Development of scores assessing the refluxogenic potential of diet of patients with laryngopharyngeal reflux

  • Jerome R. LechienEmail author
  • Francois Bobin
  • Francois Mouawad
  • Karol Zelenik
  • Christian Calvo-Henriquez
  • Carlos M. Chiesa-Estomba
  • Necati Enver
  • Andrea Nacci
  • Maria Rosaria Barillari
  • Antonio Schindler
  • Lise Crevier-Buchman
  • Stéphane Hans
  • Virginie Simeone
  • Elzbieta Wlodarczyk
  • Bernard Harmegnies
  • Marc Remacle
  • Alexandra Rodriguez
  • Didier Dequanter
  • Pierre Eisendrath
  • Giovanni Dapri
  • Camille Finck
  • Petros Karkos
  • Hillevi Pendleton
  • Tareck Ayad
  • Vinciane Muls
  • Sven Saussez



To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR).


European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient.


Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively.


REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance–pH study.


Reflux Diet Laryngitis Laryngopharyngeal Score Symptoms Food Beverage 



Vesale Grant and IRIS-Recherche Grant for the studies conducted in Brussels over the last year; these studies allowing Dr. Jerome Lechien to propose this consensus paper (Dr. Jerome R. Lechien owns the intellectual properties of diet scores).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jerome R. Lechien
    • 1
    • 2
    • 3
    • 4
    Email author
  • Francois Bobin
    • 1
    • 5
  • Francois Mouawad
    • 1
    • 6
  • Karol Zelenik
    • 1
    • 7
  • Christian Calvo-Henriquez
    • 1
    • 8
  • Carlos M. Chiesa-Estomba
    • 1
    • 9
  • Necati Enver
    • 1
    • 10
  • Andrea Nacci
    • 1
    • 11
  • Maria Rosaria Barillari
    • 1
    • 12
  • Antonio Schindler
    • 1
    • 13
  • Lise Crevier-Buchman
    • 1
    • 14
  • Stéphane Hans
    • 1
    • 14
  • Virginie Simeone
    • 1
    • 14
  • Elzbieta Wlodarczyk
    • 1
    • 15
  • Bernard Harmegnies
    • 1
    • 3
  • Marc Remacle
    • 1
    • 16
  • Alexandra Rodriguez
    • 1
    • 4
  • Didier Dequanter
    • 1
    • 4
  • Pierre Eisendrath
    • 1
    • 17
  • Giovanni Dapri
    • 1
    • 18
  • Camille Finck
    • 1
    • 19
  • Petros Karkos
    • 1
    • 20
  • Hillevi Pendleton
    • 1
    • 21
  • Tareck Ayad
    • 1
    • 22
  • Vinciane Muls
    • 1
    • 17
  • Sven Saussez
    • 1
    • 2
    • 4
  1. 1.Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS)ParisFrance
  2. 2.Laboratory of Anatomy and Cell Biology, Faculty of MedicineUMONS Research Institute for Health Sciences and Technology, University of Mons (UMons)MonsBelgium
  3. 3.Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and TechnologyUniversity of Mons (UMons)MonsBelgium
  4. 4.Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of MedicineUniversité Libre de BruxellesBrusselsBelgium
  5. 5.Department of OtolaryngologyPoitiersFrance
  6. 6.Department of Otorhinolaryngology and Head and Neck Surgery, CHU de LilleUniversité de LilleLilleFrance
  7. 7.Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital OstravaOstravaCzech Republic
  8. 8.Department of OtolaryngologyHospital Complex of Santiago de CompostelaSantiago de CompostelaSpain
  9. 9.Department of Otorhinolaryngology-Head and Neck SurgeryHospital Universitario DonostiaSan SebastianSpain
  10. 10.Department of Otolaryngology, Pendik Training and Research HospitalMarmara UniversityIstanbulTurkey
  11. 11.ENT Audiology and Phoniatric UnitUniversity of PisaPisaItaly
  12. 12.Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive MedicineUniversity of L. VanvitelliNaplesItaly
  13. 13.Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco HospitalUniversity of MilanMilanItaly
  14. 14.Department of Otorhinolaryngology and Head and Neck SurgeryFoch HospitalParisFrance
  15. 15.World Hearing CenterInstitute of Physiology and Pathology of HearingWarsawPoland
  16. 16.Department of Otorhinolaryngology and Head and Neck SurgeryCH LuxembourgLuxembourgBelgium
  17. 17.Department of Gastroenterology, CHU de Bruxelles, CHU Saint-Pierre, School of MedicineUniversité Libre de BruxellesBrusselsBelgium
  18. 18.Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University HospitalUniversité Libre de BruxellesBrusselsBelgium
  19. 19.Department of Otorhinolaryngology and Head and Neck SurgeryCHU de LiègeLiègeBelgium
  20. 20.Department of Otolaryngology-Head and Neck SurgeryThessaloniki Medical SchoolThessalonikiGreece
  21. 21.Division of Ear, Nose and Throat DiseasesMalmöSweden
  22. 22.Division of Otolaryngology-Head and Neck SurgeryCentre Hospitalier de l’Université de MontréalMontrealCanada

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