The Association Between Gastroesophageal Reflux Disease and Chronic Hoarseness

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Elektronische Zeitschriftbibliotek Logo Bielefeld Academic Search Engine Logo Erfolgreich durch internationale Zusammenarbeit LARYNGOLOGY Cite as: Archiv EuroMedica. 2025. 15; 4. DOI 10.35630/2025/15/4.019 Received 25 July 2025; Accepted 30 August 2025; Published 8 September 2025 THE ASSOCIATION BETWEEN GASTROESOPHAGEAL REFLUX DISEASE AND CHRONIC HOARSENESS Jan Drugacz1 email orcid id logo, Bartłomiej Bobrowski2 orcid id logo, Honorata Derlatka3 orcid id logo, Olaf Helbig4 orcid id logo, Klaudia Kontek5 orcid id logo, Anna Kukhtiak6 orcid id logo, Julia Marcinkowska7 orcid id logo, Martyna Radelczuk8 orcid id logo, Łukasz Skowron3 orcid id logo 1Individual medical practice Jan Drugacz, Bielsko-Biała, Poland 2Medical practice Bartosz Bobrowski, Cieszyn, Poland 3Collegium Medicum, Jan Kochanowski University, Kielce, Poland 4Poznan University of Medical Sciences: Poznan, PL 5John Paul II District Hospital in Kolbuszowa, Poland 6Faculty of Medicine, Medical University of Lodz, Lodz, Poland 7Pomeranian Medical University in Szczecin, Poland 8Military Institute of Medicine, Warsaw, Poland download article (pdf) lek.jandrugacz@gmail.com ABSTRACT Aims: Gastroesophageal reflux disease (GERD) is a widespread condition affecting approximately 13 percent of the global population. One of its most common extraesophageal manifestations is chronic hoarseness. This review aims to explore the relationship between GERD and chronic hoarseness, focusing on epidemiology, pathophysiological mechanisms, diagnostic approaches, and treatment outcomes, and to test the hypothesis that the lack of standardized diagnostic criteria for laryngopharyngeal reflux (LPR) significantly influences reported prevalence rates and treatment results. Methods: A comprehensive review of the literature up to 2025 was conducted to assess the association between GERD and chronic hoarseness. The analysis included data on prevalence, diagnostic methodologies such as 24 hour pH impedance monitoring, endoscopy, laryngoscopy, and esophageal manometry, and treatment modalities including pharmacologic, surgical, and behavioral interventions. Results: The prevalence of chronic hoarseness among GERD patients can reach 97 percent, with professional voice users affected more often than the general population. Rates vary widely between studies due to differences in diagnostic criteria and assessment methods. Pathophysiological mechanisms include mucosal injury from gastric acid, inflammatory changes, and neural dysregulation linked to LPR. Diagnostic accuracy is limited by the absence of standardized LPR criteria. Proton pump inhibitors are effective in most erosive cases but less so in non-erosive disease, with up to 40 percent showing inadequate response. Potassium competitive acid blockers provide similar efficacy with improved pharmacokinetics. Adjunctive therapies such as prokinetics, H2 receptor antagonists, baclofen, alginates, and voice therapy can improve outcomes. Laparoscopic fundoplication offers long-term relief in selected patients, and less invasive endoscopic techniques are options for those unsuitable for surgery. Conclusions: GERD-related hoarseness is a clinically significant condition that requires early recognition and targeted management. The hypothesis that a lack of standardized diagnostic criteria for LPR significantly influences prevalence estimates and treatment outcomes is supported by the reviewed evidence. Standardization of diagnostic protocols is essential to improve epidemiological accuracy and guide therapy. Optimal management requires a personalized approach that may combine pharmacological therapy, surgical intervention, and behavioral modifications, supported by multidisciplinary collaboration.