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Mathew AS, Shilpa H. Is Adjunctive Alginate Therapy Beneficial in the Treatment of Laryngopharyngeal Reflux Disease in a Rural Indian Population? A Prospective Randomized Study. Indian J Otolaryngol Head Neck Surg 2022; 74:2104-2110. [PMID: 36452699 PMCID: PMC9702034 DOI: 10.1007/s12070-020-02005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
To assess the benefit of adjunctive alginate therapy in the treatment of laryngopharyngeal reflux disease (LPRD) in a rural population in south India, by comparing the outcome of alginate plus proton pump inhibitor (PPI) therapy versus PPI monotherapy. 100 consenting adults of both sexes, with LPRD symptoms for ≥ 1 month, with both Reflux Symptom Index (RSI) > 13 and Reflux Finding Score (RFS) > 7, were included in a randomised prospective analytical clinical study. Patients were randomised into two treatment groups for 8 weeks. Group A received oral pantoprazole (40 mg, twice a day),and Group B received oral pantoprazole (40 mg) and oral alginate (500 mg/10 ml) twice a day each. Treatment outcome was assessed with RSI and RFS at 4 and 8 weeks. On follow-ups, both groups showed significant improvement in RSI. At 4 weeks, significant improvement in RFS was seen in Group B, but not in Group A; both groups showed improvement at 8 weeks. The improvement was significantly better in Group B RSI and RFS on both follow ups. On analysis of each RSI item at 8 weeks, choking sensation showed no significant improvement in Group A. All other items showed significant improvement in both groups, with all items except difficulty swallowing and choking sensation showing significantly better improvement in Group B. Analysis of each RFS item at 8 weeks, showed significant improvement in Group B but not in Group A. The addition of alginate to PPI shows greater definitive improvement in both symptoms and signs of LPRD within a short period of 8 weeks, compared to PPI monotherapy, making it a feasible treatment option with good results in routine practice in a rural set-up. Adjunctive alginate therapy enhances the resolution of clinical features of LPRD and is thus beneficial in its routine treatment in all populations.
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Affiliation(s)
- Amrita Suzanne Mathew
- Department of Otorhinolaryngology & Head and Neck Surgery, MVJ Medical College and Research Hospital, Hoskote, Bangalore, India
| | - H. Shilpa
- Department of Otorhinolaryngology & Head and Neck Surgery, MVJ Medical College and Research Hospital, Hoskote, Bangalore, India
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Kim SI, Jeong SJ, Kwon OE, Park JM, Doo JG, Park SI, Kim BH, Lee YC, Eun YG, Ko SG. Pharyngeal reflux episodes in patients with suspected laryngopharyngeal reflux versus healthy subjects: a prospective cohort study. Eur Arch Otorhinolaryngol 2021; 278:3387-3392. [PMID: 34036423 DOI: 10.1007/s00405-021-06865-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to analyze pharyngeal reflux episodes in patients with suspected LPR versus healthy subjects using 24-h MII-pH monitoring. METHODS One hundred twenty-one patients who visited our clinic with a chief complaint of LPR-related symptoms and underwent 24-h MII-pH monitoring were enrolled prospectively. Also, 27 healthy subjects were enrolled and underwent 24-h MII-pH monitoring during the same period. We analyzed sensitivity, specificity, and accuracy comprehensively to determine appropriate cut-off values of pharyngeal reflux episodes in 24-h MII-pH monitoring to diagnose patients with LPR. RESULTS Twenty-nine of 121 patients with suspected LPR showed no pharyngeal reflux episodes, while 92 showed more than one pharyngeal reflux event. In contrast, the 22 healthy subjects showed no pharyngeal reflux episodes, three showed one reflux event, and two showed two reflux events. A cut-off value of ≥ 1 showed best accuracy reflected by combined sensitivity and specificity values, while ≥ 2 demonstrated better specificity with slight loss of sensitivity and slightly lower overall accuracy, suggesting cut-off value of ≥ 1 pharyngeal reflux episodes is a good clinical indicator. CONCLUSION A cut-off value of ≥ 1 in pharyngeal reflux episodes on 24-h MII-pH monitoring in patients with suspected LPR might be an acceptable diagnostic tool for LPR.
