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Testing before Treating: Ordering 24-Hour pH Impedance, Barium Esophagram, and Endoscopy instead of Escalating PPI Treatments

This lesson is only available on the BackTable mobile app.

BackTable ENT & Allergy

Lesson 5  •  17 Sept 2026

Testing before Treating: Ordering 24-Hour pH Impedance, Barium Esophagram, and Endoscopy instead of Escalating PPI Treatments

with Dr. Inna Husain, Dr. Ashley Agan

Course overview

This course explores the spectrum of laryngopharyngeal reflux (LPR), from nuanced symptom evaluation and diagnostic strategies to practical management approaches that include lifestyle, dietary, and alginate-based therapies. Participants will gain insights into history-taking, referral pathways, emerging diagnostic tools, and the intersection of ENT and GI perspectives. Featuring expert guidance from Dr. Ashley Agan, Dr. Inna Husain, and Dr. Spencer Payne.

2.25 hours, 22 lessons

Lessons

Laryngopharyngeal Symptoms versus Reflux Disease: Diagnostic Testing and Treatment Strategies



Lesson 1

Laryngopharyngeal Symptoms versus Laryngopharyngeal Reflux Disease: Overdiagnosis, Symptom Definitions, and the Missing Diagnostic Code



Lesson 2

GERD versus Laryngopharyngeal Reflux Disease: Direct and Indirect Mechanisms, Non-Acid Refluxate, and the Role of Pepsin



Lesson 3

The LPR Clinic Visit: History Taking, Nasolaryngoscopy Findings, and Patient Counseling



Lesson 4

ENT and GI Overlap: Referral Frustration, Consensus Limitations, and Bravo-Based Diagnosis



Lesson 5

Testing before Treating: Ordering 24-Hour pH Impedance, Barium Esophagram, and Endoscopy instead of Escalating PPI Treatments



Lesson 6

Irritable Larynx, Glottic Insufficiency, and Fundoplication: Managing Laryngeal Symptoms and Assessment Strategies



Lesson 7

Emerging LPRD Diagnostics and Therapeutics: Anti-Pepsin Trials, Salivary Testing, and Reflux Thresholds



Lesson 8

Differential Diagnoses Evaluation and PPI Taper Strategies



Lesson 9

Alginate Barrier Therapy in Practice: Dosing Protocols, Acid Suppression and Setting Long-Term Expectations



Lesson 10

Personalized LPRD Care: Symptom-Based Lifestyle Counseling, GLP-1 Effects, and Hormonal Contributors





Understanding Atypical LPR: Diagnosis, Management, and Clinical Strategies



Lesson 11

Nasal and Nasopharyngeal Presentations of Laryngopharyngeal Reflux



Lesson 12

Extralaryngeal Manifestations of LPR: Cough, Dyspnea, and Oral Symptoms



Lesson 13

Clinical Pathways for Suspected LPR: Workup, Referral, and Follow-Through



Lesson 14

Neurally Mediated LPR and Globus: Clinical Implications and Diagnostic Testing



Lesson 15

Interpreting Reflux Testing: ENT versus GI Perspectives and Clinical Practice



Lesson 16

Mechanical Reflux Management: Alginates, Nerve Blocks, and Dietary Modification



Lesson 17

Identifying the Root Cause of LPR: Lifestyle, Anatomy, and Stress





Integrative Strategies for Reflux: Lifestyle, Diet, and Alginate-Based Approaches



Lesson 18

Managing Reflux-Associated Sinus Symptoms: Functional and Dietary Approaches



Lesson 19

Practical Lifestyle and Dietary Strategies for Reflux Management



Lesson 20

Physician-Driven Alginate Product: Formulation, Manufacturing, and Market Launch



Lesson 21

Alginate Pharmacology: Mechanism, Ingredients, and Clinical Use



Lesson 22

Usage, Safety, and Future Directions in Alginate Therapy

Access the full course for free on the BackTable mobile app.

The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.

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