Premium
Composite pH predicts esomeprazole response in laryngopharyngeal reflux without typical reflux syndrome
Author(s) -
Lien HanChung,
Wang ChenChi,
Liang WenMiin,
Sung FungChang,
Hsu JengYuan,
Yeh HongZen,
Chong Kareen,
Chang ChiSen
Publication year - 2013
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23780
Subject(s) - esomeprazole , reflux , gastroenterology , medicine , laryngopharyngeal reflux , proton pump inhibitor , concomitant , prospective cohort study , esophageal ph monitoring , gerd , disease
Objectives/Hypothesis Factors predicting the efficacy of proton pump inhibitors (PPIs) in patients with suspected laryngopharyngeal reflux (LPR) are unclear. PPI treatment in patients without concomitant esophageal syndrome remains controversial. We investigated whether composite pH can predict PPI treatment response for LPR with or without concomitant typical reflux syndrome (CTRS). Study Design Prospective, open‐label therapeutic cohort study. Methods Patients with LPR in a tertiary center divided by presence (n = 65) and absence (n = 42) of CTRS underwent 24‐hour esophagopharyngeal pH test and took esomeprazole (40 mg, twice daily) for 12 weeks. Positive composite pH was defined as the presence of 1) excessive pharyngeal acid reflux, and/or 2) excessive distal esophageal acid reflux. A responder was defined as a patient with ≥50% reduction in primary laryngeal symptoms. The change in reflux symptoms was determined using the reflux symptom index (RSI) questionnaire. Logistic regression and mixed model were used to evaluate the predictability of the composite pH parameter. Results After 8 and 12 weeks of treatment, participants with positive composite pH were 10.3‐fold (95% confidence interval [CI], 1.7–61.5; P = .01) and 7.9‐fold (95% CI, 1.4–44.8; P = .02) more likely to respond, respectively, than participants with negative composite pH among patients without CTRS. However, no difference was found in those with CTRS. Weekly repeated measures of RSI yielded similar findings. Conclusions In patients with suspected LPR without CTRS, a composite pH parameter, which incorporates pharyngeal and distal esophageal acid reflux, may predict response to esomeprazole therapy. Level of Evidence 2b