OBJECTIVE: The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. METHODS: Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. RESULTS: After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. CONCLUSION: A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1614-1624, 2024.

Abbvie Inc Chicago Illinois USA

Department of Biomedical and Clinical Sciences L Sacco University of Milan Milan Italy

Department of gastroenterology CHU Saint Pierre Brussels

Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan

Department of Laryngology and Broncho Esophagology Mons Belgium

Department of Metrology and Langage Science University of Mons Mons Belgium

Department of Otolaryngology Academy of Medicine Lithuanian University of Health Sciences Kaunas Lithuania

Department of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USA

Department of Otolaryngology Centre Hospitalier du Luxembourg Luxembourg Luxembourg

Department of Otolaryngology Head and Neck Surgery Department of Biomedical Science and Technology Graduate School Kyung Hee University Kyung Hee University School of Medicine Kyung Hee University Medical Center Seoul Republic of Korea

Department of Otolaryngology Head and Neck Surgery Drexel University College of Medicine Philadelphia Pennsylvania USA

Department of Otolaryngology Head and Neck Surgery Foch Hospital Paris Saclay University Research Committee of Young Otolaryngologists of the International Federations of Oto Rhino Laryngological Societies Paris France

Department of Otolaryngology Head and Neck Surgery Geisinger Medical Center Danville Pennsylvania USA

Department of Otolaryngology Head and Neck Surgery Hospital Israelita Albert Einstein São Paulo Brazil

Department of Otolaryngology Head and Neck Surgery Johns Hopkins Hospital Johns Hopkins School of Medicine Baltimore Maryland USA

Department of Otolaryngology Head and Neck Surgery Medical College of Georgia at Augusta University Augusta Georgia USA

Department of Otolaryngology Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA

Department of Otolaryngology Head and Neck Surgery New York University School of Medicine New York New York USA

Department of Otolaryngology Head and Neck Surgery University of Auckland Auckland New Zealand

Department of Otolaryngology Head Neck Surgery Montreal Hospital Montreal Canada

Department of Otolaryngology New York Medical College School of Medicine Valhalla NY; Institute for Voice and Swallowing Disorders Sleepy Hollow NY USA

Department of Otolaryngology School of Medicine São Paulo Federal University Sao Paulo Brazil

Department of Otolaryngology UC Davis Medical Center Sacramento California USA

Department of Otorhinolaryngology and Head and Neck Surgery CHU de Bruxelles CHU Saint Pierre School of Medicine Brussels Belgium

Department of Otorhinolaryngology and Head and Neck Surgery Hospital Complex of Santiago de Compostela Santiago de Compostela Spain

Department of Otorhinolaryngology and Head and Neck Surgery Polyclinic of Poitiers Poitiers France

Department of Otorhinolaryngology and Head and Neck Surgery Thessaloniki Medical School Thessaloniki Greece

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Ostrava Ostrava Czech Republic

Department of Otorhinolaryngology Clinical Hospital University of São Paulo School of Medicine Sao Paulo Brazil

Department of Otorhinolaryngology Head and Neck Surgery American University of Beirut Medical Center Beirut Lebanon

Department of Otorhinolaryngology Head and Neck Surgery CHU de Liege Liege Belgium

Department of Otorhinolaryngology Head and Neck Surgery Hospital Universitario Donostia San Sebastian Spain

Department of Surgery Drexel University Philadelphia Pennsylvania USA

Department of Surgery Oncology and Gastroenterology University of Padua Padua Italy

Disciplina de Otorrinolaringologia Universidade Federal de Ciências da Saúde de Porto Alegre Porto Alegre Brazil

Divisão de Otorrinolaringologia Fleury Medicina e Saúde Laboratórios de Diagnóstico São Paulo Brazil

Division of Gastroenterology and Hepatology Department of Medicine Stanford University Redwood City California USA

Division of Gastroenterology Hepatology and Endoscopy Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA

Division of Gastroenterology Hepatology and Nutrition Vanderbilt University Medical Center Nashville Tennessee USA

Division of Otolaryngology Head and Neck Surgery Department of Surgery Brigham and Women's Hospital and Department of Otolaryngology Head and Neck Surgery Harvard Medical School Boston Massachusetts USA

Division of Phoniatrics and Audiology Department of Mental and Physical Health and Preventive Medicine L Vanvitelli University Naples Italy

ENT Centre and Singapore Medical Specialist Centre Singapore Singapore

Faculty of Health Sciences Klaipeda university Klaipeda Lithuania

IFOS Board Paris France

International School Reduced Scar Laparoscopy Minimally Invasive General and Oncologic Surgery Center Humanitas Gavazzeni University Hospital Bergamo Italy

Netcare Park Lane Hospital Johannesburg South Africa

Queensland Voice Centre Brisbane Australia

See more in PubMed

Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127(1):32-35. https://doi.org/10.1067/mhn.2002.125760.

Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2 Suppl 53):1-78. https://doi.org/10.1002/lary.1991.101.s53.1.

Lien HC, Wang CC, Kao JY, et al. Distinct physiological characteristics of isolated laryngopharyngeal reflux symptoms. Clin Gastroenterol Hepatol. 2020;18(7):1466-1474.e4. https://doi.org/10.1016/j.cgh.2019.08.064.

Wu Y, Wang J, Huang Q, et al. The relationship between gastroesophageal reflux disease and laryngopharyngeal reflux based on pH monitoring. Ear Nose Throat J. 2021;100(4):249-253. https://doi.org/10.1177/0145561320971915.

Lechien JR, Chan WW, Akst LM, et al. Normative ambulatory reflux monitoring metrics for laryngopharyngeal reflux: a systematic review of 720 healthy individuals. Otolaryngol Head Neck Surg. 2022;166(5):802-819. https://doi.org/10.1177/01945998211029831.

Altman KW, Prufer N, Vaezi MF. A review of clinical practice guidelines for reflux disease: toward creating a clinical protocol for the otolaryngologist. Laryngoscope. 2011;121(4):717-723. https://doi.org/10.1002/lary.21429.

Gaynor EB. Otolaryngologic manifestations of gastroesophageal reflux. Am J Gastroenterol. 1991;86(7):801-808.

Sikavi DR, Cai JX, Carroll TL, Chan WW. Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol. 2021;36(8):2076-2082. https://doi.org/10.1111/jgh.15391.

Strugala V, Dettmar PW, Bittenglova R, Fremundova L, Peŝek M. Use of pepsin detection to identify airways reflux in a range of pulmonary diseases. Clin Respir J. 2017;11(5):666-667. https://doi.org/10.1111/crj.12395.

Jung YH, Lee DY, Kim DW, Park SS, Heo EY, Chung HS. Kim DK clinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:1343-1351. https://doi.org/10.2147/COPD.S84337.

Thomas JP, Zubiaur FM. Over-diagnosis of laryngopharyngeal reflux as the cause of hoarseness. Eur Arch Otorhinolaryngol. 2013;270(3):995-999. https://doi.org/10.1007/s00405-012-2244-8.

Francis DO, Vaezi MF. Should the reflex be reflux? Throat symptoms and alternative explanations. Clin Gastroenterol Hepatol. 2015;13(9):1560-1566. https://doi.org/10.1016/j.cgh.2014.08.044.

Lechien JR. Do otolaryngologists over- or underestimate laryngopharyngeal reflux symptoms and findings in clinical practice? A comparison study between the true prevalence and the otolaryngologist-estimated prevalence of symptoms and findings. J Clin Med. 2022;11(17):5192. https://doi.org/10.3390/jcm11175192.

Bor S, Capanoglu D, Vardar R, Woodcock AD, Fisher J, Dettmar PW. Validation of Peptest™ in patients with gastro-esophageal reflux disease and laryngopharyngeal reflux undergoing impedance testing. J Gastrointestin Liver Dis. 2019;28(4):383-387. https://doi.org/10.15403/jgld-335.

Lechien JR. Clinical update findings about pH-impedance monitoring features in laryngopharyngeal reflux patients. J Clin Med. 2022;11(11):3158. https://doi.org/10.3390/jcm11113158.

Van Daele DJ. Esophageal manometry, pH testing, endoscopy, and video fluoroscopy in patients with globus sensation. Laryngoscope. 2020;130(9):2120-2125. https://doi.org/10.1002/lary.28289.

de Bortoli N, Martinucci I, Bertani L, et al. Esophageal testing: what we have so far. World J Gastrointest Pathophysiol. 2016;7(1):72-85. https://doi.org/10.4291/wjgp.v7.i1.72.

Murphy MK, Black NA, Lamping DL, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2(3):i-iv. 1-88.

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900-1920; quiz 1943. https://doi.org/10.1111/j.1572-0241.2006.00630.x.

Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401-406.

Pauwels A, Boecxstaens V, Andrews CN, et al. How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut. 2019;68(11):1928-1941. https://doi.org/10.1136/gutjnl-2019-318260.

Koufman JA, Belafsky PC, Bach KK, Daniel E, Postma GN. Prevalence of esophagitis in patients with pH-documented laryngopharyngealreflux. Laryngoscope. 2002;112(9):1606-1609. https://doi.org/10.1097/00005537-200209000-00014.

