Management of laryngopharyngeal reflux with proton pump inhibitors

Reimer, Christina; Bytzer, Peter

doi:10.2147/tcrm.s6862

Cited by 24 publications

(9 citation statements)

References 39 publications

(69 reference statements)

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“…However, one study suggested that GORD would only worsen nasal symptom scores but did not cause chronic rhinosinusitis [46]. Studies data are conflicting in role of PPI in LPR as some studies found a higher response when using PPI suggesting complex patterns of LPR, while others did not show additional relief of symptoms compared with placebo [49] although a positive correlation was found between pH Ryan score and total SFAR score in another study which could be related to LPR [17]. RSI score in our study increased in responders with positive AR symptoms, suggesting that having AR increased the symptoms of LPR and vice versa, SFAR score increased with positive LPR symptoms, suggesting that having LPR increased symptoms of AR.…”

Section: Discussionmentioning

confidence: 99%

Allergic rhinitis, asthma and gastro-esophageal reflux disease: a cross-sectional study on their reciprocal relations

Kakaje

Alhalabi

Alyousbashi

et al. 2020

Preprint

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Allergic rhinitis (AR) is a very common medical condition worldwide which affects the quality of life of many for long periods throughout the year. It has many symptoms such as sneezing, a sore throat, globus pharyngeus, rhinorrhoea, congestion, and postnasal drip that may overlap with laryngopharyngeal reflux (LPR) which is a different medical condition. LPR can be considered as an extra oesophageal manifestation of gastro-oesophageal reflux disease (GORD) or a different entity altogether. LPR can go under-diagnosed as there is no definitive diagnostic tool. LPR can impose a real challenge as it may occur for years without diagnosis which can affect the quality of life even more. Having AR can also increase the chance of having asthma which is also in turn correlated with having GORD. Although AR and LPR are not life-threatening, they are persistent medical conditions, meaning they affect the everyday life and causing unnecessary distress. In this study we evaluate their correlation in Syria in the Middle East as there are not many studies on this topic. We found responders with LPR symptoms do have more AR symptoms (P<0.001) and that AR and LPR are correlated with having asthma. We also found that AR and LPR correlation is independent from having asthma P<0.0001 but with subjects with asthma, no such a correlation was found.

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Section: Discussionmentioning

confidence: 99%

Allergic rhinitis, asthma and gastro-esophageal reflux disease: a cross-sectional study on their reciprocal relations

Kakaje

Alhalabi

Alyousbashi

et al. 2020

Preprint

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“…Meta-analyses show very little difference in pretreatment and posttreatment symptoms compared with placebo, and standard practice shifts to twice daily, then 3 times daily, in cases of refractory LPRD. [24][25][26] A substantial number of patients demonstrate relative resistance to PPIs. 27 Studies on surgical treatment with fundoplication have also been inconclusive.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux

Zalvan

Greenberg

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Our data suggest that the effect of PPI on the RSI based on proportion reaching a 6-point reduction in RSI is not significantly better than that of alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions, although the difference in the 2 treatments could be clinically meaningful in favor of the dietary approach. The percent reduction in RSI was significantly greater with the dietary approach. Because the relationship between percent change and response to treatment has not been studied, the clinical significance of this difference requires further study. Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR. This approach may effectively improve symptoms and could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet.

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“…Rather, high placebo response levels suggested a more complex and multifactorial pathophysiology. 23 Like previous authors, the reviewers concluded that further studies are needed to characterise subgroups of patients with reflux-associated laryngeal symptoms who might benefit from treatment with PPI.…”

Section: Rationalementioning

confidence: 83%

“…This would accord with the magnitude of the placebo effect in TOPPITS. 23 A person's locus of control is either internal (believes to personally control his or her life) or external (believes to be controlled by others, by environmental factors that cannot be influenced or by chance). An external locus of control has been found to be related to higher placebo response.…”

