White-line: a new finding in laryngopharyngeal reflux objective evaluation

Laryngopharyngeal reflux (LPR) indicates the reflux-induced extra-esophageal disorders. LPR and gastroesophageal reflux disease (GERD) occur by the same mechanism: the escape of gastric contents into the esophagus and beyond. However, the classic GERD symptoms are not typical in LPR disease, which can cause a lot of symptoms none of which is specific, making the diagnosis often elusive. The protective mechanisms present in the esophagus are entirely lacking in the larynx, and more generally in upper aerodigestive tract, making them particularly vulnerable to injury from acidic gastric contents. Since gastric acid backflow can affect supraesophageal structures, even in the absence of heartburn or regurgitation symptoms, an early diagnosis is important to prevent the onset of histological modifications in the supraesophageal mucosa. For this scope clinicians need to use different methods to get a diagnosis. We adopted two validated scoring systems: the reflux symptom index (RSI) for symptom assessing and the reflux finding score (RFS) for sign evaluation. In our experience we detect a new objective endoscopic rhinopharyngeal marker, called "white-line" characterized by mucosal metaplasia, that in a significant proportion of patients lines up to these validated indexes as a further element in the LPR diagnosis.