic Inflammation of Mucosa
Laryngopharyngeal reflux disease
6

7. 7
Symptoms
Retrograde
acid reflux
Carbonic
anhydrase
isoenzyme III
deffect
Ciliary damage
–Mucous stasis

8. Role of Pepsin
1934-Asher Winkelstein-laryngeal symptoms due
to pepsin
Pepsin –physiologically inactive, activates in acid
environment
Max active at pH 2-4, reactivated by dietary or
further reflux acid (Cold drinks pH < 2)
Pepsin disrupts the mucosal barrier by acting on the
epithelial cell surface and intracellular damage-
golgicomplex & lysosomes (low pH)
8

9. Reduced LES pressure
Hiatus hernia
Diet: spicy and fried food, chocolate, milk product
Tobacco
Alcohol
Drugs: Calcium channel blockers, Alph-adrenergic
blockers, Anticholinergics, antibiotics
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10. Symptoms
Dysphonia
Pseudodysphagia
Hoarseness
Voice fatigue, breaking of the voice
Cough
Globus pharyngeus
Frequent throat clearing
10

11. 11
Reflux Symptom Index (RSI)

12. Investigations
IDL/FOL
Pepsin testing
24hour, ambulatory, double probe pH metry/ Multichannel
intraluminal impedance monitoring
Barium oesophagography –not physiological
12

13. 13

14. Score >7 -LPR
14
REFLUX FINDING SCORE
Pseudosulcus
0-absent
2-present
Ventricular Obliteration
0-none
2-partial
4-complete
Erythema/ Hyperemia
0-none
2-arytenoids only
4-diffuse
Vocal fold edema
0-none
1-mild
2-moderate
3-severe
4-polypoid
Diffuse laryngeal edema
0-none
1-mild
2-moderate
3-severe
4-obstructing
Posterior commissure
hypertrophy
0-none
1-mild
2-moderate
3-severe
4-obstructing
Granuloma/ Granulations
0-absent
2-present
Thick endolaryngeal mucus
0-absent
2-present

15. Treatment
•Behaviouraltherapy
•Diet
•Activities
•Voice therapy
•Medical management
•Comprise a minimum of 3 months
of treatment
•Surgical management
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16. Treatment
16
Phase I
•Lifestyle
and dietary
changes
•Barrier
agents
(Alginate)
Phase II
•Prokinetic
•H2
Blockers
•PPI
Phase III
•Anti-reflux
surgery

17. Lifestyle modifications
Stop smoking
Elevate the head of the bed during sleep
Reduce body weight
Avoid tight-fitting clothing
Avoid lying down after meals
17

18. Dietary modification
Avoid fat, caffeine, chocolate, mints,
carbonated drinks, fat, milk product,
Avoid alcohol
Avoid overeating
Avoid ingestion of food and drink 2 hours
before bed time
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19. Evaluation
and
Management
of LPRD
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20. 20

21. 21

22. Drug therapy
H2 Blockers
Ranitidine, Famotidine,
Reversibly reduces acid secretion
PPI’s
Reduces acid production
Omeprazole (20-40mg OD)
Mucosal protective (Barrier agents)
Alginates
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23. Prokinetics
Symptomatic relief
Increases gastric emptying
Metoclopramide (5-10mg), Domperidone (10-
20mg)
Surgery–Laparoscopic Nissen Fundoplication
23

24. Thank You
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