Section: Update On Ph-metry and Manometry In Throat Symptomsmentioning

confidence: 99%

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

Wilson

Stocken

Watson

et al. 2021

Health Technol Assess

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Background Persistent throat symptoms are commonly attributed to ‘laryngopharyngeal reflux’. Despite a limited evidence base, these symptoms are increasingly being treated in primary care with proton pump inhibitors. Objective To assess the value of proton pump inhibitor therapy in patients with persistent throat symptoms. Design This was a double-blind, placebo-controlled, randomised Phase III trial. Setting This was a multicentre UK trial in eight UK ear, nose and throat departments. Participants A total of 346 participants aged ≥ 18 years with persistent throat symptoms and a Reflux Symptom Index score of ≥ 10, exclusive of the dyspepsia item, were recruited. Intervention Random allocation (1 : 1 ratio) to either 30 mg of lansoprazole twice daily or matched placebo for 16 weeks. Main outcome measure Symptomatic response (i.e. total Reflux Symptom Index score after 16 weeks of therapy). Results A total of 1427 patients were screened and 346 were randomised. The mean age was 52 years (standard deviation 13.7 years, range 20–84 years); 150 (43%) participants were male and 196 (57%) were female; 184 (53%) participants had a mild Reflux Symptom Index minus the heartburn/dyspepsia item and 162 (47%) had a severe Reflux Symptom Index minus the heartburn/dyspepsia item. A total of 172 patients were randomised to lansoprazole and 174 were randomised to placebo. Main outcomes A total of 267 participants completed the primary end-point visit (lansoprazole, n = 127; placebo, n = 140), of whom 220 did so between 14 and 20 weeks post randomisation (‘compliant’ group); 102 received lansoprazole and 118 received placebo. The mean Reflux Symptom Index scores at baseline were similar [lansoprazole 22.0 (standard deviation 8.0), placebo 21.7 (standard deviation 7.1), overall 21.9 (standard deviation 7.5)]. The mean Reflux Symptom Index scores at 16 weeks reduced from baseline in both groups [overall 17.4 (standard deviation 9.9), lansoprazole 17.4 (standard deviation 9.9), placebo 15.6 (standard deviation 9.8)]. Lansoprazole participants had estimated Reflux Symptom Index scores at 16 weeks that were 1.9 points higher (worse) than those of placebo participants (95% confidence interval –0.3 to 4.2; p adj = 0.096), adjusted for site and baseline severity. Secondary outcomes Ninety-five (43%) participants achieved a Reflux Symptom Index score in the normal range (< 12) at 16 weeks: 42 (41%) in the lansoprazole group and 53 (45%) in the placebo group. A total of 226 participants completed the end-of-trial follow-up visit (lansoprazole, n = 109; placebo, n = 117), of whom 181 were ‘compliant’. The mean Reflux Symptom Index scores at 12 months reduced from baseline in both groups [lansoprazole 16.0 (standard deviation 10.8), placebo 13.6 (standard deviation 9.6), overall 14.7 (standard deviation 10.2)]. A total of 87 (48%) participants achieved a Reflux Symptom Index score in the normal range at 12 months: 33 (40%) in the lansoprazole group and 54 (55%) in the placebo group. Likewise, the Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life total scores and subscales all showed very similar changes in the lansoprazole and placebo cohorts at both 16 weeks and 12 months. Limitations Drop-out rate and compliance are issues in pragmatic clinical trials. The Trial Of Proton Pump Inhibitors in Throat Symptoms (TOPPITS) aimed to detect clinically relevant difference with 90% power. The 346 randomised participants reduced to 283 at the primary end point; 267 completed the primary outcome measure, 220 within the protocol time scale. Despite this, the powers to detect the clinically relevant difference in Reflux Symptom Index score at 16 weeks were 82% (compliant comparison) and 89% (pragmatic comparison). The lack of difference between lansoprazole and placebo is generalisable across NHS clinics. Conclusions Participants on lansoprazole did not report significantly better outcomes than participants on placebo on any of the three patient-reported outcome tools (Reflux Symptom Index, Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life). This multicentre, pragmatic, powered, definitive Phase III trial found no evidence of benefit for patients by treating persistent throat symptoms with lansoprazole. Trial registration Current Controlled Trials ISRCTN38578686 and EudraCT number 2013-004249-17. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 3. See the NIHR Journals Library website for further project information.

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Management of laryngopharyngeal reflux with proton pump inhibitors

Cited by 24 publications

References 39 publications

Allergic rhinitis, asthma and gastro-esophageal reflux disease: a cross-sectional study on their reciprocal relations

Allergic rhinitis, asthma and gastro-esophageal reflux disease: a cross-sectional study on their reciprocal relations

A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

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