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Affiliation(s)
- Su Il Kim
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Su Jin Jeong
- Statistics Support Part, Kyung Hee Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Oh Eun Kwon
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Jung Min Park
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Jeon Gang Doo
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Sang-In Park
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University Medical Center, Seoul, Korea.,East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
| | - Bo-Hyung Kim
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University Medical Center, Seoul, Korea.,East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Young-Gyu Eun
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea. .,Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea.
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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Lechien JR, Mouawad F, Barillari MR, Nacci A, Khoddami SM, Enver N, Raghunandhan SK, Calvo-Henriquez C, Eun YG, Saussez S. Treatment of laryngopharyngeal reflux disease: A systematic review. World J Clin Cases 2019; 7:2995-3011. [PMID: 31624747 PMCID: PMC6795731 DOI: 10.12998/wjcc.v7.i19.2995] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUNG For a long time, laryngopharyngeal reflux disease (LPRD) has been treated by proton pump inhibitors (PPIs) with an uncertain success rate.
AIM To shed light the current therapeutic strategies used for LPRD in order to analysis the rationale in the LPRD treatment.
METHODS Three authors conducted a PubMed search to identify papers published between January 1990 and February 2019 about the treatment of LPRD. Clinical prospective or retrospective studies had to explore the impact of medical treatment(s) on the clinical presentation of suspected or confirmed LPRD. The criteria for considering studies for the review were based on the population, intervention, comparison, and outcome framework.
RESULTS The search identified 1355 relevant papers, of which 76 studies met the inclusion criteria, accounting for 6457 patients. A total of 64 studies consisted of empirical therapeutic trials and 12 were studies where authors formally identified LPRD with pH-monitoring or multichannel intraluminal impedance-pH monitoring (MII-pH). The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk. The most used PPIs were omeprazole, esomeprazole, rabeprazole, lansoprazole and pantoprazole with a success rate ranging from 18% to 87%. Other composite treatments have been prescribed including PPIs, alginate, prokinetics, and H2 Receptor antagonists.
CONCLUSION Regarding the development of MII-pH and the identification of LPRD subtypes (acid, nonacid, mixed), future studies are needed to improve the LPRD treatment considering all subtypes of reflux.
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Affiliation(s)
- Jerome R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons 7000, Belgium
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Francois Mouawad
- Department of Otolaryngology-Head and Neck Surgery, CHU de Lille, Lille 59000, France
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Maria R Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples 80100, Italy
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Andrea Nacci
- ENT Audiology and Phoniatric Unit, University of Pisa, Pisa 56100, Italy
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Seyyedeh Maryam Khoddami
- Larynx Function and Acoustic Voice Laboratory, Department of Speech Therapy, School of Rehabilitation, Tehran 11369, Iran
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Necati Enver
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, Istanbul 34722, Turkey
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Sampath Kumar Raghunandhan
- Department of Otology, Neurotology and Skullbase Surgery, Madras ENT Research Foundation, Tamil Nadu 60028, India
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Christian Calvo-Henriquez
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela 15700, Spain
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Young-Gyu Eun
- Department of Otorhinolaryngology and Head and Neck Surgery, Kyung Hee University Medical Center, Seoul 130702, Korea
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons 7000, Belgium
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris 75000, France
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Dietary modification for laryngopharyngeal reflux: systematic review. The Journal of Laryngology & Otology 2019; 133:80-86. [PMID: 30646967 DOI: 10.1017/s0022215118002256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study aimed to determine the relationship between laryngopharyngeal reflux and dietary modification. METHODS A systematic review was conducted. The data sources for the study were PubMed, Embase, Cochrane Library and Web of Science. Articles were independently extracted by two authors according to inclusion and exclusion criteria. The outcome focus was laryngopharyngeal reflux improvement through diet or dietary behaviour. RESULTS Of the 372 studies identified, 7 met our inclusion criteria. In these seven studies, laryngopharyngeal reflux symptoms improved following dietary modifications. However, the studies did not present the independent effect of each dietary factor on laryngopharyngeal reflux. Moreover, only one of the seven studies had a randomised controlled study design. CONCLUSION The reference studies of dietary modification for laryngopharyngeal reflux patients are not sufficient to provide recommendations.
