User:Meggeo/sandbox

Hello, this is my Sandbox where I can practice formatting text and creating links, such as this one to an article I find interesting.

Laryngopharyngeal reflux
After reading through the existing Wikipedia article on laryngopharyngeal reflux, I thought of some ways in which I could contribute to improving the article. First, I believe the article could benefit from some copy-editing, as I noticed some syntactic structures that could be simplified and some disorganization in multiple sections. For example, in the initial section that provides a quick overview of the disorder, the article currently lists alternative names for laryngopharyngeal reflux in two separate paragraphs and I believe this information should be kept together. Additionally, the "Background" section begins with a sentence on gastroesophageal reflux disease and it is unclear whether and how this is related to laryngopharyngeal reflux upon reading the article for the first time. Second, I believe the article is missing important content in some sections. In the introductory section, for instance, I believe pertinent information on incidence and prevalence would be useful. I believe the "Diagnosis" section could benefit from more detailed information on the specific endoscopic procedures used to assess the structure and function of the laryngopharyngeal region.--Meggeo (talk) 23:01, 25 September 2017 (UTC)

My edits are italicized in the text below.

Introduction
Laryngopharyngeal reflux (LPR), also known as extraesophageal reflux disease (EERD), atypical reflux, silent reflux, and supra-esophageal reflux,  refers to the retrograde flow of gastric contents to the upper aero-digestive tract, which causes symptoms such as cough, wheezing, and hoarseness. It can be a relevant comorbidity of asthma.

''LPR reportedly affects approximately 30% of the U.S. population. However, as many as 50% of individuals with voice disorders experience LPR to some degree.''

Background
Note: I contributed no "new" content to this section. However, much of what was there was presented in a biased fashion through reference to specific researchers, so I attempted to rewrite it by incorporating suggestions from my peer reviewers.

LPR was not discussed as a separate clinical entity from gastroesophageal reflux disease (GERD) until the 1970s and 1980s. However, at around the same time that GERD was first recognized as a clinical entity in the mid-1930s, a link between gut symptoms and airway disease was suggested. Later, acid-related laryngeal ulcerations and granulomas were reported in 1968. Subsequent studies suggested that acid reflux might be a contributory factor in other laryngeal and respiratory conditions. In 1979, the link between these airway symptoms and reflux of gastric contents was first documented. At the same time, treatment of reflux disease results was shown to eliminate these airway symptoms.

Relationship to GERD
''LPR is often regarded as a subtype of gastroesophageal reflux disease (GERD) that occurs when stomach contents flow upward through the esophagus and reach the level of the larynx and pharynx. However, LPR is associated with a distinct presentation of symptoms. LPR and GERD frequently differ in the relative prevalence of heartburn and throat clearing. While heartburn is present in over 80% of GERD cases, it occurs in only 20% of LPR cases. Throat clearing shows the opposite prevalence pattern, occurring in approximately 87% of LPR cases and in fewer than 5% of GERD cases. Unlike GERD, laryngopharyngeal reflux also poses a risk for bronchitis or pneumonitis as reflux of stomach acid to the level of the larynx can result in aspiration. Additionally, LPR is commonly associated with erythema, or redness, as well as edema in the tissues of the larynx that are exposed to gastric contents. In contrast, most cases of GERD are nonerosive, with no apparent injury to the mucosal lining of the esophagus.''

''Differences in the molecular structure of the epithelial tissue lining the laryngopharyngeal region may be partly responsible for the different symptomatic manifestations of LPR in comparison to GERD. In contrast to the resistant stratified squamous epithelium lining the esophagus, the larynx is lined by ciliated respiratory epithelium, which is more fragile and susceptible to damage. While the epithelium lining the esophagus is capable of withstanding as many as 50 instances of exposure to gastric contents each day, which is the uppermost estimate considered to be within the range of normal physiologic functioning, injury to laryngeal epithelium can occur following exposure to only minute amounts of acidic gastric contents.''

Signs and symptoms
Extraesophageal symptoms are the result of exposure of the upper aerodigestive tract to the gastric juice. This causes a variety of symptoms, including hoarseness, postnasal drip, sore throat, difficulty swallowing, indigestion, wheezing, chronic cough, globus pharyngis and chronic throat-clearing. Some people with LPR have heartburn, while others have little or none of these symptoms. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus.

Adults who are afflicted with LPR often experience a sour taste emanating from the back of their throat due to bile. This is also likely to be accompanied by a lump-like sensation in the throat, making it difficult to swallow. The throat may also seem to burn and breathing can be difficult. These symptoms are most often prevalent just after waking.

People with more severe forms of LPR may experience abrasion of tooth enamel due to intermittent presence of gastric contents in the oral cavity.

LPR may also result in sinusitis and difficulty breathing.

Potential bibliography
Harrison's Principles of Internal Medicine --Meggeo (talk) 00:03, 26 September 2017 (UTC)

Voice Therapy: Clinical Case Studies --Meggeo (talk) 00:03, 26 September 2017 (UTC)

Extraesophageal Reflux --Meggeo (talk) 00:03, 26 September 2017 (UTC)

Reflux Laryngitis and Related Disorders --Meggeo (talk) 00:03, 26 September 2017 (UTC)

Nonerosive Reflux Disease (NERD) - An Update