JOURNAL READING

LARYNGOPHARYNGEAL REFLUX MIGHT PLAY A ROLE ON CHRONIC

NONSPECIFIC PHARYNGITIS

Supervisior:dr. H.R Soemadi, Sp. THT-KL

Represented by:Emy Novita Sari (01.208.5645)

Pharyngitis an inflammation of the mucosal and sub mucosal structures of the throat

determine most causes of

pharyngitishistories and careful physical examination

some people referred to the clinician with pharyngeal pain without an obvious explanation which is named as chronic nonspecific

pharyngitis

INTRODUCTION

Laryngopharyngeal Reflux (LPR)

the retrograde movement of gastric contents into the larynx, pharynx,and upper aerodigestive tract

may play a role in chronic nonspecific pharyngitis

patients’ etiologies

most accurate diagnostic test 24-

h esophageal pH monitoring with both

proximal and distal sensors

this test is expensive, invasive and also is not

easy to use in clinics

there is a need for a simple method for scanning suspicious

patients

Aimto perform indirect laryngoscopy by series of consecutive

patients referred for suspected chronic nonspecific pharyngitis by using RSI and RFS.

Belafsky et al Reflux Finding Score (RFS) and Reflux Symptoms Index (RSI) were used to

document the physical Findings and the severity of LPR simply economically as

well as noninvasively.

Used in this study

MATERIALS AND METHODS

Fifty patients (age range 18–72 years)

38 females

12 males

visited the out-patientdepartment for

suspected chronic nonspecific pharyngitis

Control group

Thirty healthy adults

chronic nonspecific pharyngitis symptoms

3 months+

withouth acute infection

sore throat, chronic throatirritation, chronic cough, globus sensation, cervical dysphagia,and intermittent hoarseness

14C-urea breath test to detect Helicobacter pylori infection of gastric mucosa

Excluded:organic causes such as acute infection, nasal obstruction, rhinitis, sinusitis or

tumorous lesionsAlso use a throat culture

Positive result

RSI (nine items)

0 (no problem) – 5 (severe problem)

RFS (eight items)

0 (no abnormal findings) - 26 (worst

score possible)

RFS ≥7 accepted as LPR

3 healthy subjects had high RFS

excluded

30 mg lansoprazole twice daily

evaluated before and 6 months after b.i.d

treatment

Analyze NCSS 2007 & PASS 2008 Statistical Software (Utah, USA) program.

The analyses according to the groups Student’s t test and Mann Whitney U test.

The analyses in the groups Paired samples t test.The analyses due to categorically given groups Chi square test, and The analyses in these groups Mc

Nemar test.The results were evaluated by 95% confidence interval,

and statistically significance was P < 0.05

RESULTS

RSI and RFS assessment according to the groups

The pretreatment and posttreatment sixth month RSI and RFS assessment of nonspeciWc pharyngitis

DISCUSSION

Pharyngitis is one of the most common conditions encountered by physicians. In contrast, there are a limited number of studies in the literature related to chronic

pharyngitis. Yet, no published studies have assessed rehabilitation of chronic pharyngeal complaints using antibiotic therapy.

When a patient presents with pharyngitis symptoms, the ENT physician must consider a wide range of illnesses. If patients do not have any other signs of infection,

physicians should investigate noninfectious causes such as rhinitis, allergies, laryngopharyngeal reflux, and thyroiditis.

In the literature, there are a lot of papers concerning extraesophageal reflux, but unfortunately limited of them is related to pharyngitis.

In the past, chronic nonspecific pharyngitis was considered a kind of conversion or psychosomatic disorder, but in recent studies, various organic or functional causes

have been reported.

In this study, we analyzed the relationship between chronic nonspeciWc pharyngitis and reflux. As a result we utilized an endoscopic scoring and findings to evaluate

reflux among chronic nonspecific pharyngitis patients and control groups.

We found a dramatically higher prevalence (70%) of increased inflammatory change (RFS ≥7) when compared with the control group.

The relationship between pharyngitis and reflux has been previously evaluated by biopsy-based methods or hematologic analysis. Aladaf et al. demonstrated that H.

pylori seropositivity rates were found significantly higher in chronic nonspecific pharyngitis patients than controls. They used serum H. pylori immunoglobulin G

antibody titers to assess reflux.

Helicobacter pylori infections in the pharynx of the people in the control group and the patients suffering from chronic pharyngitis were examined by biopsy. Template-directed dye terminator incorporated with fluorescence polarization detection and modified Giemsa stain were used to examine pharynx mucous membrane tissue for

H. Pylori colonization. H. pylori was detected in the pharynx of chronic pharyngitis patients. However, it is difficult to take oropharyngeal biopsies in the out-patient

department.

Although 24-h double-probe pH monitoring is the gold standard method for the diagnosis of LPR, it is difficult to put into practice this method in the out-patient

department. For this reason, we tried to find easy, cost-effective, and reproducible method for scanning reflux among pharyngitis patients. Other tools such as RFS and RSI are not invasive, and have high validity have been used to evaluate LPR in some

clinics. These tests take only about 1 min each and are simple, economical, and noninvasive.

Further investigations and large number of patients are needed to explain the potential mechanisms of interaction of LPR and chronic nonspecific pharyngitis. LPR

may be one of the causative factors in the progression of chronic nonspecific pharyngitis.

CONCLUSION

This study revealed a high rate of RSI and RFS in patients with chronic nonspecific pharyngitis. Pharmacotherapy with proton pump inhibitors may

be an acceptable treatment modality for suitable chronic nonspecific pharyngitis patients.

THANKS