Efficacy of proton pump inhibitor in combination with rikkunshito in patients complaining of globus pharyngeus

Nakano, Seiichi; Iwasaki, Hidetaka; Kondo, Eiji; Miyazaki, Katsumi; Shizuku, Haruhiko; Kamimura, Sei-Ichiro; Fukuda, Junya; Kanamura, Ryo; Takeda, Noriaki

doi:10.2152/jmi.63.227

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…39 Two studies of RKT looked at its efficacy in PPI-refractory LPR symptoms. Nakano et al 27 treated 22 PPI non-responders with globus with PPI+RKT, 14 experienced significant improvement in globus symptoms (>50% improvement measured by a VAS). Tokashiki et al 28 treated patients with persistent LPR symptoms despite 2 weeks of PPI therapy with RKT alone or RKT+PPI.…”

Section: Resultsmentioning

confidence: 99%

“…Although RKT alone improved globus, PPI treatment was discontinued immediately prior to the study and may have confounded the result. Similarly, it is unclear if the improvement with RKT in the study of Nakano et al 27 is because of an increased duration of PPI treatment or the addition of RKT since there was no control group. Previous studies have found a duration of 3 months is needed for a PPI response, which is longer than the time period used in either study.…”

Section: Discussionmentioning

confidence: 98%

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Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux

Huestis

Keefe

Kahn

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Laryngopharyngeal reflux (LPR) and associated symptoms can be refractory to treatment with acid suppressing medication. We investigated the role and evidence for complementary and alternative medicine (CAM) for LPR in this systematic review. Review Methods: Complementary and alternative treatment was defined in this systematic review as any non-acid suppressing medication, treatment, or therapy. A literature search was performed by two authors in consultation with a medical librarian using controlled vocabulary for “complementary and alternative medicine” and “laryngopharyngeal reflux” in the databases PubMed and EMBASE, with supplemental searches with Google Scholar. Results: Twenty articles were included in this review for the modalities: alginate, diet modification, prokinetics, respiratory retraining, voice therapy, rikkunshito (RKT), hypnotherapy, and sleep positioning. The studies were analyzed for bias based on the Cochrane criteria for RCTs and Methodological Index for non-RCT (MINORS) criteria for all other studies. For each modality a level of evidence was assigned to the current body of evidence using the GRADE approach. Conclusion: There is mixed evidence with a high degree of bias and heterogeneity between studies for the modalities presented in the paper. Based on this review, an anti-reflux diet is recommended for all patients and there is some low-quality evidence to support alkaline water. For patients with predominant vocal symptoms there is evidence that supports voice therapy. There is insufficient evidence to recommend prokinetics at this time. For patients with predominant globus symptoms, alginate, RKT, and relaxation strategies may be used in conjunction with acid suppressing medications for symptom relief.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux

Huestis

Keefe

Kahn

et al. 2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…In addition to behavioral approaches, certain non‐pharmacological supplements have been utilized in managing globus symptoms. Rikkunshito, a Japanese herbal medication, has been reported to improve globus symptoms, when used alone or combined with PPIs in patients with concurrent reflux disease 65,66 . In a single case report, acupuncture is reported to benefit globus symptoms 67…”

Section: Management Of Globusmentioning

confidence: 99%

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Zerbib

Rommel

Pandolfino

et al. 2020

Neurogastroenterology Motil

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Globus is a non‐painful sensation of a tightness or a lump/foreign body in the throat that is not associated with dysphagia and may actually improve during meals. While several otorhinolaryngologic, thyroid, and esophageal disorders have been linked to globus, cause‐and‐effect relationships are difficult to establish. Consequently, though part of the evaluation, objective otorhinolaryngologic and esophageal testing is often negative. The presence of alarm symptoms, particularly pain, weight loss, dysphagia, or odynophagia is indications for objective testing. A diagnosis of idiopathic globus requires exclusion of pharyngeal, laryngeal, and esophageal disorders with laryngoscopy, endoscopy, high‐resolution manometry, barium radiography, and/or ambulatory reflux monitoring. A trial of acid‐suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified. Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms. Beyond these specific approaches, further management of idiopathic globus consists of reassurance, neuromodulators, and complementary approaches. Globus has a benign course with no long‐term consequences, and the overall prognosis is good as the magnitude of symptoms may decline over time.

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Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease

Kung

Hsu

et al. 2017

Dig Dis Sci

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The management of proton pump inhibitor-refractory GERD (rGERD) is a challenge in clinical practice. Since up to one-third of patients with typical GERD symptoms (heartburn and/or acid regurgitation) are not satisfied with proton pump inhibitor (PPI) therapy, new drug development targeting different pathophysiologies of GERD is imperative. At present, no other drugs serve as a more potent acid suppression agent than PPIs. As an add-on therapy, histamine type-2 receptor antagonists, alginates, prokinetics and transient lower esophageal sphincter relaxation inhibitors have some impact on the subgroups of rGERD, but greater effectiveness and fewer adverse effects for widespread use are required. Visceral hypersensitivity also contributes to the perception of GERD symptoms, and neuromodulators including antidepressants play a role in this category. Esophageal pH-impedance monitoring helps to distinguish functional heartburn from true GERD, and psychologic medication and cognitive behavior therapy are further therapy options instead of PPIs.

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Efficacy of proton pump inhibitor in combination with rikkunshito in patients complaining of globus pharyngeus

Cited by 6 publications

References 15 publications

Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux

Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease

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