역류성 후두염

Background: To assess the prevalence of laryngopharyngeal reflux (LPR) in the Greek general population and its risk factors.

Methods: Questionnaire based epidemiological, adult participants’ survey. The Reflux Symptom Index (RSI) was used for the assessment of LPR prevalence. The RSI questionnaire was completed by 340 (183 male and 157 female) randomly selected subjects. Subjects with RSI score ≥13 were considered as LPR patients and those with RSI score <13 were considered as non LPR subjects.

Results: The prevalence of LPR in the general Greek population was found to be 18.8 % with no statistically significant difference between the two genders (p > 0.05). The age group of 50–64 years showed the higher prevalence rate. Tobacco smoking and alcohol consumption were found to be related with LPR. No reported concomitant disease or medication was found to be related with LPR.

Conclusions: LPR prevalence in the Greek general population was found to be 18.8 %. Tobacco smoking and alcohol consumption were found to be related with LPR.

The questionnaire was given to 450 subjects. Three hundred and fifty subjects (response rate 77.8 %) returned completed questionnaires. In 10 out of the 350 returned questionnaires, critical information like gender and age were lacking. Thus 340 (183 male and 157 female) duly completed questionnaires were appropriate for statistical analysis. Demographic data and patients’ behavioral characteristics are shown in Table 1. The mean age of the participants was 46.86 ± 14.54 years. Most participants belonged to the age group of 35–49 (131 subjects) while the age groups > 80 and < 20 were poorly represented (3 subjects > 80 year and 2 subjects < 20 year).

One hundred seventy four (51.2 %) participants were smokers with mean number of cigarettes per day 20.5 and mean duration of smoking 18.23 ± 8.6 years for male and 17.02 ± 8.0 years for female, with no statistically significant difference between the two genders (t-test >0,05).

One hundred and one subjects (29.7 %) drank alcohol regularly (68.3 % male and 31.7 % female). Mean alcohol consumption per day was 2.43 ± 1.62 units for males and 2.17 ± 1.32 units for females with no statistical significance between the two genders (t-test > 0.05). The most commonly reported alcoholic drinks were wine (30) followed by beer (21) and whisky (18).

One hundred forty two (41.8 %) participants reported one or more diseases. The reported diseases were: cardiovascular 50 (35.2 %), gastrointestinal 25 (17.6 %), musculoskeletal 15 (10.6 %), respiratory 10 (7.0 %), thyroidopathy 9 (6.3 %), anemia 3 (2.1 %) and other diseases 30 (21.1 %). Among the reported gastrointestinal diseases, 5 cases were gastroesophageal reflux disease (GERD), 13 dyspepsia, 5 gastritis and 2 duodenal ulcers.

One hundred and thirty seven (40.3 %) participants reported use of one or more medication for the concomitant diseases. The reported medications were: antihypertensive 43 (31.4 %), anticholesterol 19 (13.9 %), antiulcerants 19 (13.9 %), [15 PPIs (proton pump inhibitors) and 4 H2 antagonists], antidiabetics 11 (8.0 %), anti-asthmatics/COPD (chronic obstructive pulmonary disease) 11 (8.0 %), antihypothyroidism 9 (6.6 %), antiosteoporotics 7 (5.1 %) [5 calcium carbonate and 2 bisphosphonates], non steroidal anti-inflammatory drugs 4 (1,2 %) and other medications 18 (13.1 %).

Two hundred sixty six subjects (78.2 %) reported one or more symptoms included in the RSI. The most commonly reported symptoms were No 9 “Heartburn, chest pain, indigestion, or stomach acid coming up” (52 %) and No 2 “Clearing your throat” (48.2 %) (Table 2).

Sixty four subjects (18.8 %) out of the 340 participants of our study presented an RSI ≥13 and were considered as patients with LPR, compared to 276 subjects with an RSI < 13 who were considered to be subjects without LPR. The mean RSI score in patients with LPR was 24.8 ± 8.0 compared to the subjects without LPR the mean RSI of which was 2.3 ± 3.2 (p < 0.001) (Table 3).

Spearman’s Rho correlations analysis showed that all the pairs between the 9 items of the RSI were correlated, meaning that if a subject responded positively to one item there was a high probability to respond positively to the other item.

Based on the findings of our study the prevalence of LPR in the Greek general population was found to be 18.8 %. The LPR prevalence for males was 19.7 % and for females 17.8 % with no statistically significant difference between the two genders (t-test, p > 0.05).

Most subjects with LPR (RSI ≥13) belonged to the age groups of 50–64 year (40.6 %) and 35–49 (34.4 %). These two age groups represented 75 % of the LPR cases encountered in the general Greek population. No LPR cases reported in ages >80 and <20 but this may be due to the very small sample size of these two particular age groups.

Statistical analysis did not show any relation between LPR and any of the reported diseases nor LPR and reported medications (Chi-square test > 0.05 for both cases). The lack of such findings has to be accepted with reservations and not as conclusive due to the limited number of reported diseases and medications, and since the primary aim of this study was not to assess these two parameters.

A correlation was found between LPR and smoking and alcohol consumption. Factor analysis was used to assess a potential association between the Factor’s Score and the information available for every person. It was concluded that alcohol drinkers and nondrinkers have a statistically significant difference in their mean factor score, as well as smokers compared to nonsmokers (t-test, p-value < 0.001 and p-value = 0.006 respectively. The direction of this association is shown in the box plots (Figs. 1 and 2).

We should be aware that the smokers of this study tend to consume alcohol more often than non-smokers. For that reason we cannot be sure which of the two, tobacco or alcohol consumption has an effect on increasing the average score of the RSI.