research committee of yo-ifos: laryngopharyngeal reflux ... · laryngopharyngeal reflux disease:...
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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.
13
INTRODUCTION – LPR STUDY GROUP
LPR Study Group of YO IFOS: Systematic Review of Controversies in reflux
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