Lechien JR, Bobin F, Muls V, Saussez S, Hans S. Laryngopharyngeal reflux disease is more severe in obese patients: a prospective multicenter study. Laryngoscope. 2021;131(11):E2742-E2748. https://doi.org/10.1002/lary.29676.

Carroll TL, Nahikian K, Asban A, Wiener D. Nissen fundoplication for laryngopharyngeal reflux after patient selection using dual pH, full column impedance testing: a pilot study. Ann Otol Rhinol Laryngol. 2016;125(9):722-728. https://doi.org/10.1177/0003489416649974.

Samuels TL, Johnston N. Pepsin in gastroesophageal and extraesophageal reflux: molecular pathophysiology and diagnostic utility. Curr Opin Otolaryngol Head Neck Surg. 2020;28(6):401-409. https://doi.org/10.1097/MOO.0000000000000664.

Klimara MJ, Johnston N, Samuels TL, et al. Correlation of salivary and nasal lavage pepsin with MII-pH testing. Laryngoscope. 2020;130(4):961-966. https://doi.org/10.1002/lary.28182.

Lechien JR, Saussez S, Harmegnies B, Finck C, Burns JA. Laryngopharyngeal reflux and voice disorders: a multifactorial model of etiology and pathophysiology. J Voice. 2017;31(6):733-752. https://doi.org/10.1016/j.jvoice.2017.03.015.

Sereg-Bahar M, Jerin A, Jansa R, Stabuc B, Hocevar-Boltezar I. Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux - a prospective comparative study. Clin Otolaryngol. 2015;40(3):234-239. https://doi.org/10.1111/coa.12358.

Vageli DP, Doukas SG, Doukas PG, Judson BL. Bile reflux and hypopharyngeal cancer. Oncol Rep. 2021;46(5):244. https://doi.org/10.3892/or.2021.8195.

Aviv JE, Liu H, Parides M, Kaplan ST, Close LG. Laryngopharyngeal sensory deficits in patients with laryngopharyngeal refluxand dysphagia. Ann Otol Rhinol Laryngol. 2000;109(11):1000-1006. https://doi.org/10.1177/000348940010901103.

Lechien JR, Bobin F, Muls V, et al. Gastroesophageal reflux in laryngopharyngeal reflux patients: clinical features and therapeutic response. Laryngoscope. 2020;130(8):E479-E489. https://doi.org/10.1002/lary.28482.

Groome M, Cotton JP, Borland M, McLeod S, Johnston DA, Dillon JF. Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux. Laryngoscope. 2007;117(8):1424-1428.

Lechien JR, Bobin F, Mouawad F, et al. Development of scores assessing the refluxogenic potential of diet of patients with laryngopharyngeal reflux. Eur Arch Otorhinolaryngol. 2019;276(12):3389-3404. https://doi.org/10.1007/s00405-019-05631-1.

Zalvan CH, Hu S, Greenberg B, Geliebter J. A comparison of alkaline water and mediterranean diet vs proton pump inhibition for treatment of laryngopharyngeal reflux. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1023-1029. https://doi.org/10.1001/jamaoto.2017.1454.

Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011;120(5):281-287. https://doi.org/10.1177/000348941112000501.

Arivan R, Deepanjali S. Prevalence and risk factors of gastro-esophageal reflux disease among undergraduate medical students from a southern Indian medical school: a cross-sectional study. BMC Res Notes. 2018;11(1):448. https://doi.org/10.1186/s13104-018-3569-1.

Thomas FB, Steinbaugh JT, Fromkes JJ, Mekhjian HS, Caldwell JH. Inhibitory effect of coffee on lower esophageal sphincter pressure. Gastroenterology. 1980;79(6):1262-1266.

Boekema PJ, Samsom M, Smout AJ. Effect of coffee on gastro-oesophageal reflux in patients with reflux disease and healthy controls. Eur J Gastroenterol Hepatol. 1999;11(11):1271-1276.

Cao H, Huang X, Zhi X, Han C, Li L, Li Y. Association between tea consumption and gastroesophageal reflux disease: a meta-analysis. Medicine (Baltimore). 2019;98(4):e14173. https://doi.org/10.1097/MD.0000000000014173.

Lechien JR, Akst LM, Hamdan AL, et al. Evaluation and management of laryngopharyngeal reflux disease: state of the art review. Otolaryngol Head Neck Surg. 2019;160(5):762-782. https://doi.org/10.1177/0194599819827488.

Lechien JR, Akst LM, Saussez S, et al. Involvement of laryngopharyngeal reflux in select nonfunctional laryngeal diseases: a systematic review. Otolaryngol Head Neck Surg. 2021;164(1):37-48. https://doi.org/10.1177/0194599820933209.

