Laryngopharyngeal Reflux and GERD: Correlation Between Reflux Symptom Index and Reflux Finding Score

  • C. ShilpaEmail author
  • S. Sandeep
  • Swathi Chandresh
  • Akash Grampurohit
  • T. Shivaram Shetty
Original Article


To study the relationship between laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD) using clinical scoring and endoscopy. Data was collected from a sample of 100 patients with GERD symptoms who presented to ENT out-patient department, for a duration of 2 years. Patients were evaluated using Reflux Symptom Index (RSI) questionnaire and Reflux Finding Score (RFS). All patients underwent videolaryngoscopy and upper gastrointestinal endoscopy. Patient with positive findings underwent treatment with proton pump inhibitors and were followed up for 3 months. Out of 100 patients, 23 had LPR, 19 had GERD, 40 had LPR + GERD, 18 were normal. Among the LPR group, the predominant symptoms were hoarseness of voice, globus sensation and heartburn. Majority of GERD group had globus sensation, dysphagia and heartburn as their predominant symptoms. On laryngoscopy, in both LPR and LPR + GERD group, most common finding was interarytenoid erythema and vocal cord edema. On esophagogastroduodenoscopy, in both GERD and LPR + GERD group, esophagitis was the most common finding. RSI value was highest in patients with LPR + GERD. RFS value was high in LPR group followed by groups of LPR + GERD and GERD. RSI and RFS are easily administered, highly reproducible, low cost clinical scoring symptom questionnaire which can identify the patients with LPR. 82.6% of LPR patients had significant RFS scoring but with no significant findings in OGD. This study also illustrates the importance of PPI therapy in LPR patients with no evidence of GERD.


Laryngopharyngeal reflux Gastroesophageal reflux disease Reflux Symptom Index Reflux Finding Score 


Compliance with Ethical Standards

Conflict of interest

All the authors declare they have no conflicts of interest and have not received any funding.

Informed Consent

Informed consent was obtained from all individual participants in the study.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institution.


  1. 1.
    Winkelstein A (1935) Peptic esophagitis: a new clinical entity. JAMA 104:906–909CrossRefGoogle Scholar
  2. 2.
    Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101(Suppl. 53):1–78CrossRefGoogle Scholar
  3. 3.
    Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the Reflux Symptom Index (RSI). J Voice 16(2):274–277CrossRefGoogle Scholar
  4. 4.
    Belafsky PC, Postma GN, Koufman JA (2001) Validity and reliability of the Reflux Finding Score (RFS). Laryngoscope 111:1313–1317CrossRefGoogle Scholar
  5. 5.
    Pandolfino JE, Vakil NB, Kahrilas PJ (2002) Comparison of inter and intraobserver consistency for grading of esophagitis by expert and trainee endoscopists. Gastrointest Endosc 56:639–643CrossRefGoogle Scholar
  6. 6.
    Powitzky ES, Khaitan L, Garrett CG, Richards WO, Courey M (2003) Symptoms, quality of life, videolaryngoscopy and twenty-four-hour triple probe pH monitoring in patients with typical and extraesophageal reflux. Ann Otol Rhinol Laryngol 112:859–865CrossRefGoogle Scholar
  7. 7.
    Jonaitis L, Pribuisiene R, Kupscinskas L, Uloza V (2006) Laryngeal examination is superior to endoscopy in the diagnosis of the laryngeal form of gastroesophageal reflux disease. Scand J Gastroenterol 41:131–137CrossRefGoogle Scholar
  8. 8.
    Hickson C, Simpson B, Falcon R (2001) Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 111:1742–1745CrossRefGoogle Scholar
  9. 9.
    Cekin E, Ozyurt M, Erkul E, Ergunay K, Cincik H, Kapucu B, Gungor A (2012) The association between Helicobacter pylori and laryngopharyngeal reflux in laryngeal pathologies. Ear Nose Throat J 91(3):E6-9CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of ENTJSS Medical CollegeMysuruIndia

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