Acid-suppression Therapy Offers Varied Laryngopharyngeal and Esophageal Symptom Relief in Laryngopharyngeal Reflux Patients

Abstract

It is widely accepted that laryngopharyngeal reflux requires more aggressive and prolonged therapy than gastro-esophageal reflux disease. Otolaryngologists often observe that laryngopharyngeal symptoms, such as throat clearing, hoarseness, cough, and globus pharyngeus, are slower to resolve than esophageal symptoms, such as heartburn and regurgitation. The aim of this was to provide empirical evidence to support this observation and to carry out a detailed investigation of the differences between these symptoms. Forty-five patients with laryngopharyngeal and esophageal symptoms received acid-suppression therapy that involved the continuous administration of a proton-pump inhibitor for up to 6 months. We investigated the differences in response to acid-suppression therapy between patients suffering from laryngopharyngeal and esophageal symptoms, respectively, who received upper gastrointestinal endoscopy and were assayed for serum Helicobacter pylori antibodies. The significance of the rate of symptom improvement was estimated by Kaplan-Meier analysis and the logrank test. Laryngopharyngeal symptoms improved significantly more slowly than esophageal symptoms following acid-suppression therapy (49.8 vs. 78.3%, 60 days after the start of acid suppression; P = 0.003). These differences were observed both in patients with erosive esophagitis (P = 0.008) and in H. pylori-seronegative patients (P = 0.001).

Comparative outcomes of antireflux treatment for laryngopharyngeal reflux symptoms and upper abdominal symptoms in patients with endoscopic esophagitis

“…Also, LPR symptoms improve more slowly than esophageal symptoms after acid suppression therapy and 4 weeks of acid suppression therapy may not be long enough to fully estimate the effects of PPI therapy [15,16]. In our study, after 4 weeks of PPI treatment, both FSSG scores and LPR symptom scores were decreased, but the differences between pre-treatment and post-treatment values were not correlated.…”

Evaluation of upper abdominal symptoms using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease in patients with laryngopharyngeal reflux symptoms

“…The LPR symptoms were evaluated with a symptom score sheet based on the Refl ux Symptom Index proposed by Belafsky, 6 as described in our previous report 7,8 (Table 1). Endoscopic examination of the larynx and hypopharynx was performed using an electronic laryngoscope (VISERA ENF type VT; Olympus, Tokyo, Japan).…”

“…The LPR symptoms were judged to have improved if the LPR symptom score decreased to less than half its pretreatment value. 7,8 Double-sided paired and unpaired t tests were used to determine signifi cant differences in symptom frequency between before and after therapy and in the pretreatment frequency between the therapeutic response and nonresponse groups, respectively.…”

Positive findings on barium swallow in patients presenting with a “sensation of a lump in the throat”

“…Laryngopharyngeal symptoms improve significantly more slowly (60 days after the start of acid suppression) than oesophageal symptoms, but these therapeutic results can be maintained in the long term [23].…”