Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025
Clinical Profiles and Proton Pump Inhibitor Discontinuation Outcomes in Laryngopharyngeal Reflux Disease.
Контролируемое клиническое исследованиеСтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Geoffroy Lea, Lechien Jerome R
Аннотация
OBJECTIVE: To investigate the clinical presentation and weaning of patients with chronic proton pump inhibitor (PPI) therapy and laryngopharyngeal reflux disease (LPRD).
STUDY DESIGN: Prospective controlled study.
METHODS: Patients with LPRD symptoms despite ongoing PPI therapy were prospectively recruited from two centers. LPRD diagnosis required >1 pharyngeal reflux event on hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) or reflux symptom score (RSS) > 13 with reflux sign assessment (RSA) > 14. A control group with primary LPRD diagnosis was established. All patients received diet modifications, lifestyle changes, and alginate/antacid therapy for 3 months while discontinuing PPIs. Clinical presentations and treatment responses were compared between groups using RSS and RSA. PPI weaning success rates and rebound effects were evaluated.
RESULTS: Fifty-three patients with PPI therapy and 53 subjects with a primary LPRD diagnosis were consecutively recruited. PPIs were successfully discontinued in 66.0% of patients, with rebound effects occurring in 20.0% of weaned cases. Long-term PPI users (mean duration: 142.3 ± 153.9 months) exhibited significantly higher otolaryngological and respiratory symptoms than primary LPRD patients, while both groups showed comparable digestive symptoms. Only 5.7% of patients met criteria for long-term PPI therapy. Both groups demonstrated significant improvement in symptoms and signs following treatment. The PPI group showed greater reduction in reflux sign assessment scores (P = .001) compared to primary LPRD patients.
CONCLUSION: The chronic PPI consumption was not supported by clinical guidelines in most patients with LPRD. Most long-term PPI users with LPRD can successfully discontinue therapy when replaced with appropriate anti-reflux treatment alternatives.
STUDY DESIGN: Prospective controlled study.
METHODS: Patients with LPRD symptoms despite ongoing PPI therapy were prospectively recruited from two centers. LPRD diagnosis required >1 pharyngeal reflux event on hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) or reflux symptom score (RSS) > 13 with reflux sign assessment (RSA) > 14. A control group with primary LPRD diagnosis was established. All patients received diet modifications, lifestyle changes, and alginate/antacid therapy for 3 months while discontinuing PPIs. Clinical presentations and treatment responses were compared between groups using RSS and RSA. PPI weaning success rates and rebound effects were evaluated.
RESULTS: Fifty-three patients with PPI therapy and 53 subjects with a primary LPRD diagnosis were consecutively recruited. PPIs were successfully discontinued in 66.0% of patients, with rebound effects occurring in 20.0% of weaned cases. Long-term PPI users (mean duration: 142.3 ± 153.9 months) exhibited significantly higher otolaryngological and respiratory symptoms than primary LPRD patients, while both groups showed comparable digestive symptoms. Only 5.7% of patients met criteria for long-term PPI therapy. Both groups demonstrated significant improvement in symptoms and signs following treatment. The PPI group showed greater reduction in reflux sign assessment scores (P = .001) compared to primary LPRD patients.
CONCLUSION: The chronic PPI consumption was not supported by clinical guidelines in most patients with LPRD. Most long-term PPI users with LPRD can successfully discontinue therapy when replaced with appropriate anti-reflux treatment alternatives.