Not all chronic cough, globus, or voice changes are due to reflux, so how do you distinguish laryngopharyngeal symptoms (LPS) from true laryngopharyngeal reflux disease (LPRD)? In this episode of the BackTable ENT & Allergy podcast, Dr. Ashley Agan interviews laryngologist Dr. Inna Husain about how nuanced diagnostic definitions and a careful clinical approach can improve patient outcomes and avoid both under- and overdiagnosis. Together, they discuss the differences between GERD and LPRD, review the importance of detailed patient histories, endoscopic findings, and the evolving role of biomarkers like pepsin.

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Timestamps

00:00 - Introduction
02:14 - LPS Versus LPR Basics
06:34 - GERD Versus LPRD
11:28 - Clinic Workup and Scoping
18:02 - San Diego Consensus Debate
24:14 - Testing Over Empiric PPIs
31:45 - Managing Proven Reflux
34:59 - Stroboscopy Before Surgery
36:10 - Pepsin Therapies and Tests
39:54 - What Counts as Abnormal Reflux
44:24 - Tapering Off PPIs Safely
50:12 - Long Term Plan and Dietitians
55:39 - GLP One Drugs and Reflux
57:34 - Menopause Rhinitis and Hormones
01:00:09 - Final Pearl For ENTs

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More about this episode

They outline contemporary workup strategies, including the San Diego Consensus on Bravo testing, 24-hour pH impedance, and alternatives for negative reflux testing. The conversation covers management strategies, from selective PPIs and lifestyle tailoring to emerging therapies and the impact of GLP-1 drugs, helping ENT specialists refine their approach to complex laryngopharyngeal complaints.

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Resources

San Diego Consensus for LPS and LPRD:
https://doi.org/10.14309/ajg.0000000000003482

Dr. Inna Husain
https://innahusainmd.com/

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