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Lechien JR, Saussez S, Schindler A, Karkos PD, Hamdan AL, Harmegnies B, De Marrez LG, Finck C, Journe F, Paesmans M, Vaezi MF. Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta-analysis. Laryngoscope 2018; 129:1174-1187. [PMID: 30597577 DOI: 10.1002/lary.27591] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the therapeutic benefit of proton pump inhibitors (PPIs) over placebo in patients with laryngopharyngeal reflux (LPR) and to analyze the epidemiological factors of heterogeneity in the literature. METHODS An electronic literature search was conducted to identify articles published between 1990 and 2018 about clinical trials describing the efficiency of medical treatment(s) on LPR. First, a meta-analysis of placebo randomized controlled trials (RCTs) comparing PPIs versus placebo was conducted according to diet. The heterogeneity, response to PPIs, and evolution of clinical scores were analyzed for aggregate results. Second, a systematic review of diagnosis methods, clinical outcome of treatment, and therapeutic regimens was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search identified 1,140 relevant publications, of which 72 studies met the inclusion criteria for a total of 5,781 patients. Ten RCTs were included in the meta-analysis. The combined relative risk was 1.31 in favor of PPIs and increased to 1.42 when patients did not receive diet recommendations. Randomized controlled trials were characterized by a significant heterogeneity due to discrepancies in clinical therapeutic outcomes, diagnosis methods (lack of gold standard diagnostic tools), and therapeutic scheme. The epidemiological analysis of all articles supports the existence of these discrepancies in the entire literature. In particular, many symptoms and signs commonly encountered in LPR are not assessed in the treatment effectiveness. The lack of diagnosis precision and variability of inclusion criteria particularly create bias in all reported and included articles. CONCLUSION This meta-analysis supports a mild superiority of PPIs over placebo and the importance of diet as additional treatment but demonstrates the heterogeneity between studies, limiting the elaboration of clear conclusions. International recommendations are proposed for the development of future trials. Laryngoscope, 129:1174-1187, 2019.
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Affiliation(s)
- Jerome R Lechien
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology.,the Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons
| | - Sven Saussez
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology.,the Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles
| | - Antonio Schindler
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Petros D Karkos
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Abdul Latif Hamdan
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Bernard Harmegnies
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons
| | - Lisa G De Marrez
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology
| | - Camille Finck
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Fabrice Journe
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology
| | - Marianne Paesmans
- the Information Management Unit, Institut Jules Bordet, Université Libre de Bruxelles, School of Medicine, Brussels
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Lechien JR, Schindler A, De Marrez LG, Hamdan AL, Karkos PD, Harmegnies B, Barillari MR, Finck C, Saussez S. Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review. Laryngoscope 2018; 129:720-736. [DOI: 10.1002/lary.27537] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Anatomy and Experimental Oncology; Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology; Mons
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology ; University of Mons (UMons); Mons
| | - Antonio Schindler
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, School of Medicine; Université Libre de Bruxelles; Brussels
| | - Lisa G. De Marrez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
| | - Abdul Latif Hamdan
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine; University of Liège; Liège Belgium
| | - Petros D. Karkos
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital; University of Milan; Milan
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Anatomy and Experimental Oncology; Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology; Mons
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine; University of Naples SUN; Naples Italy
- Department of Otorhinolaryngology and Head and Neck Surgery; Thessaloniki Medical School; Thessaloniki Greece
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Anatomy and Experimental Oncology; Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology; Mons
- Department of Otorhinolaryngology and Head and Neck Surgery; American University of Beirut-Medical Center; Beirut Lebanon
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology ; University of Mons (UMons); Mons
