Rena Yadlapati, MD, is director of the Center for Esophageal Diseases and associate professor of Clinical Medicine at the University of California San Diego. 

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TRANSCRIPT:

Dr. Rena Yadlapati:

Hi, I'm Dr. Rena Yadlapati, associate professor at University of California, San Diego where I direct the Esophageal Center. And I'm really honored to talk about a presentation I gave at DDW this year. It was titled, Diagnostic Approaches and Challenges to Laryngopharyngeal Reflux. In GI, laryngopharyngeal reflux or LPR is a very complex and confusing scenario that we all face because patients that come in with sore throat, cough voice, voice hoarseness could have symptoms from acid reflux or it could be related to other things like lung conditions or allergies. So as a gastroenterologist, how do we tease this out? How do we discern if it is actually acid reflux?

Well, it's really important to note that there is a new recommendation in the field of LPR. If you have a patient that you're evaluating for LPR before you start acid suppressive therapy, like proton pump inhibitors, we need to do upfront diagnostic testing to make sure that the patient actually has evidence of reflux. So that would be doing an upper endoscopy or ambulatory reflux monitoring done off acid suppression.

Now, one of the areas that we don't fully understand is what's the best reflux monitoring tool? Is it prolonged wireless reflux monitoring or is it pH-impeded monitoring done over 24 hours? So that's an area that needs more research and hopefully, we'll be hearing about it soon.

Some other things to know is that laryngoscopy and oral pharyngeal pH monitoring don't have sufficient data to serve as standalone diagnostic tests for LPR, so don't rely on those, but they can provide helpful information when you're putting the whole clinical picture together. We also talked a lot about diagnostics that are on the horizon, so for instance, clinical risk prediction scores. So looking at a patient's symptoms, their demographic profile, and predicting the likelihood that they actually have LPR versus they don't. And I think that this is something we'll be hearing a lot more about in the future. Also, the potential role of salivary biomarkers. So measuring things like pepsin or bile acids in the saliva, which is a non-invasive diagnostic method, and perhaps, this can obviate the need for some patients to get more invasive testing.

In the end, where we're moving with diagnostics in LPR is rather than approaching everyone the same and using empiric approaches, we're moving towards more personalized care and using non-invasive risk stratification methods upfront and then once we have arrived at a diagnosis, utilizing an integrated, multidisciplinary approach to really personalize their therapy.

Thanks so much.
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