Jerome R. Lechien MD, PhD, MScDepartment of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre, Brussels, Belgium

Department of Thoracic – Head & Neck Surgery, Centre Oscar Lambret, Lille, France

Department of Anatomy, School of Medicine, University of Mons, Mons, Belgium

Research Committee of YO-IFOS:

Laryngopharyngeal Reflux Study Group

Tareck Ayad MD, FRCS

Montreal Hospital,

Chairman of Research

Committee

Jay Lechien MD, PhD, MS

University of Mons,

Vice-Chairman of Research

Committee

INTRODUCTION – DEFINITION OF REFLUX & CONTROVERSIES

Introduction-Inflammatory disease

-From 1996 to 2019:

Increased number of

publications

Current controversies & lack of consensus:

1. The diagnostic of LPR

2. The treatment (< poor superiority of PPIs over placebo)

3. The therapeutic outcomes

4. The relationship between LPR & GERD

50

100

1996

2016

2/11

Aim:

To develop an International Study Group

INTRODUCTION –METHODS – RESULTS – DISCUSSION - CONCLUSION

Steps of the group

Step 1: systematic & State-of-the Art Reviews to identify the current controversies.

Meta-analysis about the treatment efficacy.

Step 2: Assessment of current practices of Otolaryngologists around the world

Step 3: Development of multicenter clinical studies

Step 4: Consensus report

4

INTRODUCTION – DEVELOPMENT OF INTERNATIONAL GROUP

LPR Study Group of YO IFOS: Systematic Review of Controversies in reflux

2/11STEP 1: SYSTEMATIC REVIEW & META-ANALYSIS

Main results: Superiority of PPIs = controversial & Poor Clinical therapeutic Outcomes

2/11STEP 1: SYSTEMATIC REVIEW & META-ANALYSIS

Conclusion of Step 1:

1. Superiority of PPIs over placebo is controversial

2. The current patient-reported outcomes questionnaires (symptoms) & Instruments evaluating the findings of reflux are incomplete and not reliable.

3. There are a few studies that used alginate or magaldrate in the treatment of LPR

2/11

Aim: To identify the practice of otolaryngologists in the LPR management

STEP 2: ASSESSMENT OF PRACTICES OF OTOLARYNGOLOGISTS

Elaboration of Survey: 20 questions about:

Definition - Clinical presentation – Diagnostic - Treatment

MonkeySurvey® Professional

YO-IFOS mailing list (IFOS Congress of Paris) – SFORL – Korean, Greece, SIFEL

> 3,000 otolaryngologists

450 responses => the most important survey (worldwlide)

Project = European paper, Asian Paper, North America paper, Speciality paper, & World Trends’ paper

Lechien JR, Mouawad F, Mortuaire G, Remacle M, Bobin F, Huet K, Nacci A, Barillari MR, et al. Awareness of European

Otolaryngologists and General Practitioners Towards Laryngopharyngeal Reflux. Ann Otol Rhinol Laryngol, 2019.

2/11

Lechien JR, Bobin F, Muls V, Thill MP, Horoi M, Ostermann K, Huet K, Harmegnies B, Dequanter D, Dapri G, Maréchal

MT, Finck C, Rodriguez A, Saussez. Reliability & Validity of the Reflux Symptom Score. Laryngoscope, 2019. 8

Aim: To develop Reflux Symptom Score & Reflux Sign Assessment

STEP 3: DEVELOPMENT OF NEW CLINICAL TOOLS

9Lechien JR, Rodriguez A, Dequanter D, Bobin F, Mouawad F, Muls V, Huet K, Harmegnies B, Remacle S, Finck C, Saussez. Validity and

Reliability of the Reflux Sign Assessment. Under Review in Ann Otol Rhinol Laryngol, 2019.

STEP 3: DEVELOPMENT OF NEW CLINICAL TOOLS

Aim: To develop Reflux Symptom Score & Reflux Sign Assessment

103 patients with LPR

10

Impedance-pH monitoring:

Acid vs Nonacid vs Mixed

Personalized treatment:

Lechien JR, Akst LM, Hamdan AL, Schindler A, Karkos PD, Barillari MR, Calvo-Henriquez C, Crevier-Buchman L, Finck C, Eun YG, Saussez S,

Vaezi MF. Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review. Otolaryngol-Head Neck Surg, 2019

Acid LPR: diet + PPIs (2/d) + Gaviscon

Nonacid LPR: diet + Gaviscon/Riopan

Mixed LPR: diet + PPIs + Gaviscon (3/d)

STEP 3: DEVELOPMENT OF NEW CLINICAL TOOLS

RSS Acid

Evolution RSS & RSA (N=102)

RSS Nonacid RSS mixed

RSA Acid RSA Nonacid RSA mixed

P=0.001 P=0.015 P=0.042

P=0.013 P=0.036 P=0.004

Significant improvement of ENT & Digestive Symptoms and Laryngealand Extra-laryngeal signs. No difference between groups. 11

STEP 3: DEVELOPMENT OF NEW CLINICAL TOOLS

2/11SUMMARIZE

Step 1:

-Lechien, Schindler et al. Instruments Evaluating the Clinical Findings of Laryngopharyngeal Reflux: A Systematic Review. Laryngoscope. 2019

-Lechien, Askt et al. Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review. Otolaryngol Head Neck Surg, 2019.

-Lechien, Saussez et al. Clinical Outcomes of Laryngopharyngeal reflux Treatment: A Systematic review and Meta-analysis. Laryngoscope.

-Lechien, Saussez, et al. Association between Laryngopharyngeal Reflux and Benign Vocal Folds Lesions: A Systematic Review. Laryngoscope, 2019

-Lechien, Dapri et al. Surgical treatment for laryngopharyngeal reflux disease: A systematic review of 2,190 patients. JAMA Otolaryngol Head Neck Surg. 2019.

-Lechien, Muls et al. Management of Patients with recalcitrant Laryngopharyngeal Reflux: Contemporary Review. Clin Otolaryngol, 2019.

-Lechien, Saussez & Karkos. Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018. Curr Opin Otolaryngol Head Neck Surg, 2018.

Step 2:

Lechien, Mouawad et al. Awareness of European Otolaryngologists and General Practitioners Towards Laryngopharyngeal Reflux. Accepted for publication in Ann Otol Rhinol Laryngol, 2019

Step 3:Lechien, Bobin et al. Validity and reliability of the Reflux Symptom Score. Laryngoscope. 2019Lechien, Rodriguez et al. Validity and reliability of the Reflux Sign Assessment. Under review. 2019

Step 4: In process => Next IFOS Congress, Vancover, Canada.

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INTRODUCTION – LPR STUDY GROUP

LPR Study Group of YO IFOS: Systematic Review of Controversies in reflux