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Zalvan CH, Hu S, Greenberg B, Geliebter J. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg 2017; 143:1023-1029. [PMID: 28880991 DOI: 10.1001/jamaoto.2017.1454] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Laryngopharyngeal reflux (LPR) is a common disorder with protean manifestations in the head and neck. In this retrospective study, we report the efficacy of a wholly dietary approach using alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions compared with that of the traditional treatment approach of proton pump inhibition (PPI) and standard reflux precautions. Objective To determine whether treatment with a diet-based approach with standard reflux precautions alone can improve symptoms of LPR compared with treatment with PPI and standard reflux precautions. Design, Setting, and Participants This was a retrospective medical chart review of 2 treatment cohorts. From 2010 to 2012, 85 patients with LPR that were treated with PPI and standard reflux precautions (PS) were identified. From 2013 to 2015, 99 patients treated with alkaline water (pH >8.0), 90% plant-based, Mediterranean-style diet, and standard reflux precautions (AMS) were identified. The outcome was based on change in Reflux Symptom Index (RSI). Main Outcomes and Measures Recorded change in the RSI after 6 weeks of treatment. Results Of the 184 patients identified in the PS and AMS cohorts, the median age of participants in each cohort was 60 years (95% CI, 18-82) and 57 years (95% CI, 18-93), respectively (47 [56.3%] and 61 [61.7%] were women, respectively). The percentage of patients achieving a clinically meaningful (≥6 points) reduction in RSI was 54.1% in PS-treated patients and 62.6% in AMS-treated patients (difference between the groups, 8.05; 95% CI, -5.74 to 22.76). The mean reduction in RSI was 27.2% for the PS group and 39.8% in the AMS group (difference, 12.10; 95% CI, 1.53 to 22.68). Conclusions and Relevance Our data suggest that the effect of PPI on the RSI based on proportion reaching a 6-point reduction in RSI is not significantly better than that of alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions, although the difference in the 2 treatments could be clinically meaningful in favor of the dietary approach. The percent reduction in RSI was significantly greater with the dietary approach. Because the relationship between percent change and response to treatment has not been studied, the clinical significance of this difference requires further study. Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR. This approach may effectively improve symptoms and could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet.
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Affiliation(s)
- Craig H Zalvan
- Department of Otolaryngology, New York Medical College, Valhalla
| | - Shirley Hu
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Barbara Greenberg
- Department of Epidemiology and Community Health, New York Medical College, Valhalla
| | - Jan Geliebter
- Department of Otolaryngology, New York Medical College, Valhalla.,Department of Microbiology and Immunology, New York Medical College, Valhalla
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Eguchi K, Suzuki M, Ida S, Kudo S, Ando K, Ebara T, Higuchi K. Successful treatment of radiation-induced mucositis with proton pump inhibitor administration: A report of two laryngeal cancer cases. Auris Nasus Larynx 2017; 44:122-125. [DOI: 10.1016/j.anl.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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Lechien JR, Huet K, Khalife M, Fourneau AF, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study. J Otolaryngol Head Neck Surg 2016; 45:59. [PMID: 27825368 PMCID: PMC5101798 DOI: 10.1186/s40463-016-0171-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023] Open
Abstract
Background Laryngopharyngeal reflux is a prevalent, not well-understood disease affecting a high proportion of patients who seek laryngology consultation. The objective of this prospective case series is to explore the subjective and objective voice modifications in Laryngopharyngeal reflux (LPR), especially the usefulness of acoustic parameters as treatment outcomes, and to better understand the pathophysiological mechanisms underlying the development of voice disorder. Methods Forty-one patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily for three months. RSI, RFS, Voice Handicap Index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) were assessed at baseline and after three months post-therapy. Acoustic parameters were measured by selecting the most stable interval of the vowel /a/. A study of correlations between acoustic measurements and laryngoscopic signs was conducted in patients with roughness. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS). Results Significant improvement in RSI, RFS, VHI, jitter, percent jitter, relative average perturbation (RAP), shimmer, percent shimmer, and amplitude perturbation quotient (APQ) was found at 3 months of treatment (p < .05). A correlation analysis revealed significant correlations between the grade of dysphonia, breathiness, asthenia, instability and jitter, percent jitter, RAP, shimmer, percent shimmer and APQ. In dividing our cohort into two groups of patients according to the presence of roughness, shimmer, percent shimmer and APQ significantly improved in patients with roughness, but no positive correlation was found between acoustic parameters and laryngoscopic signs. Conclusion Acoustic parameters can help to better understand voice disorders in LPR and can be used as treatment outcomes in patients with roughness.
