THE SAN DIEGO CONSENSUS FOR LARYNGOPHARYNGEAL SYMPTOMS AND LARYNGOPHARYNGEAL REFLUX DISEASE

Background: The term ‘laryngopharyngeal reflux’ (‘LPR’) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. This initiative aimed to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines. Methods: A 28-member international inter-disciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations. Results: The term ‘laryngopharyngeal symptoms’ (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. ‘Laryngopharyngeal reflux disease’ (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for non-reflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive anti-reflux management. The two recommended ambulatory reflux monitoring modalities, 24h pH-impedance and 96h wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators. Conclusions: The San Diego Consensus represents the formal modern-day inter-disciplinary care paradigm to evaluate and manage LPS and LPRD.