Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up‐front, pH‐impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease

Carroll, Thomas L.; Werner, Astrid C; Nahikian, Kael; Dezube, Aaron R.; Roth, Douglas F.

doi:10.1002/lary.26806

Cited by 50 publications

(39 citation statements)

References 46 publications

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“…These results were comparable to a similar study conducted by Carroll et al, which demonstrated that a once-daily, 40 mg omeprazole and once nightly, 300 mg ranitidine (QD/QHS) dosing improved the majority (67%) of patients who presented with signs and symptoms of LPR and ultimately responded to empiric acid suppression. 19 Although similar results have been demonstrated in studies of Belafsky et al 12 and Bilgen et al 32 but these studies used pH monitoring for diagnosis of LPR and used only PPIs in the treatment of LPR. pH monitoring was not done in our study.…”

Section: Discussionsupporting

confidence: 60%

“…Some studies demonstrated clinically evident benefits in the treatment but some studies did not report any clinical benefits of the use of H2RA in LPR. [19][20][21][22] There are very few studies that have studied the effects of combination therapy with PPI and H2RA (BBF/HS dose) in patients with LPR. The objective of this study was to evaluate once-daily, 40 mg pantoprazole and once nightly, 300 mg ranitidine (BBF/HS) dosing as an alternative empiric regimen in the management of LPR.…”

Section: Introductionmentioning

confidence: 99%

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Combination drug therapy for laryngopharyngeal reflex

Hussain

Makhdoomi

Showkat

2020

Int J Otorhinolaryngol Head Neck Surg

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Background: We sought to evaluate the combination of high-dose prebreakfast proton pump inhibitors (PPIs) (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing as a surrogate and rational regimen for LPR.Methods: 60 subjects that presented to ENT and HNS OPD with symptoms of laryngopharyngeal reflux (LPR) were prospectively evaluated and underwent a comprehensive otolaryngological examination. All subjects were treated sequentially and outcomes recorded using reflux finding score (RFS) and reflux symptom index (RSI). Results: The mean age of the cohort was 35±06.51 (age range, 8-55). Mean RSI of all patients was 24.8 before treatment with combination of PPIs and H2 receptor antagonists. Significant change in RSI were observed after the first 8 weeks of therapy and no further significant changes were observed over the next 16 weeks. Mean RFS of the patients was 12 before starting the treatment and there was a significant response in mean RFS at 16 weeks of therapy.Conclusions: A surrogate high-dose prebreakfast PPI (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing regimen is effective in improving RSI and RFS in majority of cases who present with LPR.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Combination drug therapy for laryngopharyngeal reflex

Hussain

Makhdoomi

Showkat

2020

Int J Otorhinolaryngol Head Neck Surg

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“…In less than 50% of cases, these complaints are associated with gastro‐oeosophageal reflux disease (GERD) symptoms such as heartburn and regurgitation. LPR‐related symptoms impair quality of life and require prolonged treatment, which is associated with a significant cost …”

Section: Introductionmentioning

confidence: 99%

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Lechien

Muls

Dapri

et al. 2019

Clinical Otolaryngology

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Objective: To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. Methods:A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated.Results: Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did | 785 LECHIEN Et aL

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“…Over the past few decades, the empirical therapeutic trial based on proton pump inhibitors (PPIs) was proposed as the main cost-effective approach to treat and support the LPR diagnosis [71][72][73][74][75][76][77][78][79][80][81][82][83][84]. Nowadays, this approach is increasingly challenged for many reasons [64,75]. First, PPIs are suspected to have short-and long-term side effects (Table 3) that support the PPI prescription only in patients with an identified acid reflux disease and for the shorter duration [64].…”

Section: Cost-effective Empirical Approachmentioning

confidence: 99%

Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians

Lechien

Saussez

Muls

et al. 2020

JCM

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Laryngopharyngeal reflux (LPR) is a common disease in the general population with acute or chronic symptoms. LPR is often misdiagnosed in primary care because of the lack of typical gastroesophageal reflux disease (GERD) symptoms and findings on endoscopy. Depending on the physician’s specialty and experience, LPR may be over- or under-diagnosed. Management of LPR is potentially entirely feasible in primary care as long as General Practitioners (GPs) are aware of certain “red flags” that will prompt referral to a Gastroenterologist or an Otolaryngologist. The use of patient-reported outcome questionnaires and the consideration of some easy ways to diagnose LPR without special instrumentation oropharyngeal findings may help the GP to diagnose and often manage LPR. In this review, we provide a practical algorithm for LPR management for GPs and other specialists that cannot perform fiberoptic examination. In this algorithm, physicians have to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and “red flags”. They may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the symptom severity. Proton pump inhibitors and alginates remain a popular choice in order to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

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Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up‐front, pH‐impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease

Abstract: 4. Laryngoscope, 127:S1-S13, 2017.

Cited by 50 publications

References 46 publications

Combination drug therapy for laryngopharyngeal reflex

Combination drug therapy for laryngopharyngeal reflex

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians

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