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The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux.

Abstract
Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Increasing evidence has demonstrated that LPR is a contributing factor in some cases of hoarseness, vocal fatigue, voice breaks, cough and globus and chronic throat clearing. However, several randomised placebo-controlled trials of proton pump inhibitors in the treatment of LPR have been reported with the majority showing no significant benefit in patient symptom scores over placebo. The aim of this pilot clinical study was to investigate whether any improvement in LPR-related symptoms, using the Reflux Symptom Index (RSI), and clinical findings, using the Reflux Finding Score (RFS), could be achieved with treatment with a liquid alginate suspension compared to control (no treatment). Patients presenting with the symptoms of LPR to the Otorhinolaryngology Outpatient Department at the Queen's Medical Centre, Nottingham, UK were considered eligible if they had an RSI of greater than 10 and an RFS greater than 5 based on a fibreoptic examination of the larynx. A total of 49 patients were randomised into the open, parallel group study; 24 patients were randomised to receive 10 ml liquid alginate suspension (Gaviscon Advance) four times daily after meals and at bedtime, and 25 patients into the control group (no treatment). Patients were assessed pre-treatment and at 2, 4 and 6 months post treatment. Mean (SD) RSI and RFS pre-treatment scores were 23.9 (7.0) and 10.4 (3.6) for the treatment group and 24.6 (7.4) and 10.3 (3.3) for the control group, respectively. Significant differences between treatment and control were observed for RSI at the 2-month (11.2 (7.0) vs. 16.8 (6.4), P=0.005) and 6-month (11.2 (8.1) vs. 18.3 (9.4), P=0.008) assessments and for RFS at the 6-month (7.1 (2.8) vs. 9.5 (3.4), P=0.005) assessment. Significant improvement in symptom scores and clinical findings were achieved with liquid alginate suspension (Gaviscon Advance) compared to control and further evaluation for the management of patients presenting with LPR is warranted.
AuthorsJulian A McGlashan, Lesley M Johnstone, John Sykes, Vicki Strugala, Peter W Dettmar
JournalEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Eur Arch Otorhinolaryngol) Vol. 266 Issue 2 Pg. 243-51 (Feb 2009) ISSN: 1434-4726 [Electronic] Germany
PMID18506466 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Validation Study)
Chemical References
  • Alginates
  • Drug Combinations
  • Suspensions
  • Silicic Acid
  • Aluminum Hydroxide
  • alginate, aluminium hydroxide, magnesium trisilicate, sodium bicarbonate drug combination
  • Sodium Bicarbonate
Topics
  • Administration, Oral
  • Adult
  • Alginates (administration & dosage)
  • Aluminum Hydroxide (administration & dosage)
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Combinations
  • Female
  • Follow-Up Studies
  • Gastroesophageal Reflux (complications, diagnosis, drug therapy)
  • Humans
  • Hypopharynx (drug effects, pathology)
  • Laryngitis (diagnosis, drug therapy, etiology)
  • Laryngoscopy (methods)
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Observer Variation
  • Probability
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Silicic Acid (administration & dosage)
  • Sodium Bicarbonate (administration & dosage)
  • Suspensions (administration & dosage)
  • Treatment Outcome

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