{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:55:07Z","timestamp":1790283307273,"version":"4.1.0"},"reference-count":84,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:00:00Z","timestamp":1564531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients\u2014those who do not respond to anti\u2010reflux medical treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti\u2010reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non\u2010responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow\u2010up and quality of outcome assessment were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 139 articles screened, 45 met the inclusion criteria. The definition of non\u2010responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non\u2010responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non\u2010acid or mixed) or addressed personalised treatment with the addition of alginate or magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non\u2010responder LPR patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>2a.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/coa.13395","type":"journal-article","created":{"date-parts":[[2019,6,23]],"date-time":"2019-06-23T09:03:53Z","timestamp":1561280633000},"page":"784-800","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0845-0845","authenticated-orcid":false,"given":"Jerome R.","family":"Lechien","sequence":"first","affiliation":[{"name":"Laryngopharyngeal Reflux Study Group of Young\u2010Otolaryngologists of the International Federations of Oto\u2010rhino\u2010laryngological Societies (YO\u2010IFOS) Paris France"},{"name":"Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology University of Mons (UMons) Mons Belgium"},{"name":"Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology University of Mons (UMons) Mons Belgium"},{"name":"Department of Otorhinolaryngology and Head and Neck Surgery CHU de Lille Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinciane","family":"Muls","sequence":"additional","affiliation":[{"name":"Laryngopharyngeal Reflux Study Group of Young\u2010Otolaryngologists of the International Federations of Oto\u2010rhino\u2010laryngological Societies (YO\u2010IFOS) Paris France"},{"name":"Department of Gastroenterology and Endoscopy, CHU Saint\u2010Pierre Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Dapri","sequence":"additional","affiliation":[{"name":"Laryngopharyngeal Reflux Study Group of Young\u2010Otolaryngologists of the International Federations of Oto\u2010rhino\u2010laryngological Societies (YO\u2010IFOS) Paris France"},{"name":"Department of Gastrointestinal Surgery, CHU Saint\u2010Pierre Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Mouawad","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery CHU de Lille Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Eisendrath","sequence":"additional","affiliation":[{"name":"Laryngopharyngeal Reflux Study Group of Young\u2010Otolaryngologists of the International Federations of Oto\u2010rhino\u2010laryngological Societies (YO\u2010IFOS) Paris France"},{"name":"Department of Gastroenterology and Endoscopy, CHU Saint\u2010Pierre Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Schindler","sequence":"additional","affiliation":[{"name":"Laryngopharyngeal Reflux Study Group of Young\u2010Otolaryngologists of the International Federations of Oto\u2010rhino\u2010laryngological Societies (YO\u2010IFOS) Paris France"},{"name":"Department of Biomedical and clinical sciences, Phoniatric Unit, L. 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