DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20163473

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

Kavitha Y., Angshuman Dutta, Sabarigirish K., Joish Upendra Kumar

Abstract


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.


Keywords


Laryngopharyngeal reflux, Reflux symptom index, Reflux finding score, Proton pump inhibitor

Full Text:

PDF

References


Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24 hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development laryngeal injury. Laryngoscope. 1991;101(52):1–78.

Belafsky PC, Postma GN, Koufman JA. The validity and reliability of reflux symptom index. J Voice. 2002;16:274-7.

Belafsky PC, Postma GN, Koufman JA. The validity and reliability of reflux finding score. Laryngoscope. 2001;111:1313–7.

Sen P, Georgalas C. A systematic review of the role of the proton pump inhibitors for symptoms of laryngo-pharyngeal reflux. Clin Otolaryngol. 2005;31:20–4.

Delgaudio JM, Waring P. Empiric esomeprazole in the treatment of laryngopharyngeal reflux. Laryngoscope. 2003;113:598–601.

Habermann W, Schmid C, Neuman K, DeVaney T, Hammer HF. Reflux symptom index and reflux finding score in Otolaryngologic practice. J Voice. 2012;26:1237.

Mesallam TA, Stemple JC. Reflux symptom index versus reflux finding score. Ann Otol Rhinol Laryngol. 2007;116:436–40.

Karkos PD, Yates PD. Is laryngo-pharyngeal reflux related to functional dysphonia. Ann Otol Rhinol Laryngol. 2007;116(1):24–9.

Pieter-Noordzij J, Khidir A. Correlation of pH probe measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope. 2002;112(12):2192–5.

Koufman JA, Aviv JE, Casiano RR. Laryngopharyngeal reflux; position statement of the committee on speech, voice, and swallowing disorders of the American academy of otolaryngology head and neck surgery. Otolaryngol Head Neck Surg. 2002;127(1):32–5.

Thomas R, Eubanks DO, Pablo E, Omelanczuk MD. Pharyngeal pH monitoring in 222 with suspected laryngeal reflux. J Gastrointestinal Surg. 2001;5(2):183–91.

Toros SZ, Toros AB. Association of laryngopharyngeal manifestation and gastroesophageal reflux. Eur Arch Otorhino-laryngol. 2008;266(3):403–9.

Tezer MS, Kockar MC. Laryngopharyngeal reflux finding scores correlate with gastroesophageal reflux disease and helicobacter pylori expression. Acta Otolaryngol. 2006;126:958–61.

Bilgen C, Ogut F. The comparison of empiric proton pump inhibitor trial versus 24 hour double probe Ph monitoring in laryngopharyngeal reflux. J Laryngo Otol. 2003;117:386–90.

Vaezi MF, Hicks DM, Abelson TI. Laryngeal signs and symptoms and GERD: a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003;1:333–44.

Metz DC, Childs ML. Pilot study of the oral omeprazole test for reflux laryngitis. Otol Laryngol Head Neck Surg. 1997;116:41–6.

Koufman J, Sataloff RT, Toohill R, Laryngopharyngeal reflux: consensus conference report. J voice. 1996;10:215-6.

Amin MR, Postma G, Johnson P, Digges N, Koufman JA. Proton pump inhibitor resistance in the treatment of laryngopharyngeal reflux. Otolaryngol Head Neck Surg. 2001;125:374–8.

Klinkenberg-Knol EC, Meuwissen SGM. Temporary cessation of long-term maintenance treatment with omeprazole in patients with H2 receptor antagonist resistant reflux esophagitis. Scand J Gastroenterol. 1990;25:1144-50.

Van de Mierop F, Flockhart D, Gallagher J, Maher K, Soukhova N, Gupta PK, et al. Omeprazole metabolism in refractory GERD: pharmacokinetics and pharmacodynamics. Gastroenterology. 1995;108:249.

Rademaker JW, Cederberg C, Hunt RH. Refractory peptic ulcers with normal omeprazole pharmacokinetics. Gastroenterology. 1991;100:145.

Klinkenberg-Knol EC, Meuwissen SGM. Combined gastric and esophageal 24-hour pH monitoring and esophageal manometry in patients with reflux disease, resistant to treatment with omeprazole. Aliment Pharmacol Ther. 1990;4:485-95.