Proton Pump Inhibitors versus Solitary Lifestyle Modification in Management of Laryngopharyngeal Reflux and Evaluating who is at Risk: Scenario in a Developing Country

Abstract

BACKGROUNDLaryngopharyngeal reflux disease can present with a varied symptomatology because of the involvement of multiple sub-sites of the upper aero-digestive tract. It is a very common disease to be encountered in routine practice by both medical and ENT personnel. Its association with multiple pathologies including malignancy warrants an early diagnosis and management. The lack of cost effective and non-invasive tests constitutes a major hurdle in its early management.OBJECTIVES1. To define the “at risk” population, prone to developing laryngopharyngeal reflux. 2. To formulate major and minor risk factors for the clinical diagnosis of patients with laryngopharyngeal reflux. 3. To evaluate the efficacy of lifestyle management alone as a treatment option. 4. To formulate a treatment protocol for the management of patients and to prevent recurrence.STUDY DESIGNWe performed a prospective analysis of 234 patients diagnosed with laryngopharyngeal reflux. Patients were randomized into study and control groups based on the treatment protocol, using a computer generated randomization table and were single blinded to the type of therapy received. A complete analysis of the possible risk factors, symptoms, and signs was performed with statistical analysis.RESULTS AND CONCLUSIONThe data has helped us define the “at risk” population and formulate the criteria to diagnose cases of laryngopharyngeal reflux, clinically. The results emphasize the non-requirement of invasive or costly investigations for all patients and indicate the probable protocol to be followed prior to considering further investigation. The role of long term proton pump inhibitor treatment along with lifestyle modification in the initial phase of treatment, as mentioned in the literature, was re-confirmed by our study. However, in addition to the initial treatment, the study establishes the need for continuing lifestyle modification further for at least six months after the cessation of proton pump inhibitor therapy to prevent early recurrence of symptoms.

Proton Pump Inhibitor Therapy for the Treatment of Laryngopharyngeal Reflux

“…Compared with Qadeer's meta-analysis, we identified 6 newly published eligible RCTs 7,9,10,12,16,22 in this updated metaanalysis and found that PPI therapy could improve reflux symptoms significantly, as the response rate was higher (risk difference = 0.15; 95% CI, 0.01-0.30) and the total RSI (SMD = 1.65; 95% CI, 0.15-3.14) improved significantly in patients treated with PPI therapy than in patients with placebo. The possible reason might be that the sample size was larger in our meta-analysis.…”

“…After the first screen by abstracts, 17 full-text articles were retrieved for further review. [7][8][9][10]12,[16][17][18][19][20][21][22][23][24][25][26][27] After rigorous selection, 3 trials were excluded for the reason of not comparing with placebo. Thus, 14 eligible RCTs 7-10,12,16-24 were included and analyzed, and the detailed selection process is shown in Figure 1.…”

“…Several randomized controlled trials (RCTs) have been performed to investigate the treatment efficacy of PPI therapy for LPR. [7][8][9][10] However, most of these RCTs had a relatively small sample size and no unified criteria in the monitoring of the treatment response. In 2006, Qadeer et al 11 performed a meta-analysis of RCTs to investigate this issue and found that PPI therapy could not offer significant clinical benefit over placebo in patients with GERD-related LPR.…”

“…After Qadeer's reports, many RCTs have been conducted. [7][8][9][10] For example, the clinical trial by Lam et al 9 demonstrated that PPI therapy improved reflux symptoms significantly compared with placebo.…”

Chronic Cough as a Symptom of Laryngopharyngeal Reflux—Two Case Reports

“…The alteration of lifestyle importantly improves LPR treatment (decline in RSI), but it is necessary to follow the above mentioned recommendations for at least 6 months after the IPP therapy [14].…”