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Affiliation(s)
- Jérôme R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Avenue du Champ de mars, 6, B7000, Mons, Belgium. .,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium. .,Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium.
| | - Kathy Huet
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Mohamad Khalife
- Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium
| | - Anne-Françoise Fourneau
- Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium
| | - Véronique Delvaux
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Myriam Piccaluga
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Avenue du Champ de mars, 6, B7000, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium
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Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients. Eur Arch Otorhinolaryngol 2016; 274:1-23. [DOI: 10.1007/s00405-016-3984-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/10/2016] [Indexed: 02/06/2023]
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Wan Y, Yan Y, Ma F, Wang L, Lu P, Maytag A, Jiang JJ. LPR: how different diagnostic tools shape the outcomes of treatment. J Voice 2014; 28:362-8. [PMID: 24491501 DOI: 10.1016/j.jvoice.2013.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/06/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To seek a deeper and more comprehensive understanding of two major diagnostic methods for laryngopharyngeal reflux by exploring whether and how differences exist before and after treatment between patients diagnosed by either Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) or 24-hour pH monitoring. MATERIALS AND METHODS Two groups of patients who confirmed laryngopharyngeal reflux disease (LPRD) by either a combination of RSI and RFS (Questionnaire group, 35 patients) or 24-hour multichannel intraluminal impedance (MII) pH monitoring (pH Group, 23 patients) were recruited. All patients were prescribed esomeprazole 20 mg twice a day for 1 month. RSI, RFS, and acoustic parameters before and after treatment were compared between the two groups. Intrinsic correlations involving multiple parameters were investigated as well. RESULTS Except for excess throat mucus (P = 0.019) and subglottic edema (P = 0.042), most RSI and RFS items before treatment were not significantly different between the Questionnaire and pH Groups, and nearly all such items in both groups exhibited distinct remission after therapy (P < 0.05). Absolute value of remission in RSI after treatment was more prominent in pH Group than in the Questionnaire group (P = 0.007). Jitter (P = 0.252), shimmer (P = 0.815), and harmonics-to-noise ratio (P = 0.117) descended to normal value after treatment. Moderate to high levels of correlation were found between the patient's original status and the absolute value of remission in most items of RSI and RFS as well as voice parameters. CONCLUSION The 24-hour MII pH monitoring and a combination of RSI and RFS are quite competitive with each other in selecting LPRD patients. Although treatment worked out on nearly all the symptoms, laryngeal images and voice parameters, 24-hour MII pH seems to be more promising in a greater symptom relief. The extent of relief that can take place in most of the measurements is considerably determined by their initial status.
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Affiliation(s)
- Yichen Wan
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China; Department of Otolaryngology- Head and Neck Surgery, Peking University, International Hospital, Beijing, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Furong Ma
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China.
| | - Li Wang
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Peiquan Lu
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Allison Maytag
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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