Chronic cough, hoarseness, and other laryngopharyngeal symptoms (LPS) are common complaints that often prompt a referral to an allergist/immunologist. Laryngopharyngeal reflux disease (LPRD) can cause LPS, and due to its symptom overlap with many other conditions, it is critical to understand how to clinically evaluate and treat this disease. Assessing for the presence or absence of concomitant gastroesophageal reflux disease symptoms is critical. The importance of direct visualization via laryngoscopy, and in some cases endoscopic evaluation and pH testing, also highlight the importance of taking a multidisciplinary approach to evaluate suspected LPRD patients. This manuscript reviews LPS, the pathophysiology and diagnostic criteria of LPRD, and the often multidisciplinary approach required to best evaluate and manage this group of patients.

Modern reflux monitoring technology provides for both prolonged wireless and 24-hour catheter-based testing options. Wireless pH monitoring offers the advantages of patient comfort and prolonged assessment for up to 96 hours to account for day-to-day variation of GERD, but only distal acid reflux is measured. pH-impedance monitoring detects all reflux episodes regardless of acidity, characterizes refluxate content, identifies proximal extent, and measures baseline mucosal impedance which reflects mucosal integrity as well as longitudinal reflux-related injury, but the indwelling catheter causes patient discomfort and limits monitoring to 24 hours. Metrics from reflux monitoring and findings from endoscopy, together with adjunctive tests such as high-resolution manometry, can provide conclusive and/or supportive evidence for or against pathologic reflux, utilizing the Lyon Consensus 2.0 framework. Selection of optimal testing strategy should depend on presenting symptom phenotypes, clinical indications and scenarios, local testing options, and patient tolerance. Testing should be performed off acid suppressive therapy for patients with unproven GERD, while those with proven GERD and persistent symptoms despite optimized anti-reflux therapy should undergo pH-impedance monitoring on acid suppression. If endoscopy is indicated, wireless monitoring can be performed at the same setting, especially for typical perceptive (heartburn, chest pain) symptoms. pH-impedance monitoring is preferred for primary regurgitation and belching, while both modalities are options for atypical symptoms. Reflux monitoring may be indicated for assessing symptoms after foregut interventions, although no consensus on post-operative thresholds or optimal testing methodology has been established. Reflux monitoring is a valuable tool for evaluating and directing management of esophageal symptoms.

Proton pump inhibitors (PPIs) are widely prescribed for the management of gastric acid-related diseases, such as gastroesophageal reflux disease (GERD), and are generally well tolerated, with few or mild adverse effects. We present a case of an elderly female patient who developed hypomagnesemia, a rare but serious complication associated with chronic PPI therapy. The patient had been receiving esomeprazole 40 mg daily for approximately 12 months. She developed secondary electrolyte disorders, with hypocalcemia being the most evident. Her clinical manifestations initially included muscle cramps and tremors, which progressed to a seizure and eventually to altered mental status with a positive Trousseau sign. Despite institutional constraints, PPI-associated hypomagnesemia was considered, and the patient improved following electrolyte replacement and discontinuation of esomeprazole. Because fractional excretion of magnesium could not be calculated, the mechanism of magnesium loss could not be definitively established. This report highlights the importance of considering PPI-associated hypomagnesemia, an infrequent but potentially serious adverse effect, in patients receiving prolonged PPI therapy who develop compatible clinical manifestations.

Chronic hiccups, defined as lasting more than 48hours, represent an underestimated clinical entity with potentially severe impacts on patients' quality of life. The pathophysiology involves a reflex arc comprising the phrenic and vagus nerves, integrated at the pontomedullary level. Recent advances highlight the role of a central pattern generator and neurotransmitter systems (GABA, dopamine, serotonin) in the genesis and perpetuation of hiccups. Epidemiological data reveal a striking male predominance (82-92% of cases), with an organic cause identified in over 90% of men. Etiologies are dominated by gastrointestinal causes, particularly gastroesophageal reflux disease (up to 80% of cases), followed by central neurological causes including Wallenberg syndrome. The diagnostic approach relies on targeted history and physical examination, complemented by laboratory tests, chest radiography, upper gastrointestinal endoscopy, and brain imaging when clinically indicated. Therapeutic management follows a stepwise approach: etiological treatment, proton pump inhibitors as first-line therapy, followed by baclofen or gabapentin. Refractory cases may require neuroleptics or interventional techniques (phrenic nerve block, acupuncture). Despite the absence of formal guidelines, this review proposes a pragmatic diagnostic and therapeutic algorithm based on current literature evidence.