{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:14:36Z","timestamp":1787800476422,"version":"build-2784847793"},"reference-count":71,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,3,26]],"date-time":"2020-03-26T00:00:00Z","timestamp":1585180800000},"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":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Diagnosis and treatment of presumed laryngopharyngeal reflux (LPR) remain controversial. Empiric medication trials remain widespread for suspected LPR despite emerging evidence against proton pump inhibitor (PPI) safety and for pepsin as a mediator of LPR symptoms. Ongoing concerns exist related to inaccurate diagnosis, the cost and morbidity of potentially unnecessary PPI prescriptions, and availability and interpretation of objective reflux testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To review contemporary evidence that does and does not support empiric medication trials for presumed LPR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed, Scopus and Cochrane Library were searched for literature about benefits, limitations and alternatives to empiric medication trial for LPR, in order to present both sides of this debate and identify best practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of physicians perform prolonged empiric medication trial with PPIs for patients with suspected LPR. Because symptoms and signs of LPR are non\u2010specific, empiric medication trials require exclusion of other conditions that can mimic LPR. Following a PPI empiric medication trial, over one\u2010third of patients remain non\u2010responders. The use of hypopharyngeal\u2010oesophageal multichannel intraluminal impedance\u2010pH monitoring (HEMII\u2010pH) has benefits and limitations in objective diagnosis of LPR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Use of PPIs for single\u2010agent empiric medication trial does not account for possible non\u2010responders with non\u2010acid or mixed LPR. If LPR diagnosis remains uncertain, alginates can be added to PPI trials. HEMII\u2010pH testing upfront is ideal for patients with suspected LPR, but not always practical; it is indicated when PPI and alginate empiric medication trials have failed or when comorbidities confuse the diagnosis. A more comprehensive, combination therapy empiric medication trial regimen may be needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13518","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T21:20:11Z","timestamp":1582665611000},"page":"450-458","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Is empirical treatment a reasonable strategy for laryngopharyngeal reflux? A contemporary review"],"prefix":"10.1111","volume":"45","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":"Department of Human Anatomy and Experimental Oncology Faculty of Medicine UMONS Research Institute for Health Sciences and Technology University of Mons (UMons) Mons Belgium"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery CHU Saint\u2010Pierre School of Medicine Universit\u00e9 Libre de Bruxelles Brussels Belgium"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Foch Hospital UFR Simone Veil University Versailles Saint\u2010Quentin\u2010en Yvelines (University Paris Saclay) Paris 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