High Prevalence of Laryngopharyngeal Reflux Disease in Patients With Lumbar Kyphosis

Published:December 28, 2015DOI:https://doi.org/10.1016/j.jvoice.2015.11.013



      To evaluate the relationship between laryngopharyngeal reflux disease and presence of lumbar kyphosis.

      Study Design

      A cross-sectional study.


      We included 20 patients with lumbar kyphosis and 31 control subjects. A diagnosis of laryngopharyngeal reflux disease and gastroesophageal reflux disease was made if the Reflux Symptom Index score was ≥13 and if the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease was ≥8, respectively. We compared the prevalence of the two reflux diseases, frequent reflux symptoms, and demographic factors between the two groups.


      There was no significant difference in demographic factors between the two groups. Five (25%) of 20 patients with lumbar kyphosis had a Reflux Symptom Index ≥13 compared with one (3.2%) of 31 controls. Seven (35.0%) of 20 patients had a Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease ≥8 compared with three (9.7%) of 31 controls. A comparison of the prevalence of laryngopharyngeal reflux disease and gastroesophageal reflux disease showed a significant difference between patients with kyphosis and controls (P value = 0.029 and 0.036, respectively). In Reflux Symptom Index, heartburn, hoarseness, and a swallowing problem were significantly frequent symptoms in the kyphosis group compared with the control group.


      The prevalence of laryngopharyngeal reflux disease and gastroesophageal reflux disease was significantly higher in patients with lumbar kyphosis than in controls. Therefore, otolaryngologists and orthopedic surgeons should be aware that patients with lumbar kyphosis are likely to have gastroesophageal reflux disease and also laryngopharyngeal reflux disease.

      Key Words

      To read this article in full you will need to make a payment


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • de Bortoli N.
        • Nacci A.
        • Savarino E.
        • et al.
        How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?.
        World J Gastroenterol. 2012; 18: 4363-4370
        • Wise S.K.
        • Wise J.C.
        • DelGaudio J.M.
        Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing.
        Otolaryngol Head Neck Surg. 2006; 135: 253-257
        • Reavis K.M.
        • Morris C.D.
        • Gopal D.V.
        • et al.
        Laryngopharyngeal reflux symptoms better predict the presence of esophageal adenocarcinoma than typical gastroesophageal reflux symptoms.
        Ann Surg. 2004; 239: 849-858
        • Hamdan A.L.
        • Jabbour J.
        • Barazi R.
        • et al.
        Prevalence of laryngopharyngeal reflux disease in patients with diabetes mellitus.
        J Voice. 2013; 27: 495-499
        • Polomsky M.
        • Siddall K.A.
        • Salvador R.
        • et al.
        Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: a link toward understanding its pathogenesis.
        J Am Coll Surg. 2009; 208: 562-569
        • Muramatsu N.
        • Akiyama H.
        Japan: super-aging society preparing for the future.
        Gerontologist. 2011; 51: 425-432
        • Belafsky P.C.
        • Postma G.N.
        • Koufman J.A.
        Validity and reliability of the reflux symptom index (RSI).
        J Voice. 2002; 16: 274-277
        • Kusano M.
        • Shimoyama Y.
        • Sugimoto S.
        • et al.
        Development and evaluation of FSSG: frequency scale for the symptoms of GERD.
        J Gastroenterol. 2004; 39: 888-891
        • Kanda Y.
        Investigation of the freely available easy-to-use software “EZR” for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Schwab F.
        • Patel A.
        • Ungar B.
        • et al.
        Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery.
        Spine (Phila Pa 1976). 2010; 35: 2224-2231
        • Miyakoshi N.
        • Kasukawa Y.
        • Sasaki H.
        • et al.
        Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis.
        Osteoporos Int. 2009; 20: 1193-1198
        • Imagama S.
        • Hasegawa Y.
        • Wakao N.
        • et al.
        Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people.
        Eur Spine J. 2012; 21: 2149-2157
        • Fujiwara Y.
        • Arakawa T.
        Epidemiology and clinical characteristics of GERD in the Japanese population.
        J Gastroenterol. 2009; 44: 518-534
        • Yamaguchi T.
        • Sugimoto T.
        • Yamauchi M.
        • et al.
        Multiple vertebral fractures are associated with refractory reflux esophagitis in postmenopausal women.
        J Bone Miner Metab. 2005; 23: 36-40
        • Kusano M.
        • Hashizume K.
        • Ehara Y.
        • et al.
        Size of hiatus hernia correlates with severity of kyphosis, not with obesity, in elderly Japanese women.
        J Clin Gastroenterol. 2008; 42: 345-350
        • Ford C.N.
        Evaluation and management of laryngopharyngeal reflux.
        JAMA. 2005; 294: 1534-1540
        • Sherman P.M.
        • Hassall E.
        • Fagundes-Neto U.
        • et al.
        A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population.
        Am J Gastroenterol. 2009; 104 (quiz1296): 1278-1295
        • Roth D.F.
        • Ferguson B.J.
        Vocal allergy: recent advances in understanding the role of allergy in dysphonia.
        Curr Opin Otolaryngol Head Neck Surg. 2010; 18: 176-181
        • Belafsky P.C.
        • Postma G.N.
        • Koufman J.A.
        The validity and reliability of the reflux finding score (RFS).
        Laryngoscope. 2001; 111: 1313-1317
        • Armstrong D.
        • Bannett J.R.
        • Blum A.L.
        • et al.
        The endoscopic assessment of esophagitis: a progress report on observer agreement.
        Gastroenterology. 1996; 111: 85-92
        • Mesallam T.A.
        • Stemple J.C.
        • Sobeih T.M.
        • et al.
        Reflux symptom index versus reflux finding score.
        Ann Otol Rhinol Laryngol. 2007; 116: 436-440
        • Hamdan A.L.
        • Jabbour J.
        • Al Zaghal Z.
        • et al.
        Goiter and laryngopharyngeal reflux.
        ISRN Endocrinol. 2012; 2012: 208958