Yadlapati R, Weissbrod P, Walsh E, et al. The San Diego consensus for laryngopharyngeal symptoms and laryngopharyngeal reflux disease. American Journal of Gastroenterology. April 08, 2025.

Авторы: Yadlapati R. / Weissbrod Ph.A.  / Walsh E.H.  / Carroll T.L.  / Chan W.W. / Gartner-Schmidt J. / Guadagnoli L.A. / Jette M. / Myers J.C. / O’Rourke A.K.  / Sweis R. / Wu J. / Barkmeier-Kraemer J.M. / Cates D. / Chen Ch.-L.  / Coss-Adame E. / Dion G.R. / Francis D.O. / Kaneko M. / Lechien J.R. / Misono St. / Rameau A. / Roman S. / Vertigan A.E.  / Xiao Y. / Zerbib F. / Greytak M. / Pandolfino J.E. / Gyawali C.P.

American Journal of Gastroenterology Publish Ahead of Print

DOI: 10.14309/ajg.0000000000003482

The San Diego consensus for laryngopharyngeal symptoms and laryngopharyngeal reflux disease

¹ Center for Esophageal Diseases, University of California San Diego, La Jolla, CA, USA
² Department of Otolaryngology, University of California San Diego, La Jolla, CA, USA
³ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA and Division of Otolaryngology, Brigham and Women’s Hospital, Boston, MA
⁴ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
⁵ Carlow University, Department of Speech-Language Pathology, Pittsburgh, PA, USA
⁶ Kenneth C. Griffin Esophageal Center Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
⁷ Department of Otolaryngology – Head & Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
⁸ Oesophageal Function, The Queen Elizabeth Hospital & Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
⁹ Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
¹⁰ Division of Gastroenterology, University College London Hospital
¹¹ Department of Medicine & Therapeutics, The Chinese University of Hong Kong.
¹² Department of Otolaryngology – Head & Neck Surgery, University of Utah
¹³ Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
¹⁴ Department of Gastroenterology, GI Motility Lab, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
¹⁵ Dept of Otolaryngology – Head and Neck Surgery, University of Cincinnati, Cincinnati, OH
¹⁶ Division of Otolaryngology, Department of Surgery, University of Wisconsin – Madison
¹⁷ Department of Otolaryngology Head & Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto Japan
¹⁸ Department of Surgery, University of Mons, Mons, Belgium.
¹⁹ Department of Otolaryngology, University of Minnesota
²⁰ Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
²¹ Digestive Physiology, Hospices Civils de Lyon, Hopital E Herriot, F-69437, LYON, France
²² Digestive Physiology, Lyon I University, F-69008, LYON, France
²³ LabTAU, INSERM, Université Lyon 1, Univ Lyon, F-69003, LYON, France
²⁴ Speech Pathology Department, John Hunter Hospital, Newcastle, Australia
²⁵ Centre for Asthma and Breathing, Hunter Medical Research Institute, Newcastle, Australia
²⁶ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
²⁷ Department of gastroenterology and hepatology, First affiliated hospital, Sun Yat-sen University.
²⁸ CHU de Bordeaux, Centre Medio-chirurgical Magellan, Hopital Haut-Leveque, Department of Gastroenterology, Universite de Bordeaux, France
²⁹ Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA


ABSTRACT

Background: The term ‘laryngopharyngeal reflux’ (‘LPR’) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. This initiative aimed to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.

Methods: A 28-member international inter-disciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations.

Results: The term ‘laryngopharyngeal symptoms’ (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. ‘Laryngopharyngeal reflux disease’ (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for non-reflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive anti-reflux management. The two recommended ambulatory reflux monitoring modalities, 24h pH-impedance and 96h wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators.

Conclusions: The San Diego Consensus represents the formal modern-day inter-disciplinary care paradigm to evaluate and manage LPS and LPRD.




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