Article Text

Download PDFPDF

Original research
Laryngopharyngeal reflux in war-torn Syria and its association with smoking and other risks: an online cross-sectional population study
  1. Ameer Kakaje,
  2. Mohammad Marwan Alhalabi,
  3. Ayham Alyousbashi,
  4. Aya Hamid,
  5. Yousef Mahmoud
  1. Damascus University Faculty of Medicine, Damascus, Syrian Arab Republic
  1. Correspondence to Dr Ameer Kakaje; ameer.kakaje{at}


Objectives To demonstrate the burden of laryngopharyngeal reflux (LPR) in Syria and its associated variables.

Design This is a cross-sectional study that used online questionnaires that included demographics, smoking, war-related questions and reflux symptom index (RSI).

Setting This research was conducted online across Syria and included the general population.

Participants Participants who lived in Syria, agreed to participate, and responded to all the RSI questions were included. This research comprised 734 participants, with 94.6% response rate, 75.5% being females, and a mean age of 24 years.

Results Overall, 31.9% of subjects had symptoms suggestive of LPR. Participants who were 30 years and younger had fewer symptoms suggestive of LPR compared with the older group p=0.012 (OR 0.534; 95% CI 0.325 to 0.877). While having an epigastric burning sensation, chest pain and indigestion were the most common symptoms, having a sore throat was the least common. Being distressed from war noises was associated with more symptoms p=0.009 (OR 1.562; 95% CI 1.117 to 2.183). However, losing someone or changing place of living due to war were not significantly associated with these symptoms p>0.05. RSI scores were associated with cigarette and/or shisha smoking p<0.05. Finally, asthma, allergic disorders and having a job were associated with having LPR symptoms p<0.05. No significant findings were observed in consanguinity, marital status, educational level and socioeconomic status.

Conclusions War, smoking, asthma, allergies, respiratory conditions and having a job were associated with LPR symptoms. However, they may be associated with these symptoms independently from LPR; for instance, similar symptoms can be caused by the mental disorders from war, the unique environment and irritant substances of the laryngeal mucosa.

  • epidemiology
  • asthma
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • MMA and AA contributed equally.

  • Contributors AK: first and senior author; conceptualisation; data curation; formal analysis; investigation; software; methodology; project administration; supervision; validation; original draft; writing—review and editing. MMA: data curation; formal analysis; software; original draft; writing—review and editing. AA: software; methodology; conceptualisation; validation; writing editing; investigation. AH: conceptualisation; original draft; writing—review. YM: project administration; writing editing; investigation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods and materials' section for further details.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by Damascus University, Faculty of Medicine and approved according to the principles embodied in the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data will be made available on reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.