Impact of COVID-19 Lockdown on Stress and Diet Adherence in Patients with Laryngopharyngeal Reflux

Objectives:To study the impact of lockdown on diet adherence and stress in patients treated for laryngopharyngeal reflux (LPR). Methods:Patients with a positive LPR diagnosis at the hypopharyngeal-esophageal impedance-pH monitoring were treated from the pre- to lockdown period with diet, behavioral changes and an association of proton pump inhibitors and alginate. The following outcomes were used to assess the clinical features of patients: reflux symptom score-12 (RSS-12) and reflux sign assessment (RSA). At post-treatment time, patients were invited to evaluate the impact of lockdown on diet adherence and stress management with a predefined grid of foods and beverages and perceived stress scale (PSS), respectively. Results:Thirty-two patients completed the evaluations. RSS-12 and RSA significantly improved from baseline to three-month post-treatment. Most patients experienced mild-to-severe stress level at the end of the lockdown. The level of stress substantially increased in 34% of patients due to lockdown, while it did not change in 44%. In 34% of cases, patients reported that adherence to antireflux diet was better than initially presumed thanks to the lockdown period, while 44% believed that the lockdown did not impact their adherence to diet. PSS and RSS-12 were significantly correlated at the end of the pandemic (p<0.001). The increase of stress level was positively associated with the lack of adherence to diet (p=0.039). Conclusion:During the lockdown, diet habits were improved or unchanged in most LPR cases, while stress level was increased in one-third of patients.