Objectives: This study evaluated the characteristics of reflux in
patients with laryngopharyngeal reflux (LPR) refractory to proton pump
inhibitor (PPI) therapy using the 24-h multichannel intraluminal
impedance (MII)-pH monitoring. Design: Prospective cohort study.
Setting: A tertiary care otolaryngology clinic. Participants: Patients
with suspected LPR underwent 24-hour MII-pH monitoring and were
prescribed high-dose PPI twice daily. One-hundred and eight patients
followed up for at least 2 months were enrolled. Main outcome measures:
Patients with suspected LPR showing more than one proximal reflux
episode were considered to have LPR. Patients with LPR showing ≥50%
decrease in the follow-up reflux symptom index (RSI) score compared to
the pre-treatment RSI score during treatment periods were defined as
responders; others were defined as non-responders. Various parameters in
the 24-h MII-pH monitoring between non-responders and responders with
LPR were compared using Student’s t-test. Results: Of 108 patients with
suspected LPR, 80 were diagnosed with LPR. Patients with LPR were
categorized as non-responders (n = 19) and responders (n = 61). Proximal
all reflux time and proximal longest reflux time in MII parameters were
significantly higher in responders than in non-responders (p = 0.0040
and 0.0216, respectively). The proximal all reflux time
>0.000517% was a better cut-off value to predict
responders with LPR compared to the proximal longest reflux time
>0.61 min (sensitivity + specificity: 1.317 vs. 1.291).
Conclusions: The proximal all reflux time can be helpful to predict the
response to PPI therapy and establish a personalized therapeutic scheme
in patients with LPR.
The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study