Aldhahrani A, Powell J, Ladak S, et al. The potential role of bile acids in acquired laryngotracheal stenosis. Laryngoscope. 2018;128(9):2029-2033. https://doi.org/10.1002/lary.27105.

Bobin F, Auregan G, Muls V, et al. Impedance-pH monitoring profile of patients with reflux and obstructive sleep apnea syndrome: a controlled study. Clin Otolaryngol. 2021;46(4):816-822. https://doi.org/10.1111/coa.13745.

Formánek M, Komínek P, Jančatová D, et al. Laryngopharyngeal reflux is a potential risk factor for juvenile-onset recurrent respiratory papillomatosis. Biomed Res Int. 2019;2019:1463896. https://doi.org/10.1155/2019/1463896.

Zeleník K, Javorská Z, Taimrová R, et al. Association between inferior turbinate hypertrophy and extraesophageal reflux. JAMA Otolaryngol Head Neck Surg. 2022;148(8):773-778. https://doi.org/10.1001/jamaoto.2022.1638.

Altundag A, Cayonu M, Salihoglu M, et al. Laryngopharyngeal reflux has negative effects on taste and smell functions. Otolaryngol Head Neck Surg. 2016;155(1):117-121. https://doi.org/10.1177/0194599816640249.

Zubčić Ž, Mendeš T, Včeva A, Mihalj H, Bogović V, Milanković SG. Presence of pepsin in laryngeal tissue and saliva in benign and malignant neoplasms. Biosci Rep. 2020;40(11):BSR20200216. https://doi.org/10.1042/BSR20200216.

Pan Y, Li J, Wang X, Zhang J, Zhang C, Liu Z. Prognosis of patients with laryngeal contact granuloma: development and validation of RCGSG score. Laryngoscope Investig Otolaryngol. 2022;7(6):1973-1978. https://doi.org/10.1002/lio2.969.

Carr TF, Peters AT. Chapter 12: asthma: principles of treatment. Allergy Asthma Proc. 2012;33(Suppl 1):39-43. https://doi.org/10.2500/aap.2012.33.3545.

Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut. 2007;56(12):1654-1664. https://doi.org/10.1136/gut.2007.122465.

Kang JW, Lee YC, Ko SG, Eun YG. The key timing of pharyngeal reflux in patients with laryngopharyngeal reflux. Auris Nasus Larynx. 2022;S0385-8146(22):00221-8. https://doi.org/10.1016/j.anl.2022.11.002.

Lechien JR, Bobin F, Dapri G, et al. Hypopharyngeal-esophageal impedance-pH monitoring profiles of laryngopharyngeal reflux patients. Laryngoscope. 2021;131(2):268-276. https://doi.org/10.1002/lary.28736.

Ren JJ, Zhao Y, Wang J, et al. PepsinA as a marker of laryngopharyngeal reflux detected in chronic rhinosinusitis patients. Otolaryngol Head Neck Surg. 2017;156(5):893-900.

Kayalı Dinc AS, Cayonu M, Sengezer T, Sahin MM. Smoking cessation improves the symptoms and the findings of laryngeal irritation. Ear Nose Throat J. 2020;99(2):124-127. https://doi.org/10.1177/0145561319881559.

Francis DO, Patel DA, Sharda R, et al. Patient-reported outcome measures related to laryngopharyngeal reflux: a systematic review of instrument development and validation. Otolaryngol Head Neck Surg. 2016;155(6):923-935. https://doi.org/10.1177/0194599816664330.

Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274-277. https://doi.org/10.1016/s0892-1997(02)00097-8.

Beaver ME, Stasney CR, Weitzel E, et al. Diagnosis of laryngopharyngeal reflux disease with digital imaging. Otolaryngol Head Neck Surg. 2003;128(1):103-108. https://doi.org/10.1067/mhn.2003.10.

Lechien JR, Bobin F, Muls V, et al. Changes of laryngeal and extralaryngeal symptoms and findings in laryngopharyngeal reflux patients. Laryngoscope. 2021;131(6):1332-1342. https://doi.org/10.1002/lary.28962.

Lechien JR, Bobin F, Muls V, et al. Validity and reliability of the reflux symptom score. Laryngoscope. 2020;130(3):E98-E107. https://doi.org/10.1002/lary.28017.

Lechien JR, Bobin F, Rodriguez A, et al. Development and validation of the short version of the reflux symptom score: reflux symptom Score-12. Otolaryngol Head Neck Surg. 2021;164(1):166-174. https://doi.org/10.1177/0194599820941003.

