A review of clinical practice guidelines for reflux disease: toward creating a clinical protocol for the otolaryngologist.

OBJECTIVES Reflux disease, including gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR), is an extremely common condition that is diagnosed and treated routinely in an otolaryngology practice. There is great variability in the methods of both diagnosis and treatment amongst otolaryngologists. Our aim is to review current clinical practice guidelines on reflux disease, to identify areas of agreement and controversy, and to begin to work toward a clinical protocol for reflux disease for the otolaryngologist. STUDY DESIGN Literature review with discussion. METHODS A PubMed search was performed looking for clinical practice guidelines on either GERD or LPR. Five hundred seventy articles were identified and the most clinically relevant practice guidelines were selected. RESULTS Thirteen key articles were identified. Eleven of these come from the gastroenterology literature, and none of them come from the otolaryngology literature. There appears to be a consensus on empiric medication trial as first-line therapy for presumed uncomplicated GERD and on prioritizing early identification of patients with severe disease complications. Areas of controversy include the definition of GERD and LPR, which diagnostic algorithm to use in which patient, and the long-term management of medical therapy. CONCLUSIONS Although there are many clinical aspects of reflux disease that still remain a mystery, there is enough literature to support a rudimentary clinical protocol at this time. As further data become available from outcomes measurements, such a protocol may result in improved quality and standardization.