Proton Pump Inhibitor Therapy for Chronic Laryngo‐Pharyngitis: A Randomized Placebo‐Control Trial

Steward, David L.; Wilson, Keith; Kelly, Dan H.; Patil, Mona Sadanand; Schwartzbauer, Heather Rose; Long, John D.; Welge, Jeff

doi:10.1016/j.otohns.2004.03.037

Cited by 181 publications

(199 citation statements)

References 18 publications

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“…Attempts were made to contact study authors for additional information needed for full analysis of their data. [12][13][14][15][16] Results…”

Section: Analysis Of Therapeutic Gainmentioning

confidence: 99%

“…[13][14][15][16][34][35][36][37][38] All assessed pharmacologic interventions for cough (no placebo-controlled studies assessing surgery were found); eight assessed PPIs (once daily or bid for 8-16 weeks) [13][14][15][16][34][35][36][37] ; and one assessed the histamine type 2-receptor antagonist ranitidine, 150 mg daily for 8 weeks. 38 No unpublished data were used in this review because no additional information that aided the analysis was obtained from authors.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five used patient diaries consisting of visual analog scales to assess cough severity and/or frequency ( Table 1), 13,16,34,36,38 questionnaires were used in two studies ( Table 1 ), 14,35 and two studies did not specify the method of data acquisition ( Table 1 ). 15,37 Two studies assessed efficacy in terms of the proportion of patients who met prespecifi ed criteria for response ( Table 1 ) 16,36 ; the remainder measured change in mean cough scores relative to baseline for treatment vs placebo.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Kahrilas

Howden

Hughes

et al. 2013

Chest

152

100

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Background: Epidemiologic and physiologic studies suggest an association between gastroesophageal refl ux disease (GERD) and chronic cough. However, the benefi t of antirefl ux therapy for chronic cough remains unclear, with most relevant trials reporting negative fi ndings. This systematic review aimed to reevaluate the response of chronic cough to antirefl ux therapy in trials that allowed us to distinguish patients with or without objective evidence of GERD. Methods: PubMed and Embase systematic searches identifi ed clinical trials reporting cough response to antirefl ux therapy. Datasets were derived from trials that used pH-metry to characterize patients with chronic cough. Results: Nine randomized controlled trials of varied design that treated patients with acid suppression were identifi ed (eight used proton pump inhibitors [PPIs], one used ranitidine). Datasets from two crossover studies showed that PPIs signifi cantly improved cough relative to placebo, albeit only in the arm receiving placebo fi rst. Therapeutic gain in seven datasets was greater in patients with pathologic esophageal acid exposure (range, 12.5%-35.8%) than in those without (range, 0.0%-8.6%), with no overlap between groups. Conclusions: A therapeutic benefi t for acid-suppressive therapy in patients with chronic cough cannot be dismissed. However, evidence suggests that rigorous patient selection is necessary to identify patient populations likely to be responsive, using physiologically timed cough events during refl ux testing, minimal patient exclusion because of presumptive alternative diagnoses, and appropriate power to detect a modest therapeutic gain. Only then can we hope to resolve this vexing clinical management problem. CHEST 2013; 143(3):605-612Abbreviations: GERD 5 gastroesophageal refl ux disease; LPR 5 laryngopharyngeal refl ux; PPI 5 proton pump inhibitor

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“…Attempts were made to contact study authors for additional information needed for full analysis of their data. [12][13][14][15][16] Results…”

Section: Analysis Of Therapeutic Gainmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Kahrilas

Howden

Hughes

et al. 2013

Chest

152

100

View full text Add to dashboard Cite

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“…Ideal dietary changes would restrict chocolate, fats, citrus fruits, carbonated beverages, spicy tomato-based products, red wines, caffeine, and late-night meals. Such behavioral changes appear to be an independently significant variable in determining response to medical therapy [5]. Along with advice on lifestyle and dietary modifications, most of the patients will require some form of medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Assessment of treatment response in patients with laryngopharyngeal reflux

Joshi

Chiplunkar

Bradoo

2017

Indian J Otolaryngol Head Neck Surg

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To evaluate treatment response in patients with laryngopharyngeal reflux (LPR). A prospective study of 100 patients with voice disorders was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70°rigid laryngoscope. Patients with RFS score of 7 or more were diagnosed of having LPR and were started with anti-reflux therapy for a period of 6 months. Patients were assessed at regular intervals using RSI and RFS. The prevalence of LPR in patients with voice disorders was found to be 25%. The mean RSI score improved gradually and significantly over a period of 6 months from 11.84 at presentation to 2.04 after 6 months of treatment (p value \0.001). The mean value of RFS improved from 7.92 at entry to 1.52 after 6 months of treatment (p value \0.001). However, it was found that the improvement was not significant at end of first month of treatment, and improvement in RSI and RFS scores was found only after 2 months of treatment. RSI and RFS improve significantly after treatment for 6 months with PPI like Omeprazole. But the improvement starts from the 2nd month from the onset of treatment. Treatment of LPR for at least 6 months may be indicated to attain a full resolution of physical findings.

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“…These drugs show significant improvement in both symptoms and local findings with more than 80% patients showing promising response in three months. Some recent evidence has however failed to show similar promise and therefore in our clinical practice, we insist on a positive pH metry finding before commencing PPIs [11,12]. The role of empirical usage of PPIs based on symptoms / symptom scores alone is not recommended as per a systematic review [13].…”

Section: Treatmentmentioning

confidence: 99%

Laryngopharyngeal Reflux : Larynx on Fire

Datta

Venkatesh

2010

Medical Journal Armed Forces India

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Laryngopharyngeal Reflux (LPR) is a commonly occurring and recently described clinical entity due to the retrograde flow of gastric contents into the pharynx. It accounts for many symptoms of upper airway including hoarseness, chronic throat irritation and globus sensation. The sensitive laryngeal mucosa is prone to damage by the combination of acid and pepsin. The inflammatory changes that follow are presumed to cause the symptoms and predispose the individual to laryngeal disorders. Diagnosis can usually be made clinically based on symptoms and laryngeal signs but a 24 hour pH metry is essential to establish diagnosis. Treatment centres on lifestyle modifications, vocal hygiene measures and long term use of proton pump inhibitors. Recent research in this field may lead to a better understanding of the pathophysiology of the disease and change the way LPR is managed. MJAFI 2010; 66 : 245-248

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Proton Pump Inhibitor Therapy for Chronic Laryngo‐Pharyngitis: A Randomized Placebo‐Control Trial

Abstract: Compared to baseline, lifestyle modification for 2 months significantly improved chronic laryngo-pharyngitis symptoms. When compared to control, treatment with a PPI failed to demonstrate significantly greater improvement in reflux symptoms, health status, or laryngeal appearance.

Cited by 181 publications

References 18 publications

Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Assessment of treatment response in patients with laryngopharyngeal reflux

Laryngopharyngeal Reflux : Larynx on Fire

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