A clinical study of symptomatic profile and response in objective and subjective parameters to proton pump inhibitor in laryngopharyngeal reflux

Background: The study was conducted to identify the various clinical presentations and findings in cases of LPR and also to study the role of proton pump inhibitor in the management of laryngopharyngeal reflux by observing the effect of proton pump inhibitor on reflux finding score (RFI) and reflux symptom index (RSI).Methods: A prospective, interventional, cohort study of 50 diagnosed cases of LPR with RSI >13 and RFS >7 (based on fibreoptic laryngoscopic findings) at the time of initial presentation was done. They were treated with a 6 month course of oral cap omeprazole (20 mg twice daily 30 minutes before meals) and followed up at 0, 4, 8 and 24 weeks for any improvement in RSI and RFS scores. Results: Most frequent symptoms detected in the cases were frequent clearing of throat, dry cough and sensation of lump in the throat all of which showed significant improvement at follow up at 4 weeks. Most common finding on fibreoptic laryngoscopy was erythema and diffuse laryngeal oedema, both of which showed significant improvement on follow up.There was also a significant change in RSI and RFS after receiving Omeprazole at 4 weeks, 8 weeks and at 24 weeks duration (p <0.0001).Conclusions: This study dealt mainly with study of combination of clinical features that LPR presents time line of improvement of these features with capsule omeprazole. It is proposed that a presumptive diagnosis of LPR can be made based on the criteria of RSI and patients be given an empirical therapeutic trial including behavioral and dietary recommendations and 6 months of twice-daily proton-pump inhibitor therapy for an excellent clinical response.

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The effect of anti-reflux treatment on subjective voice measurements of patients with laryngopharyngeal reflux

The Journal of Laryngology & Otology ◽

10.1017/s0022215113000832 ◽

2013 ◽

Vol 127 (6) ◽

pp. 590-594 ◽

Cited By ~ 8

Author(s):

T J Beech ◽

G Campbell ◽

A L McDermott ◽

A J Batch

Keyword(s):

Proton Pump ◽

Speech Therapy ◽

Laryngopharyngeal Reflux ◽

Proton Pump Inhibitor Therapy ◽

Reflux Symptom ◽

Reflux Symptom Index ◽

Symptom Scale ◽

Symptom Index ◽

Scale Scores ◽

The Impact

AbstractObjective:To assess the impact of anti-reflux treatment and speech therapy on subjective voice measurements of patients with laryngopharyngeal reflux.Methods:This paper reports a prospective study of patients seen in a voice clinic over a three-year period who were being treated for laryngopharyngeal reflux. Patients were assessed at presentation using the reflux symptom index and voice symptom scale, and were reassessed at three months and six months post-treatment. Treatment entailed twice daily proton pump inhibitor therapy and speech therapy.Results:The study comprised 74 patients. The reflux symptom index and voice symptom scale scores significantly improved following treatment at both three and six months. There was a correlation between improved reflux symptom index scores and improved voice symptom scale scores.Conclusion:Treatment of laryngopharyngeal reflux with twice daily proton pump inhibitors and speech therapy resulted in improved subjective voice measurements for patients.

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Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux

Diseases of the Esophagus ◽

10.1093/dote/doy072 ◽

2018 ◽

Vol 32 (4) ◽

Cited By ~ 6

Author(s):

N Agrawal ◽

R Yadlapati ◽

N Shabeeb ◽

C PE Price ◽

A Lidder ◽

...

