Manifestation and response of laryngopharyngeal reflux to treatment in Kurdistan -Iraq

الملخص EN

Background : In 1972 complete description of the inflammation of posterior third of the vocal cords was done, with barium swallow confirming Gastro Esophageal Disease (GRED) and subsequent successful symptomatic treatment with antacid.

The possible association between GERD and chronic laryngitis was initially known as acid laryngitis.

Objective : To record the common presentation symptoms of laryngopharyngeal reflux LPR in Kurdistan- Iraq.

To study the significance of fibro optic laryngoscope in diagnosis and improvement of laryngopharyngeal reflux (LPR) and to evaluate the effect of medical therapy on these nonspecific symptoms and Laryngoscopy finding.

Methods : A prospective study was conducted over a two year period at Rizgary teaching hospital, Kurdistan / Iraq; on 132 patients who presented primarily with Laryngopharyngeal symptoms.

They were evaluated using special questionnaire for recording these symptoms : persistent chronic cough, globus sensation, throat clearing, voice change, regurgitation, heartburn, symptoms of peptic ulcer disease, and any other non specific respiratory symptom.

These symptoms and Laryngoscopy findings, pre and post anti-reflux therapy were recorded.

Esophagogastr -duodenoscopy findings were also recorded but only on presentation.

Results : A total of 132 patients were evaluated over a two year period .Respiratory symptoms at presentation were persistent irritative cough (92%), itchy throat (85%), globus pharynges (83%), and cricopharngeal spasm (57%).

Endoscope findings revealed gastroduodenitis in 5%, non specific gastritis in 9%, duodenal ulcer in 2%, and normal findings in 62.7%, while Laryngoscopic finding were mainly posterior commissure injection 82%, vocal cord edema 74%, laryngeal erythema 77% and subglottic edema 24%.

Patients were treated medically with antacids, H2 antagonists, proton pump inhibitors and were followed up and reexamined by laryngoscope ; all data about improvement in symptom and in the laryngeal signs by Laryngoscopic findings were collected following anti-reflux therapy and showed significant improvement in both ,all were analyzed in special figures and tables.

Conclusion : Reflux laryngitis and LPR should be a differential diagnosis in patients with pharyngeal and laryngeal symptoms not associated with upper respiratory tract disease in the presence or absence of GERD or peptic ulcer symptoms, dyspepsia, regurgitation.

The management should be multidisciplinary.

Laryngoscopic findings were of value in the diagnosis of the changes in laryngeal mucosa pre and post medical treatment by Proton Pump Inhibitors empirical therapy.