title: Unmet needs in treating laryngo-pharyngeal reflux disease: where do we go from here?
abstract: BACKGROUND
  Many patients experience ear, nose and throat symptoms associated with their gastroesophageal reflux disease. These symptoms are purportedly caused by reflux of gastroduodenal contents into the larynx, which leads to laryngopharyngeal reflux (LPR). Various modalities are used to diagnose LPR, including ambulatory pH monitoring, laryngoscopy, and esophagogastroduodenoscopy, as well as a few new emerging diagnostic tests. However, there are still no established diagnostic criteria or gold standard methodologies that can reliably distinguish LPR from other conditions.
  
  
  METHODS
  In this review, we will evaluate currently available diagnostic tests and therapeutic options for patients with laryngeal signs and symptoms of reflux and briefly discuss the development and emergence of new treatments. Numerous studies have investigated the role of proton pump inhibitor therapy in this patient population, but have led to disparate and often inconsistent results. Expert commentary: While a subgroup of patients with LPR appears to respond to PPI therapy, many patients show no symptomatic improvement, particularly with respect to extraesophageal symptoms. As such, there is a vital need to explore alternative treatment options, including anti-reflux surgery, lifestyle changes, and other classes of medications to better address LPR.
authors.affiliation: a Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Meera R
authors.initials: MR
authors.lastname: Wright
authors.affiliation: b Division of Gastroenterology, Hepatology and Nutrition , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharda
authors.affiliation: b Division of Gastroenterology, Hepatology and Nutrition , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Vaezi
mesh_terms: D002614:Chelating Agents / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D002614:Chelating Agents; D018377:Neurotransmitter Agents; D054328:Proton Pump Inhibitors
keywords: GERD; LPR; extraesophageal reflux; mucosal impedance testing; pH monitoring; proton pump inhibitor therapy