Keyword(s):

Proton Pump Inhibitor ◽

Proton Pump ◽

Laryngopharyngeal Reflux ◽

Care Center ◽

Tertiary Care ◽

Variable Response ◽

Reflux Symptom Index ◽

Symptom Index ◽

Endoscopic Findings

Summary Laryngopharyngeal reflux (LPR) is a clinical entity diagnosed by history laryngoscopic findings that has a variable response to empiric proton-pump inhibitor (PPI) therapy. While the reflux finding score (RFS), an endoscopic scoring scheme, has been advanced as a measure of LPR, it has not been externally validated against symptom severity in practice. Extralaryngeal pharyngeal endoscopic findings may have diagnostic utility but remain underexplored. This study assesses the correlation between extralaryngeal findings and (1) 24-hour oropharyngeal pH & (2) PPI response in patients with suspected LPR. Subjects presented to a tertiary care center with laryngeal symptoms ≥1 month and reflux symptom index (RSI) ≥13. Following baseline questionnaires, laryngoscopy, and a 24-hour oropharyngeal pH probe study, subjects were prescribed 8–12 week omeprazole trials. Baseline endoscopic findings were scored in a blinded fashion using the RFS and extralaryngeal score criteria, summatively the ‘ELS.’ PPI response was defined as ≥50% improvement in RSI. Thirty-three subjects with flexible endoscopic recordings completed baseline and follow-up questionnaires. The cohort's baseline mean RSI was 23.0 ± 7.2 with a ΔRSI = 9.8 after PPI therapy. The baseline RFS score averaged 5.3 ± 2.7. 45% of our subjects was found to be PPI responsive. The Cohen's kappa for the ELS but not the RFS was significant. There were no significant differences between the RFS (P = 0.10) or ELS (P = 0.07) for PPI responders & nonresponders. Oropharyngeal pH measures did not correlate with the RFS or ELS. In conclusion, endoscopic scores of laryngeal and extralaryngeal findings did not predict PPI response or oropharyngeal acid exposure in suspected LPR.

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Impact on Quality of Life after Treatment with Proton Pump Inhibitor in Laryngopharyngeal Reflux

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2019.00899 ◽

2020 ◽

Vol 63 (11) ◽

pp. 517-522

Author(s):

Hae-Won Choi ◽

Hyun-Woong Jun ◽

Jin Hyuk Jung ◽

Moo Keon Kim ◽

Kyung Tae ◽

...

Keyword(s):

Quality Of Life ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Laryngopharyngeal Reflux ◽

Reflux Symptom Index ◽

Symptom Index ◽

Significant Impairment ◽

Eortc Qlq ◽

The Impact

Background and Objectives Several studies have assessed the impact of laryngopharyngeal reflux disease (LPRD) on the health-related quality of life (HR-QoL), showing significant impairment of HR-QoL. This study aims to assess the impact of proton pump inhibitor (PPI) treatment of LPRDs to enhance HR-QoL.Subjects and Method We prospectively collected data from LPRD patients from April 2017 to July 2019. Patients who have reflux symptom index (RSI) of ≥13 or reflux finding score (RFS) of ≥7 were enrolled in this study. We assessed HR-QoL using a questionnaire with EORTC QLQ-H&N35, -C30 on the first visit. Patients were treated with PPI (Ilaprazole 20 mg/day) on their visits at 4, 8, and 12 weeks. RSI and RFS were measured at each visit and HR-QoL was reevaluated on the last visit.Results Ninety-five patients completed the 3-months follow-up and were enrolled in this study. Female : male ratio was 71:24 and the mean age was 57.0±11.9 (27-80). The initial RSI and RFS were 16.3±8.8 and 12.6±2.9, respectively, but were changed to 11.1±9.7 and 9.7±2.6 (p<0.001 in both) at 12 weeks after the treatment. Global health status/QoL, speech problem, dry mouth, and coughing were significantly improved.Conclusion PPI administration is effective in treating LPRD, where effects begin to appear at 4 weeks after treatment. HR-QoL was also improved in patients who have RSI improvement.

