The comparison of an empiric proton pump inhibitor trial vs 24-hour double-probe Ph monitoring in laryngopharyngeal reflux

Abstract

Laryngopharyngeal reflux (LPR), which is defined as the backflow of gastric contents into the upper aerodigestive tract, is a relatively common disorder. However, its diagnosis still poses many problems. Twenty-four-hour double-probe pH monitoring is currently the diagnostic test of choice, but it has many disadvantages. Thus, an empiric trial of antireflux therapy has been suggested as an alternative method for diagnosis. The purpose of this article is to evaluate the validity of this alternative method in the management of LPR. The study group consisted of 36 patients with symptoms and physical findings suggesting LPR. The control subjects were 23 healthy adults. Twenty-four-hour double-probe pH monitoring was performed both in the study group and the control group, and the results were compared. In addition, the symptoms and physical findings in the study group was scored by the modified reflux symptom index (MRSI) and reflux finding score (RFS) at four intervals: before the start of therapy and at the second, fourth and sixth months of the therapy. The results of the 24-hour double-probe pH monitoring showed no significant difference between the study and the control groups (p>0.05). In the study group, the MRSI before the therapy was 13.6+/-4.4. This index improved significantly to 4.3+/-1.9 at the second month; to 1.5+/-0.6 at the fourth month, and to 0.5+/-0.2 at the sixth month of the therapy (p<0.05). The RFS before the start of the therapy was 14.8+/-3.8; and it improved significantly to 7.7+/-3.8 at the second month; to 4.5+/-2.3 at the fourth month, and to 1.4+/-0.9 at the sixth month of the therapy (p<0.05). The significant improvement in the MRSI and the RFS during the course of proton pump inhibitor therapy relates the patients' symptoms and physical findings to LPR. This implies the validity of the method, not only in the treatment of LPR, but in the diagnosis of this disorder, as well. Unfortunately, 24-hour double-probe pH monitoring has failed to differentiate LPR patients from healthy individuals.

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

“…3,13 Symptomatic improvement in patients in our study was seen after 2 months of therapy however improvement in laryngeal signs took 4 months. These results are similar to studies by Belafsky et al and Bilgen et al 3,14 Overall RFS showed significant change at 4 weeks of therapy and again at 8 and 24 weeks of therapy and this is similar to various other studies. 2,3 There is currently no accepted protocol for the most effective treatment for LPR.…”

The Reflux Finding Score: Reliability and Correlation to the Reflux Symptom Index

“…Therefore, otolaryngologists should inquire regarding specific symptoms of LPR and also acknowledge nonspecific findings of laryngeal irritation and inflammation observed through laryngoscopic examination (17,18). RSI and RFS, developed by Belafsky et al (11,12), have been widely used for the diagnosis of LPR as they are simple, inexpensive, and noninvasive (14,19).…”

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

“…Limited data exist about the value of proximal pH probe monitoring in patients with chronic cough and GERD; however, many studies have shown the inefficiency of this technique for the diagnosis of laryngopharyngeal reflux . 33 MII-pH monitoring for the diagnosis of GERD allowed for the detection of gaseous and weak-nonacidic reflux in addition to acidic and liquid reflux. Proximal reflux episodes and nonacidic reflux associated with cough episodes have been observed in a small portion of the patient population, and an increase in reflux episodes in patients with chronic cough compared to healthy volunteers is seldom observed.…”