Effect of pantoprazole on the course of reflux-associated laryngitis: a placebo-controlled double-blind crossover study.

Abstract

BACKGROUND:

The optimal management of patients with reflux-associated laryngitis is unclear. We performed a placebo-controlled crossover trial in patients with proven reflux disease and associated laryngitis to determine the effect of pantoprazole and to gain information on the natural course of the disease.

METHODS:

Sixty-two consecutive non-smoking patients with hoarseness and proven laryngitis were examined. Scores with respect to the larynx and for subjective complaints were determined and 24-h pH-metry to assess acid reflux in the lower oesophagus and pharynx was performed. Patients with pathologic reflux were given the chance to enter a double-blinded randomized crossover trial with pantoprazole 40 mg b.i.d. and placebo for a duration of 3 months each, separated by a 2-week washout period.

RESULTS:

Twenty-four of 62 patients showed pathological reflux; 21 patients were included in the study and 14 concluded all parts of the study. Both pantoprazole and placebo resulted in a marked improvement in laryngitis scores (decrease of 8.0 +/- 1.4 versus 5.6 +/- 2.6; no significant difference between the 2 treatments) and symptoms after the first 3 months (decrease of oesophageal symptom score of 2.2 +/- 1.4 versus 5.4 +/- 2.8; decrease of laryngeal scores of 8.3 +/- 3.6 versus 10.3 +/- 3.9; also no significant difference between the 2 treatments). A second pH-metry 2 weeks thereafter proved the persistence of reflux in most of these patients. Switching to pantoprazole led to a further improvement of scores. In the group switched to placebo there was recurrence only in a minority of patients.

CONCLUSIONS:

The self-limited nature of reflux-associated laryngitis in non-smokers is largely underestimated. Laryngitis improves despite the persistence of reflux. Pantoprazole may be helpful especially in relieving acute symptoms, but the advantage of long-term treatment over placebo has been greatly overestimated.

• Authors: A J Eherer, W Habermann, H F Hammer, K Kiesler, G Friedrich, G J Krejs
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 38 Issue 5 Pg. 462-7 (May 2003) ISSN: 0036-5521 [Print] England
• PMID: 12795454 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• 2-Pyridinylmethylsulfinylbenzimidazoles
• Anti-Ulcer Agents
• Benzimidazoles
• Proton Pump Inhibitors
• Sulfoxides
• Pantoprazole
• Omeprazole

Topics

• 2-Pyridinylmethylsulfinylbenzimidazoles
• Adult
• Aged
• Anti-Ulcer Agents (therapeutic use)
• Benzimidazoles (therapeutic use)
• Cross-Over Studies
• Double-Blind Method
• Female
• Gastroesophageal Reflux (complications, drug therapy)
• Humans
• Laryngitis (drug therapy, etiology)
• Male
• Middle Aged
• Omeprazole (analogs & derivatives)
• Pantoprazole
• Proton Pump Inhibitors
• Recurrence
• Severity of Illness Index
• Sulfoxides (therapeutic use)