User:JessicaVoiceDisorders/sandbox

Laryngopharyngeal Reflux
LPR is the retrograde flow of gastric contents into the larynx, oropharynx and/or the nasopharynx.LPR causes respiratory symptoms such as cough and wheezing and is often associated with head and neck complaints such as dysphonia, globus pharyngeus, and dysphagia. LPR may play a role in other diseases such as sinusitis, otitis media, and rhinitis,[6] and can be a comorbidity of asthma.[5] While LPR is commonly used interchangeably with gastroesophageal reflux disease (GERD), it presents with a different pathophysiology.

Signs and Symptoms
LPR is a chronic and intermittent disease in children. LPR in children is commonly concomitant with laryngeal disorders such as laryngomalacia, subglottic stenosis and recurrent papillomatosis.

Diagnosis
LPR presents with non-specific symptoms and signs that make differential diagnosis difficult to achieve. Furthermore, symptoms of the disorder overlap greatly with symptoms of other disorders. Therefore, LPR is under-diagnosed and under-treated.

There is no agreed-upon assessment technique to identify LPR in children. Of these debated diagnostic tools, multichannel intraluminal impedance with pH monitoring (MII-pH) demonstrates relative strengths as it recognizes both acid and non-acid reflux. A more common technique that is used is 24-h dual probe pH monitoring. Both of these tools are expensive and are therefore not widely used.

Questionnaires can be administered to receive information about the patient's medical history as well as their symptomatology. The following questionnaires may be used: Reflux Symptom Index (RSI), Quality-of-Life Index (QLI) for LPR, Glottal Closure/Function Index (GCI) and Voice Handicap Index (VHI). Other, more invasive tests, such as fibre-optic transnasal laryngoscopy, 24-hour ambulatory dual probe pHmetry, pharyngeal pHmetry, transnasal esophagoscopy (TNE) and biopsy may be used. A noninvasive test for diagnosis of LPR is the collection of refluxate where the refluxed material is collected and analyzed.[7] Another noninvasive diagnostic test that can be used is an empirical trial of proton-pump inhibitor therapy; however, this test is mostly successful in diagnosing GERD.

In the laryngopharyngeal reflux (LPR) page, I plan to add the following:

1) Make a clear distinction between LPR and GERD.

2) Discuss the prevalence of LPR.

3) Add a section on LPR in the paediatric population, focusing on assessment.

4) Discuss the role of helicobactor pylori in LPR.