Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

Introduction: Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective: To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion: Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR...

Laryngopharyngeal reflux: diagnosis, treatment, and latest research.

Introduction Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

Síndrome metabólica: complacência arterial e a velocidade de onda de pulso / Metabolic syndrome: arterial compliance and the pulse wave velocity

A Síndrome Metabólica (SM) caracteriza-se como um distúrbio complexo representado por um conjunto de fatores de risco cardiovascular, tendo sua frequência estimada entre 20% a 25% da população adulta mundial. Os diversos componentes da SM são responsáveis por alterações estruturais e funcionais de grandes artérias, dentre as quais destaca-se a diminuição da complacência arterial como um importante marcador de risco cardiovascular. A medida da Velocidade de Onda de Pulso (VOP) configura-se como um método relevante na avaliação da rigidez arterial. Discute-se, nesta revisão, os principais mecanismos pelos quais os componentes da SM atuam provocando estas alterações vasculares, a relevância destas modificações e o reflexo da influência terapêutica nestes casos. A revisão bibliográfica foi realizada através de consulta às bases de dados eletrônicos Medline, Lilacs e Pubmed, entre os anos de 2008 e 2009. Foram utilizados os descritores “metabolic syndrome”, “pulse wave velocity” e “arterial stiffness”, nos idiomas português e inglês, sendo selecionados estudos datados entre 1962 e 2009. Observou-se através dos estudos revisados que os componentes da SM atuam através de diferentes mecanismos para promover o aumento da VOP. A principal alteração vascular relacionada a estes componentes foi a diminuição da complacência das grandes artérias. A avaliação da complacência arterial através da medida da VOP permite o acompanhamento dos resultados obtidos através das intervenções terapêuticas e a identificação precoce destas alterações vasculares. Desta forma, torna-se possível a adoção de uma medida terapêutica precoce, possibilitando diminuir significativamente a progressão destas alterações vasculares e, portanto, reduzir a mortalidade cardiovascular destes pacientes.

The metabolic syndrome (MS) is characterized as a complex disorder represented by a set of cardiovascular risk factors, its frequency estimated between 20% to 25% of the adult population worldwide. The various components of MS are responsible for structural and functional alterations of large arteries, among which a decrease in arterial compliance stands out as an important cardiovascular risk marker. Measurement of Pulse Wave Velocity (PWV) figures as a relevant method in the evaluation of arterial stiffness. This review discusses the main mechanisms by which components of MS act causing these vascular changes, the relevance of these changes and the reflex of treatment influence in these cases. A literature review was conducted by consulting electronic databases Medline, Pubmed and Lilacs between years 2008 and 2009. Metabolic syndrome, pulse wave velocity and arterial stiffness, and their Portuguese equivalents, were the search words used, selecting studies dating from 1962 to 2009. The reviewed studies showed that the components of MS act through different mechanisms to promote the increase of PWV. The main change related to these vascular components was decreased compliance of large arteries. Assessment of arterial compliance by measuring PWV allows tracking the results obtained through therapeutic interventions and early identification of these vascular changes. It thus becomes possible to adopt an early treatment measure, which allows to slow down the progression of these vascular changes significantly and therefore reduce cardiovascular mortality in these patients.