Efficacy of super high dose proton pump inhibitor administration in refractory laryngopharyngeal reflux: a pilot study.

Abstract

OBJECTIVES:

Proton pump inhibitors (PPIs) are the mainstay of current medical management for laryngopharyngeal reflux (LPR) but may be insufficient in managing some patients' disease. This study was designed to investigate the effectiveness of superdose PPI therapy in the improvement of 24-hour pH impedance studies and stroboscopy findings in patients with LPR refractory to standard dosing (BID PPI).

STUDY DESIGN:

Retrospective chart review.

METHODS:

This study examined 35 patients ranging from 20 to 76 years diagnosed with refractory LPR who were treated with super high dose PPIs. Reflux finding scores (RFS) obtained by three blinded raters and 24-hour pH impedance study scores were compared for patients on standard and then super high dose PPI regimens.

RESULTS:

Statistical analysis of the stroboscopy evaluation revealed a modest but statistically significant decrease in the RFS scores for those patients on super high dose therapy, with good intrarater reliability. The DeMeester score showed no significant change between standard and super high dose regimens. The results of the 24-hour pH impedance monitoring showed no statistically significant decrease in acid reflux episodes despite an average of 7.6 fewer proximal acid reflux episodes.

CONCLUSION:

Super high dose therapy seems to improve laryngeal signs of irritation as reflected by RFS. This improvement was not reflected in our patient population's severity of reflux while on super high dose therapy when compared with standard LPR therapy as measured by 24-hour pH impedance monitoring, although this finding may reflect selection bias. RFS and 24-hour pH impedance may be insufficiently sensitive to detect improvements in LPR with adequate treatment.

• Authors: Joel E Portnoy, Naomi D Gregory, Claudia E Cerulli, Mary J Hawkshaw, Deborah Lurie, Philip O Katz, Robert T Sataloff
• Journal: Journal of voice : official journal of the Voice Foundation (J Voice) Vol. 28 Issue 3 Pg. 369-77 (May 2014) ISSN: 1873-4588 [Electronic] United States
• PMID: 24495427 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Chemical References

• Proton Pump Inhibitors

Topics

• Adult
• Aged
• Esophageal pH Monitoring
• Female
• Humans
• Laryngopharyngeal Reflux (diagnosis, drug therapy)
• Laryngoscopy
• Larynx (drug effects, physiopathology)
• Male
• Middle Aged
• Pilot Projects
• Predictive Value of Tests
• Proton Pump Inhibitors
• Retrospective Studies
• Stroboscopy
• Surveys and Questionnaires
• Time Factors
• Treatment Outcome
• Young Adult