Best Practices in Treatment of Laryngopharyngeal Reflux Disease: A Multidisciplinary Modified Delphi Study

Afrin N. Kamal, Shumon I. Dhar, Jonathan M. Bock, John O. Clarke, Jerome R. Lechien, Jacqueline Allen, Peter C. Belafsky, Joel H. Blumin, Walter W. Chan, Ronnie Fass, P. Marco Fisichella, Michael Marohn, Ashli K. O’Rourke, Gregory Postma, Edoardo V. Savarino, Michael F. Vaezi, Thomas L. Carroll, Lee M. Akst

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Laryngopharyngeal reflux (LPR) is a common otolaryngologic diagnosis. Treatment of presumed LPR remains challenging, and limited frameworks exist to guide treatment. Methods: Using RAND/University of California, Los Angeles (UCLA) Appropriateness Methods, a modified Delphi approach identified consensus statements to guide LPR treatment. Experts independently and blindly scored proposed statements on importance, scientific acceptability, usability, and feasibility in a four-round iterative process. Accepted measures reached scores with ≥ 80% agreement in the 7–9 range (on a 9-point Likert scale) across all four categories. Results: Fifteen experts rated 36 proposed initial statements. In round one, 10 (27.8%) statements were rated as valid. In round two, 8 statements were modified based on panel suggestions, and experts subsequently rated 5 of these statements as valid. Round three’s discussion refined statements not yet accepted, and in round four, additional voting identified 2 additional statements as valid. In total, 17 (47.2%) best practice statements reached consensus, touching on topics as varied as role of empiric treatment, medication use, lifestyle modifications, and indications for laryngoscopy. Conclusion: Using a well-tested methodology, best practice statements in the treatment of LPR were identified. The statements serve to guide physicians on LPR treatment considerations.

Original languageEnglish (US)
Pages (from-to)1125-1138
Number of pages14
JournalDigestive Diseases and Sciences
Issue number4
StatePublished - Apr 2023


  • Delphi
  • Gastroesophageal reflux
  • Laryngopharyngeal reflux

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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