Efficacy of Anti-Reflux Surgery on Refractory Laryngopharyngeal Reflux Disease in Professional Voice Users: A Pilot Study

Weber, Brittany; Portnoy, Joel E.; Castellanos, Andres; Hawkshaw, Mary J.; Lurie, Deborah; Katz, Philip O.; Sataloff, Robert T.

doi:10.1016/j.jvoice.2013.12.009

Cited by 22 publications

(13 citation statements)

References 23 publications

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“…As described in Figure , from the initial electronic search, 10 cohort studies which did not discuss primary treatment outcomes overall (ie not part of the 35 studies above) did otherwise specifically address aetiology or management of non‐responder patients . Table summarises the details of these studies relative to diagnosis, management, and treatment.…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…However, the accuracy of diagnosis of LPR could be a problem. With strict screening via multichannel intraluminal impedance-pH[39,40] or oropharyngeal pH-monitoring, symptoms of LPR are likely to demonstrate improvement following anti-reflux surgery.…”

Section: Discussionmentioning

confidence: 99%

Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

Zhang¹,

Hu²,

Chen³

et al. 2017

WJG

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AIMTo compare the outcomes between laparoscopic Nissen fundoplication (LNF) and proton pump inhibitors (PPIs) therapy in patients with laryngopharyngeal reflux (LPR) and type I hiatal hernia diagnosed by oropharyngeal pH-monitoring and symptom-scale assessment.METHODSFrom February 2014 to January 2015, 70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment, oropharyngeal pH-monitoring, manometry, and gastrointestinal endoscopy were enrolled in this study. All of the patients met the inclusion criteria. All of the patients underwent LNF or PPIs administration, and completed a 2-year follow-up. Patients’ baseline characteristics and primary outcome measures, including comprehensive and single symptoms of LPR, PPIs independence, and satisfaction, and postoperative complications were assessed. The outcomes of LNF and PPIs therapy were analyzed and compared.RESULTSThere were 31 patients in the LNF group and 39 patients in the PPI group. Fifty-three patients (25 in the LNF group and 28 in the PPI group) completed reviews and follow-up. Oropharyngeal pH-monitoring parameters were all abnormal with high acid exposure, a large amount of reflux, and a high Ryan score, associated reflux symptom index (RSI) score. There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups (P < 0.05), as well as typical symptoms of gastroesophageal reflux disease. Improvement in the RSI (P < 0.005) and symptom scores of cough (P = 0.032), mucus (P = 0.011), and throat clearing (P = 0.022) was significantly superior in the LNF group to that in the PPI group. After LNF and PPIs therapy, 13 and 53 patients achieved independence from PPIs therapy (LNF: 44.0% vs PPI: 7.14%, P < 0.001) during follow-up, respectively. Patients in the LNF group were more satisfied with their quality of life than those in the PPI group (LNF: 62.49 ± 28.68 vs PPI: 44.36 ± 32.77, P = 0.004). Body mass index was significantly lower in the LNF group than in the PPI group (LNF: 22.2 ± 3.1 kg/m2 vs PPI: 25.1 ± 2.9 kg/m2, P = 0.001).CONCLUSIONDiagnosis of LPR should be assessed with oropharyngeal pH-monitoring, manometry, and the symptom-scale. LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

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“…98 The RFS is also insensitive to postfundoplication symptomatic benefit. 99 In a selected series of 78 patients with chronic cough and/or suspected vocal cord dysfunction, 100 87% had a RSI score of > 13 and 51% had a RFS of > 7. Salivary pepsin had a sensitivity of 78% and specificity of 53% for predicting a high RFS.…”