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CONTINUOUS VERSUS ON-DEMAND PROTON PUMP INHIBITOR TREATMENT FOR LARYNGOPHARYNGEAL REFLUX: A RANDOMIZED CLINICAL TRIAL

International Journal of Applied Pharmaceutics ◽

10.22159/ijap.2019.v11s6.33530 ◽

2019 ◽

pp. 20-23

Author(s):

SUSYANA TAMIN ◽

ABDUL AZIZ RANI ◽

ADANG BACHTIAR

Keyword(s):

Clinical Trial ◽

Proton Pump Inhibitor ◽

Randomized Clinical Trial ◽

Proton Pump ◽

Laryngopharyngeal Reflux ◽

Reflux Symptom Index ◽

Symptom Index ◽

Treatment Groups ◽

Lingual Tonsil ◽

Grade Ii

Objective: This study aimed to compare continuous and pro re nata (PRN) proton pump inhibitor (PPI) treatments for laryngopharyngeal reflux (LPR). Methods: This randomized clinical trial included 52 LPR patients with lingual tonsil hypertrophy (LTH). Those patients who showed LPR improvement with an initial PPI trial were randomly divided into continuous and PRN PPI treatment groups. The Reflux Symptom Index (RSI) score, Reflux Finding Score (RFS), and LTH grade were used to assess the treatment results. Results: The PPI treatment (30 mg of lansoprazole twice daily) for 6 mo resulted in a significantly decreasing RSI score (p<0.001). The PPI treatments for the first 8 w and the second 8 w also showed significant LPR improvement. However, there was no significant improvement after the third 8 w (p>0.05). After 6 mo, the PPI treatment also resulted in a continuous decrease in the RFS (p<0.001). There were no significant differences in the mean RSI scores (p=0.518) and mean RFSs (p=0.393) between the continuous and PRN PPI groups. In the grade II LTH cases, there was a significant improvement after 6 mo of PPI treatment (p<0.001), although there was no improvement after the first 2 mo in the treatment group. For the grade III LTH cases, there was no significant improvement after the first 2 mo and 6 mo of the PPI treatment. Conclusion: Six months of PPI treatment improved the RSI score, RFS, and LTH grade, although there was no difference between the continuous and PRN PPI treatment groups.

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A Randomized Clinical Trial of Proton Pump Inhibitors Combined with Traditional Chinese Medicine in the Treatment of Laryngopharyngeal Reflux Disease

Acupuncture & Electro-Therapeutics Research ◽

10.3727/036012921x16321477053845 ◽

2021 ◽

Author(s):

Feng Pei ◽

Wei Jia Hu ◽

Yi Nan Mao ◽

Yu Liang Zhao

Keyword(s):

Proton Pump ◽

Reflux Disease ◽

Laryngopharyngeal Reflux ◽

Short Form ◽

Therapeutic Effects ◽

Reflux Symptom Index ◽

Symptom Index ◽

Laryngopharyngeal Reflux Disease ◽

Group A ◽

Group B

Background:To explore whether combined with TCM based on classical proton pumpinhibitors PPIs therapy can achieve better efficacy for patients withlaryngopharyngeal reflux disease. Methods: There were 150 laryngopharyngeal refluxpatients enrolled and divided into three groups randomly, with 50 cases in each group.Patients in group A were treated with the proton pump inhibitor (PPI) lansoprazole.Patients in group B were treated with lansoprazole combined with Banxia Houpudecoction, and patients in group C were treated with acupuncture treatments and acombination of Chinese and Western medicine. The reflux symptom index (RSI), refluxfinding score (RFS), and quality of life (36 item short form health survey questionnaire)were assessed before and 4 and 8 weeks after treatment. Results: The RSI and RFSscores of the three groups were significantly reduced after treatment (P < 0.001). Ingroup B and C, they were lower than in group A at 8 weeks (P < 0.01). The SF 36 scoreof 3 groups increased after treatment. At both 4 and 8 weeks (P < 0.001), and patientsin groups B and C scored higher than patients in group A (P < 0.001). The total effectiverate of group B and group C was higher than that of group A (P < 0.05). Conclusion:All three treatments have therapeutic effects on the disease, but the efficacy of a PPIalone is not as good as the combined treatments’ efficacies. Moreover, PPI combinedwith Banxia Houpu decoction and/or acupuncture treatment substantially affects lifeimprovement.

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