Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease: Diagnostic Testing and Clinical Approach Based on the San Diego Consensus.

backgroundThe San Diego Consensus for Laryngopharyngeal Symptoms (LPS) and Laryngopharyngeal Reflux Disease (LRPD) offers a modern interdisciplinary paradigm that focuses on symptoms and aligns evaluation with underlying mechanisms of disease. PURPOSE: This review uses the San Diego Consensus as the framework to discuss who should be tested for reflux, timing and selection of diagnostic testing, and practical diagnostic algorithms in patients with LPS and LPRD. Patient reported outcome measures are useful to characterize LPS, quantify symptom burden and monitor response, but are not specific for a diagnosis of LPRD. Patients presenting with both LPS and typical esophageal symptoms have higher pretest probability of LPRD, and time limited empiric acid suppressive agents and alginates may be appropriate. In contrast, upfront objective testing is recommended in isolated LPS prior to long-term acid suppressive therapy. Laryngoscopy or stroboscopy can identify alternative etiologies of LPS. Esophagoscopy can demonstrate conclusive reflux evidence, but diagnostic yield is low. pH-impedance monitoring, especially with hypopharyngeal sensors, assesses reflux mechanisms when investigating LPS, and can provide numbers of reflux episodes irrespective of acidity as well as proximal extent of these episodes. High-resolution manometry does not provide a diagnosis of LPRD but serves to rule out motility disorders that mimic LPS. Prolonged wireless pH monitoring may be appropriate when typical esophageal reflux symptoms coexist. The evaluation of LPS requires a paradigm shift away from reflexive attribution to reflux and toward a structured diagnostic approach that systematically considers alternative etiologies of LPS.