The Role of Empirical Treatment with Proton Pump Inhibitor as a Diagnostic Tool in Laryngopharyngeal Reflux

Chugh, Rajeev

doi:10.1007/s12070-019-01750-7

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…The use of PPIs in the management of LPR is still a matter of controversy, as some studies have shown significant improvement, 34,41,46,47 while others have reported no superiority over placebo if treated for 4 weeks or less. 47 This suggests that the effectiveness of PPIs depends on the dose and duration of treatment, with Karkos et al 48 recommending that PPIs be prescribed for 2 to 6 months. 49 Moreover, the conflicting response to PPI treatment could be attributed to the role of non-acid refluxate in inducing such symptoms.…”

Section: Discussionmentioning

confidence: 99%

Association Between Chronic Rhinosinusitis and Reflux Diseases in Adults: A Systematic Review and Meta-Analysis

Aldajani,

Alhussain,

Mesallam

et al. 2023

Am J Rhinol�Allergy

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Background Over the last few decades, reflux diseases, such as laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD), have been identified as significant contributors to inflammatory upper aerodigestive tract diseases. Establishing a direct relationship between reflux disease and chronic rhinosinusitis (CRS) is challenging due to the high prevalence of both diseases and their potential for independent coexistence. Objective The purpose of this study is to review the existing literature and evaluate the evidence of an association between reflux diseases and CRS. Methods A comprehensive electronic search was conducted across multiple databases to identify all studies that investigated the relationship between LPR, GERD, and CRS from January 1, 1950, to June 16, 2022. Only studies with English manuscripts involving adult populations were included, while case series, case reports, and in vitro studies were excluded. The risk of bias was evaluated using The Newcastle-Ottawa Scale for case-control studies and the NIH quality assessment tool for observational cohort and cross-sectional studies. Results The search strategy yielded a total of 427 articles, out of which 25 studies examined the correlation between reflux diseases and CRS. The meta-analysis indicated a significant association between the presence of GERD and CRS compared to control groups ( P < .001; CI 3.56 [2.25, 5.65]), as well as significantly higher pH values and pepsin detection in CRS patients when compared to healthy individuals ( P = .003). Furthermore, all studies that evaluated proton pump inhibitor (PPI) therapy in CRS patients reported positive outcomes, with 93% of CRS patients showing improvement on PPIs. Conclusion The existing literature provides suggestive evidence of an association between reflux diseases and CRS, with regards to both prevalence and treatment. Nonetheless, further studies are required to confirm this relationship.

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Section: Discussionmentioning

confidence: 99%

Association Between Chronic Rhinosinusitis and Reflux Diseases in Adults: A Systematic Review and Meta-Analysis

Aldajani,

Alhussain,

Mesallam

et al. 2023

Am J Rhinol�Allergy

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“…28 There was no mention regarding the application of Belafsky's validated instruments (RSI or RFS) in the CPG or position statement, Several prospective studies that do report the effectiveness of PPIs on significantly reducing RSI and/or RFS are either not placebocontrolled studies or do not have control groups for comparison. [29][30][31][32][33] Extensive search for placebo-controlled RCTs only yielded eight independent data sets (nine articles) that met the eligibility criteria for our meta-analysis, most of which had relatively small sample sizes. This clearly shows the need for the conduction of RCTs with larger samples to create a more precise analysis of the true effect of PPIs in reducing symptoms and laryngeal findings of LPR.…”

Section: Discussionmentioning

confidence: 99%

“…17,18,22 This is contrary to the range of observational studies that did make use of both the RSI and RFS. [29][30][31][32][33] Instead of creating a larger pool of studies which could have resulted in a potentially more homogenous set of data and a more precise and powerful meta-analysis, those studies decreased the number of RCTs that could have been included.…”

Section: Discussionmentioning

confidence: 99%

Effect of Proton Pump Inhibitors on Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in Patients with Laryngopharyngeal Reflux: A Systematic Review and Meta-Analysis

Soriano¹,

Llanes²,

Cruz³

et al. 2022

Philipp J Otolaryngol Head Neck Surg

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Objectives: The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR). Methods: Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias. Results: Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10). Conclusion: This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.

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The Role of Empirical Treatment with Proton Pump Inhibitor as a Diagnostic Tool in Laryngopharyngeal Reflux

Cited by 2 publications

References 19 publications

Association Between Chronic Rhinosinusitis and Reflux Diseases in Adults: A Systematic Review and Meta-Analysis

Association Between Chronic Rhinosinusitis and Reflux Diseases in Adults: A Systematic Review and Meta-Analysis

Effect of Proton Pump Inhibitors on Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in Patients with Laryngopharyngeal Reflux: A Systematic Review and Meta-Analysis

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