A clinical study of symptomatic profile and response in objective and subjective parameters to proton pump inhibitor in laryngopharyngeal reflux

Abstract

INTRODUCTIONLaryngopharyngeal reflux has been reported in upto 10% of patients, presenting to an ENT OPD. 1Laryngopharyngeal reflux is a known etiological factor behind the development of various conditions of the upper aero-digestive tract like recurrent laryngospasm, cricoarytenoid joint fixation and stenosis as well as many other otolaryngology related conditions, including globus pharyngeus, cervical dysphagia, carcinoma and subglottic stenosis.A nine-item reflux symptom index (RSI) is a preset questionnaire introduced by Belafsky et al answered by the patient himself to find out the severity of laryngopharyngeal reflux.2 RSI also evaluates treatment efficacy, which has excellent reproducibility and criterion-based validity. ABSTRACT Background:The study was conducted to identify the various clinical presentations and findings in cases of LPR and also to study the role of proton pump inhibitor in the management of laryngopharyngeal reflux by observing the effect of proton pump inhibitor on reflux finding score (RFI) and reflux symptom index (RSI). Methods: A prospective, interventional, cohort study of 50 diagnosed cases of LPR with RSI >13 and RFS >7 (based on fibreoptic laryngoscopic findings) at the time of initial presentation was done. They were treated with a 6 month course of oral cap omeprazole (20 mg twice daily 30 minutes before meals) and followed up at 0, 4, 8 and 24 weeks for any improvement in RSI and RFS scores. Results: Most frequent symptoms detected in the cases were frequent clearing of throat, dry cough and sensation of lump in the throat all of which showed significant improvement at follow up at 4 weeks. Most common finding on fibreoptic laryngoscopy was erythema and diffuse laryngeal oedema, both of which showed significant improvement on follow up.There was also a significant change in RSI and RFS after receiving Omeprazole at 4 weeks, 8 weeks and at 24 weeks duration (p <0.0001). Conclusions: This study dealt mainly with study of combination of clinical features that LPR presents time line of improvement of these features with capsule omeprazole. It is proposed that a presumptive diagnosis of LPR can be made based on the criteria of RSI and patients be given an empirical therapeutic trial including behavioral and dietary recommendations and 6 months of twice-daily proton-pump inhibitor therapy for an excellent clinical response.