Effect of Laryngopharyngeal Reflux and Potassium-Competitive Acid Blocker (P-CAB) on the Microbiological Comprise of the Laryngopharynx.

OBJECTIVE: To probe the microbiota composition progressing from healthy individuals to those with laryngopharyngeal reflux disease (LPRD) and subsequently undergoing potassium-competitive acid inhibitor (P-CAB) therapy. STUDY DESIGN: Prospective case-control study. SETTING: Academic Medical Center. METHODS: Forty patients with LPRD and 51 patients without LPRD were recruited. An 8-week P-CAB therapy was initiated (post-T-LPRD), and 39 had return visits. In total, 130 laryngopharyngeal saliva samples were collected and sequenced by targeting the V3-V4 region of the 16S ribosomal RNA (rRNA) gene using an Illumina MiSeq. Amplicon sequence variants (ASVs) and clinical indices were analyzed. RESULTS: Alpha and beta diversities were compared among the non-LPRD, LPRD, and post-T-LPRD groups, and the Observed_ASVs were not significantly different. At the same time, the Shannon and Simpson indices, unweighted Unifrac, weighted Unifrac, and binary Jaccard distance were significantly different between non-LPRD and LPRD groups. In addition, significant differences were found in the abundance of Streptococcus, Prevotella, and Prevotellaceae in the LPRD versus non-LPRD groups, and Neisseria, Leptotrichia, and Allprevotella in the LPRD versus post-T-LPRD groups. The genera model was used to distinguish patients with LPRD from those without, and a better receiver operating characteristic curve was formed after combining the clinical indices of reflux symptom index, reflux finding score, and pepsin, with an area under the curve of 0.960. CONCLUSION: Laryngopharyngeal microbial communities changed after laryngopharyngeal reflux and were modified further after P-CAB treatment, which provides a potential diagnostic value for LPRD, especially when combined with clinical indices.

Assessing the role of dryness and burning sensation in diagnosing laryngopharyngeal reflux.

Laryngopharyngeal reflux disease (LPRD) is a condition characterized by the regurgitation of stomach and duodenal contents into the laryngopharynx, with variable and non-specific symptoms. Therefore, developing an accurate symptom scale for different regions is essential. Notably, the symptoms of "dryness and burning sensation in the laryngopharynx or mouth" are prevalent among the Chinese population but are often omitted from conventional symptom assessment scales, such as the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) scales. To address this gap, our study incorporated the symptoms into the RSI and RSS-12 scales, developing the RSI-10/RSS-13 scales. Afterward, we assessed the role of the new scale's reliability (Cronbach's α and test-retest reliability), construct validity (confirmatory factor analysis and confirmatory factor analysis), and diagnostic efficiency. Our study encompassed 479 participants (average = 39.5 ± 13.4 years, 242 female) and 91 (average = 34.01 ± 13.50 years, 44 female) completed 24 h MII-pH monitoring. The Cronbach's α values of 0.80 and 0.82 for the RSI-10 and RSS-13 scales, respectively. RSI-10 and RSS-13 exhibited strong test-retest reliability (ICCs = 0.82-0.96) and diagnostic efficacy (AUC = 0.84-0.85). Furthermore, the factor analysis identified the RSS-13 and its three sub-scales (ear-nose-throat, digestive tract, respiratory tract) exhibited good to excellent structural validity (χ2/df = 1.95, P < 0.01; CFI = 0.95, RMSEA = 0.06, SRMR = 0.05). The AUC optimal thresholds for the RSI-10 and RSS-13 in the Chinese population were 13 and 36, respectively. Besides, the inclusion of the new item significantly improved the diagnostic efficiency of the RSI scale (P = 0.04), suggesting that RSI-10 holds promise as a more effective screening tool for LPRD, and global validation is needed to demonstrate the impact of this new symptom on the diagnosis of LPRD.

[Analysis of reliability and validity of the Chinese version of reflux symptom score 12].

Objective: To standardize the 12-item reflux symptom scale in Chinese and evaluate its reliability, validity, and effect on diagnoses. Methods: A systematic translation version of the RSS-12 scale was performed using the Brislin model. The scale with 12 items included three dimensions of symptoms in ear, nose and throat, gastrointestinal tract and respiratory tract. The effect was assessed by three aspects containing symptom frequency, severity, and the quality of life. The Chinese version of RSS-12 was used to test 432 patients who attended the outpatient ENT department of Fujian Provincial Hospital between March 2021 and December 2021, and 413 patient questionnaires were classified as valid, aged 17-78(40.8±13.3) years, 203 were female and 210 were male. SPSS 26.0 and AMOS 24.0 statistical software were used to evaluate the performance of the scale. Results: The scale was highly discriminatory among items and correlated well among dimensions. The I-CVI ranged from 0.67 to 1.00, and the S-CVI was 0.81. The exploratory factor analysis showed that the cumulative variance contribution was 63.583%. The validation factor analysis showed that the model adaptation was good, and the correlation coefficient with the RSI was 0.796. Cronbach's α coefficient was 0.814, the retest reliability was 0.939, and the Spearman-Brown half reliability was 0.892, all of which showed a high level of reliability. Using 24h MII-pH as the diagnostic criterion for LPRD, the RSS-12 scale had a diagnostic compliance rate of 79.4%, with a sensitivity of 0.768 and specificity of 0.857. Conclusion: The Chinese version of the RSS-12 scale has good reliability, validity, and diagnostic ability, which can be used as a screening tool to diagnose pharyngeal reflux diseases.