{"doi":"10.1016/j.cgh.2022.10.017","title":"Hypervigilance and Anxiety are Elevated Among Patients With Laryngeal Symptoms With and Without Laryngopharyngeal Reflux","abstract":"Most patients experiencing laryngeal symptoms are labeled as having laryngopharyngeal reflux (LPR).1Yadlapati R. et al.Clin Gastroenterol Hepatol. 2022; 20: 776-786Google Scholar LPR has classically been defined as an extraesophageal manifestation of gastroesophageal reflux disease (GERD) in which gastric refluxate leads to irritation of and increased nociception at the upper aerodigestive tract.2Katz P.O. et al.Am J Gastroenterol. 2022; 117: 27-56Google Scholar Diagnosis of LPR poses a significant challenge to clinicians and patients. For instance findings on laryngoscopy graded according to the validated reflux finding score are nonspecific for LPR because multifactorial etiologies including postnasal drip or allergies can result in an elevated reflux finding score.2Katz P.O. et al.Am J Gastroenterol. 2022; 117: 27-56Google Scholar Similarly, patient-reported symptoms as measured by several validated instruments (eg, Reflux Symptom Index) have poor prognostic performance in predicting laryngeal symptom response.3Wilson J.A. et al.Health Technol Assess. 2021; 25: 1-118Google Scholar Because not all laryngeal symptoms are driven by acidic refluxate, hence often not responsive to traditional antireflux therapies, current guidelines and best practice updates recommend ambulatory reflux monitoring off acid suppression in patients with isolated LPR symptoms before a trial of proton pump inhibitor therapy.2Katz P.O. et al.Am J Gastroenterol. 2022; 117: 27-56Google Scholar Furthermore, a recent study demonstrated that patients with laryngeal symptoms present with distinct phenotypes (eg, LPR/GERD, LPR/hypersensitivity, no LPR/no GERD), among which cognitive-affective processes may drive symptom burden to varying degrees across phenotypes.1Yadlapati R. et al.Clin Gastroenterol Hepatol. 2022; 20: 776-786Google Scholar This notion that cognitive-affective processes impact symptom severity and quality of life in the realm of typical GERD is increasingly accepted, and consequently gut-directed behavioral therapies are recommended across the spectrum of GERD.4Guadagnoli L. et al.Neurogastroenterol Motil. 2021; 33e14081Google Scholar Furthermore, the validated esophageal hypervigilance and anxiety scale (EHAS) patient report instrument assesses levels of symptom-associated anxiety and hypervigilance.5Taft T.H. et al.Aliment Pharmacol Ther. 2018; 47: 1270-1277Google Scholar One such questionnaire, the Newcastle Laryngeal Hypersensitivity Questionnaire, was validated for LPR; however, unlike the EHAS, it focuses on symptoms rather than the impact of cognitive-affective processes on symptom perception.6Vertigan A.E. et al.Cough. 2014; 10: 1Google Scholar Unfortunately, the current paradigm for LPR largely ignores the interplay of psychological stressors on symptom burden.7Krause A.J. et al.Ann N Y Acad Sci. 2022; 1510: 5-17Google Scholar This dearth of research in the role of psychological stressors and behavioral therapy is a tremendous missed opportunity to help patients with chronic laryngeal complaints. To address this knowledge gap, we aimed to measure hypervigilance and anxiety in patients with laryngeal symptoms and compare hypervigilance and anxiety levels between symptomatic patients with and without LPR. This single center observational study enrolled patients over 2 years (September 2019–September 2021). Patients were included if they were adults with laryngeal symptoms (cough, dysphonia, throat clearing, sore throat, mucous in throat, globus) that underwent ambulatory reflux monitoring off acid suppression and completed the EHAS. Patients were defined as having true LPR if acid exposure time (AET) on reflux monitoring was ≥6% (LPR+) and no LPR if AET <6% (LPR-). The study was approved by the institutional review board. See the Supplementary Methods for more information. A total of 77 patients are included in the analysis: mean age was 49.8 years (standard deviation [SD], 15.3) and 60 (78%) were female. Twenty-two (29%) met criteri","journal":"Clinical Gastroenterology and Hepatology","year":2022,"id":253863,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":22,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9584,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":394874,"name":"Madeline Greytak","orcid":"0000-0002-7203-6518","position":1,"is_corresponding":false},{"id":106288,"name":"Zoe C. Burger","orcid":"0000-0002-6842-0760","position":2,"is_corresponding":false},{"id":540776,"name":"Tiffany Taft","orcid":"0000-0002-4670-2441","position":3,"is_corresponding":false},{"id":303660,"name":"Rena Yadlapati","orcid":"0000-0002-7872-2033","position":4,"is_corresponding":false},{"id":318573,"name":"Amanda J. Krause","orcid":"0000-0001-9792-0417","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T00:24:59.596040Z","pmid":"36309340","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}