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Received Jul 18, 2017; Revised Dec 9, 2017; Accepted Jan 8, 2018
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1. Introduction
During the last decades, interest in exploring gastric reflux and understanding its comorbidity has increased. Asher Winkelstein discovered gastroesophageal reflux disease (GERD) in 1935, and it was clinically diagnosed by the presence of typical symptoms such as heartburn and acidic regurgitation [1]. Interestingly, otolaryngologists found that some patients presented with no specific symptoms arising from the upper aerodigestive tract with substantial evidence of acidic reflux sequelae despite a lack of typical GERD symptoms [2]. A new era of interest in the field of GERD research was subsequently established to answer the following questions: what is laryngopharyngeal reflux (LPR)? What are the factors that distinguish LPR from GERD? How can we diagnose LPR? And finally, what is the perfect plan to manage LPR [3]?
Reflux of gastric contents into the upper aerodigestive tract despite the absence of heartburn and regurgitation is what defines LPR [4]. As stated in the literature, there are debates regarding whether to consider it as an atypical presentation of GERD or an entirely different disease entity known as LPR [5, 6]. LPR and GERD can be differentiated; heartburn and acidic regurgitation that commonly occur at night and frequently in the supine position in addition to classical sequelae that demonstrate the presence of esophagitis as detected by endoscopy or pH monitoring systems indicate a diagnosis of GERD [4, 7]. In contrast, the diagnosis of the LPR is a complex process. The diagnosis encompasses cumulative results of clinical interviews and investigations and even challenging treatment methods [7–9]. Based on clinical history, LPR presents with ambiguous symptoms such as hoarseness, throat clearing, and globus pharyngeus [7, 10]. Thus, the determination of the precise prevalence of LPR is a challenge.
LPR was initially reported in 1968 by Cherry and Margulies [2]. Since that time, the association of LPR with other medical conditions has been recognized. This association encompasses chronic pharyngitis [11], obstructive sleep apnea [12], chronic rhinosinusitis [13–15], and asthma [16]. Furthermore, the awareness of LPR as an airway disease has grown...