Section: The Reflux Finding Score Is Unreliablementioning

confidence: 98%

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

Wilson

Stocken

Watson

et al. 2021

Health Technol Assess

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Background Persistent throat symptoms are commonly attributed to ‘laryngopharyngeal reflux’. Despite a limited evidence base, these symptoms are increasingly being treated in primary care with proton pump inhibitors. Objective To assess the value of proton pump inhibitor therapy in patients with persistent throat symptoms. Design This was a double-blind, placebo-controlled, randomised Phase III trial. Setting This was a multicentre UK trial in eight UK ear, nose and throat departments. Participants A total of 346 participants aged ≥ 18 years with persistent throat symptoms and a Reflux Symptom Index score of ≥ 10, exclusive of the dyspepsia item, were recruited. Intervention Random allocation (1 : 1 ratio) to either 30 mg of lansoprazole twice daily or matched placebo for 16 weeks. Main outcome measure Symptomatic response (i.e. total Reflux Symptom Index score after 16 weeks of therapy). Results A total of 1427 patients were screened and 346 were randomised. The mean age was 52 years (standard deviation 13.7 years, range 20–84 years); 150 (43%) participants were male and 196 (57%) were female; 184 (53%) participants had a mild Reflux Symptom Index minus the heartburn/dyspepsia item and 162 (47%) had a severe Reflux Symptom Index minus the heartburn/dyspepsia item. A total of 172 patients were randomised to lansoprazole and 174 were randomised to placebo. Main outcomes A total of 267 participants completed the primary end-point visit (lansoprazole, n = 127; placebo, n = 140), of whom 220 did so between 14 and 20 weeks post randomisation (‘compliant’ group); 102 received lansoprazole and 118 received placebo. The mean Reflux Symptom Index scores at baseline were similar [lansoprazole 22.0 (standard deviation 8.0), placebo 21.7 (standard deviation 7.1), overall 21.9 (standard deviation 7.5)]. The mean Reflux Symptom Index scores at 16 weeks reduced from baseline in both groups [overall 17.4 (standard deviation 9.9), lansoprazole 17.4 (standard deviation 9.9), placebo 15.6 (standard deviation 9.8)]. Lansoprazole participants had estimated Reflux Symptom Index scores at 16 weeks that were 1.9 points higher (worse) than those of placebo participants (95% confidence interval –0.3 to 4.2; p adj = 0.096), adjusted for site and baseline severity. Secondary outcomes Ninety-five (43%) participants achieved a Reflux Symptom Index score in the normal range (< 12) at 16 weeks: 42 (41%) in the lansoprazole group and 53 (45%) in the placebo group. A total of 226 participants completed the end-of-trial follow-up visit (lansoprazole, n = 109; placebo, n = 117), of whom 181 were ‘compliant’. The mean Reflux Symptom Index scores at 12 months reduced from baseline in both groups [lansoprazole 16.0 (standard deviation 10.8), placebo 13.6 (standard deviation 9.6), overall 14.7 (standard deviation 10.2)]. A total of 87 (48%) participants achieved a Reflux Symptom Index score in the normal range at 12 months: 33 (40%) in the lansoprazole group and 54 (55%) in the placebo group. Likewise, the Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life total scores and subscales all showed very similar changes in the lansoprazole and placebo cohorts at both 16 weeks and 12 months. Limitations Drop-out rate and compliance are issues in pragmatic clinical trials. The Trial Of Proton Pump Inhibitors in Throat Symptoms (TOPPITS) aimed to detect clinically relevant difference with 90% power. The 346 randomised participants reduced to 283 at the primary end point; 267 completed the primary outcome measure, 220 within the protocol time scale. Despite this, the powers to detect the clinically relevant difference in Reflux Symptom Index score at 16 weeks were 82% (compliant comparison) and 89% (pragmatic comparison). The lack of difference between lansoprazole and placebo is generalisable across NHS clinics. Conclusions Participants on lansoprazole did not report significantly better outcomes than participants on placebo on any of the three patient-reported outcome tools (Reflux Symptom Index, Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life). This multicentre, pragmatic, powered, definitive Phase III trial found no evidence of benefit for patients by treating persistent throat symptoms with lansoprazole. Trial registration Current Controlled Trials ISRCTN38578686 and EudraCT number 2013-004249-17. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 3. See the NIHR Journals Library website for further project information.

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Efficacy of Anti-Reflux Surgery on Refractory Laryngopharyngeal Reflux Disease in Professional Voice Users: A Pilot Study

Cited by 22 publications

References 23 publications

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

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

Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

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