| Abstract [eng] |
Introduction. Laryngopharyngeal reflux is defined as retrograde exposure of the upper aerodigestive tract mucosa to gastric contents, resulting in chemical irritation, inflammatory mucosal changes, and a broad spectrum of throat-related symptoms. Although the disease is often considered within the gastroesophageal reflux disease spectrum, distinct pathophysiology and the etiology of damage, along with the heterogeneity of proximal exposure, justify a specific diagnostic and therapeutic algorithm. Aim. To identify and analyze the essential aspects of laryngopharyngeal reflux diagnosis and management based on the latest scientific literature and to provide evidence-based recommendations. Methods. A narrative literature review was conducted using keyword-based search in international databases, including open-access English publications from 2015 onwards. Results. Laryngopharyngeal reflux most commonly presents with throat and voice complaints, yet symptoms and laryngoscopic findings are non-specific and overlap with other otorhinolaryngological conditions. In clinical practice, a stepwise evaluation is applied, differentiating alternative causes of symptoms, while symptom questionnaires and laryngoscopic findings scales are used to monitor dynamics and response to treatment. Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring provides the most objective assessment of proximal reflux exposure, and >1 hypopharyngeal reflux event within 24 hours is considered a diagnostic threshold. First-line management is based on dietary and behavioural modifications, with alginates described as a safe adjuvant option suitable for integration into the initial treatment strategy. Acid suppression is recommended selectively, when phenotype characteristics and (or) objective test results support acid exposure as the predominant mechanism rather than as a universal empirical approach. Agents aimed at reducing the frequency of reflux episodes should be reserved for selected patients, as their use is limited by intolerance and adverse effects. Evidence supporting endoscopic and surgical anti-reflux interventions in laryngopharyngeal reflux remains limited, with the greatest potential benefit observed in phenotypes overlapping with gastroesophageal reflux disease. Conclusions. Laryngopharyngeal reflux is considered a heterogeneous spectrum of clinical phenotypes, therefore, diagnostic and therapeutic strategies should be individualised according to the predominant pathophysiological mechanism, while objective phenotyping enables more targeted selection of conservative interventions and provides a justification for the use of invasive approaches in appropriately selected patients. |
