Laryngopharyngeal reflux in chronic obstructive pulmonary disease - a multi-centre study
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LETTER TO THE EDITOR
Open Access
Laryngopharyngeal reflux in chronic obstructive pulmonary disease - a multicentre study Julia Sanchez1, Desiree M. Schumann1, Meropi Karakioulaki1, Eleni Papakonstantinou1, Frank Rassouli2, Matthias Frasnelli3, Martin Brutsche2, Michael Tamm1 and Daiana Stolz1*
Abstract Reflux of gastric content has been associated with recurrent exacerbations of chronic obstructive pulmonary disease (COPD). We aimed to assess the prevalence of laryngopharyngeal reflux (LPR) in COPD and if LPR is a contributing factor to clinically relevant outcomes in COPD. We evaluated a total of 193 COPD patients (GOLD I-IV) with a 24-h laryngo-pharyngeal pΗ-monitor. LPR was observed in 65.8% of COPD patients and it was not significantly associated with clinically relevant outcomes of COPD. Treatment with PPI significantly decreased the upright RYAN score (p = 0.047) without improving lung function. Furthermore, the presence or severity of LPR cannot be diagnosed based solely on symptoms and questionnaires. Keywords: Laryngopharyngeal reflux, Chronic obstructive pulmonary disease, Proton pump inhibitor therapy, RYAN score, Gastroesophageal reflux
Background Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease and one of the leading causes of mortality worldwide [1]. The clinical severity of COPD is determined by comorbidities, one of which is the gastroesophageal reflux disease (GERD) [2–5]. GERD is a common cause of chronic cough [6] and a potential risk factor for exacerbations of COPD [7–10]. Frequent exacerbators have a high prevalence of GERD, however approximately 58% of these patients lack typical GERD symptoms [11, 12]. Laryngopharyngeal reflux (LPR) represents an extraesophageal manifestation of GERD. The reflux of gastric contents is fundamental in both LPR and GERD, but the mechanism and the symptoms of the disorders are distinct [13–15]. LPR occurs when gastric contents pass * Correspondence: [email protected] 1 Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland Full list of author information is available at the end of the article
the upper esophageal sphincter and usually occurs during daytime in the upright position, while GERD occurs when gastric contents pass the lower esophageal sphincter and takes place more often in the supine position at night-time or during sleep [16]. LPR may be a contributing factor in patients with symptomatic COPD however, there are only a few studies analyzing the impact of LPR in patients with COPD [13, 17, 18]. In a large longitudinal study of COPD patients, selfreported GERD or use of PPIs was associated with a 20– 60% increased risk of moderate-severe exacerbations and hospitalized exacerbations during 3 years of follow up [19]. Yet, this study was based on a subjective, selfreported history of a physician’s diagnosis of GERD and studies based on objective evaluations by laryngealpharyngeal pH monitoring in a large COPD cohort are still missing. Here, we in
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