Bruhn J, Brockmann-Bauser M, Swing T, Bohlender JE, Runggaldier D. Transcultural German translation of the reflux symptom score-12 questionnaire. HNO. 2022;70(12):886-890. https://doi.org/10.1007/s00106-022-01233-2.

Zheng XW, Chen LQ, Chen T, et al. Analysis of reliability and validity of the Chinese version of reflux symptomscore 12. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022;57(9):1087-1094. https://doi.org/10.3760/cma.j.cn115330-20220303-00091.

Min HK, Jeon SY, Lechien JR, et al. Translation and validation of the Korean version of the reflux symptom score. J Voice. 2021;S0892-1997(21):00306-4. https://doi.org/10.1016/j.jvoice.2021.08.026.

Ceccon FP, Aires MM, Lechien JR, et al. Translation and cultural adaptation of the short version of the reflux symptom score: reflux symptom score-12 into Brazilian Portuguese. Braz J Otorhinolaryngol. 2022;S1808-8694(22):00076-3. https://doi.org/10.1016/j.bjorl.2022.05.005.

Kohansal A, Khoddami SM, Ansari NN, Lechien JR, Aghazadeh K. Validity and reliability of the Persian version of reflux symptom score-12 in patients with laryngopharyngeal reflux disease. J Voice. 2022;S0892-1997(22):00224-7. https://doi.org/10.1016/j.jvoice.2022.07.022.

Eckley CA, Tangerina R. Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis. Braz J Otorhinolaryngol. 2023;89(1):54-59. https://doi.org/10.1016/j.bjorl.2021.08.003.

Lechien JR, Schindler A, De Marrez LG, et al. Instruments evaluating the clinical findings of laryngopharyngeal reflux: a systematic review. Laryngoscope. 2019;129(3):720-736. https://doi.org/10.1002/lary.27537.

Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111(8):1313-1317. https://doi.org/10.1097/00005537-200108000-00001.

Reichel O, Issing WJ. Should patients with pH-documented laryngopharyngeal reflux routinely undergo oesophagogastroduodenoscopy? A retrospective analysis. J Laryngol Otol. 2007;121(12):1165-1169. https://doi.org/10.1017/S0022215107000680.

Hoppo T, Sanz AF, Nason KS, et al. How much pharyngeal exposure is “normal”? Normative data for laryngopharyngeal reflux events using hypopharyngeal multichannel intraluminal impedance (HMII). J Gastrointest Surg. 2012;16:16-24.

Zelenik K, Kajzrlikova IM, Vitek P, Urban O, Hanousek M, Kominek P. There is no correlation between signs of reflux laryngitis and reflux oesophagitis in patients with gastro-oesophageal reflux disease symptoms. Acta Otorhinolaryngol Ital. 2017;37(5):401-405.

Tseng WH, Hsu WC, Hsiao TY, et al. Anatomical and physiological characteristics in patients with laryngopharyngeal reflux symptoms: a case-control study utilizing high-resolution impedance manometry. J Formos Med Assoc. 2022;121(6):1034-1043. https://doi.org/10.1016/j.jfma.2021.07.025.

Borges LF, Salgado S, Hathorn KE, Feldman N, Carroll TL, Chan WW. Failed swallows on high-resolution manometry independently correlates with severity of LPR symptoms. J Voice. 2022;36(6):832-837.

Borges LF, Chan WW, Carroll TL. Dual pH probes without proximal esophageal and pharyngeal impedance may be deficient in diagnosing LPR. J Voice. 2019;33(5):697-703.

Liu Z, Zhang C, Wang X, et al. Characteristics of laryngopharyngeal reflux in patients of different genders and ages. J Voice. 2022;S0892-1997(22):00387-3. https://doi.org/10.1016/j.jvoice.2022.11.035.

Ulualp SO, Toohill RJ, Hoffmann R, Shaker R. Pharyngeal pH monitoring in patients with posterior laryngitis. Otolaryngol Head Neck Surg. 1999;120(5):672-677. https://doi.org/10.1053/hn.1999.v120.a91774.

Calvo-Henríquez C, Ruano-Ravina A, Vaamonde P, Martínez-Capoccioni G, Martín-Martín C. Is pepsin a reliable marker of laryngopharyngeal reflux? A systematic review. Otolaryngol Head Neck Surg. 2017;157(3):385-391. https://doi.org/10.1177/0194599817709430.

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.

The role of an anti-reflux diet in the treatment of chronic cough caused by laryngopharyngeal reflux

European clinical practice guideline: managing and treating laryngopharyngeal reflux disease

Narrative review of relationship between chronic cough and laryngopharyngeal reflux