Empiric trial of high-dose omeprazole in patients with posterior laryngitis: a prospective study.
The optimal management of patients suspected with gastroesophageal reflux-related posterior laryngitis is unclear. History, physical examination, and ambulatory pH monitoring all have significant limitations in identifying patients who will respond to antireflux therapy.


OBJECTIVE
To evaluate the merit of empiric omeprazole therapy in patients with posterior laryngitis.


METHODS
Twenty-two patients (11 men/11 women, median age 58 yr) with newly diagnosed posterior laryngitis were enrolled. All had persistent laryngeal symptoms for at least 1 month. An empiric trial of omeprazole at 40 mg q.h.s. was given for 8 wk. Four laryngeal symptoms (hoarseness, throat burning/pain, throat clearing, and cough) and four esophageal symptoms (heartburn, regurgitation, dysphagia, and odynophagia) were scored from 0 to 3. Symptom scores were obtained before, 4 wk after, and 8 wk after the start of omeprazole. Patients were classified as responders if they were symptom free or satisfied with results. Omeprazole was stopped in the responders to look for relapse. Ambulatory pH monitoring was performed in patients who did not respond.


RESULTS
One patient discontinued omeprazole and withdrew from the study. In the remaining 21 patients, the total laryngeal and esophageal symptom scores significantly improved after empiric omeprazole. Fourteen patients (67%) were classified as responders. Eight patients (38%) had a relapse when omeprazole was stopped. Six patients (29%), interestingly, did not relapse and did not require long-term antireflux therapy. Seven patients (33%) were classified as nonresponders. Ambulatory pH monitoring was abnormal in four of the five patients who agreed to have this test. Increasing the dose of omeprazole to 40 mg b.i.d. provided no additional benefit in the nonresponders.


CONCLUSIONS
Empiric omeprazole therapy is a reasonable, initial approach to patients with suspected gastroesophageal reflux-related posterior laryngitis. A significant number of patients do well with a short course of antireflux therapy. Additionally, a third of the patients may not completely respond to intensive medical therapy despite the fact that reflux is documented.
Wo
J M
JM
Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Grist
W J
WJ
Gussack
G
G
Delgaudio
J M
JM
Waring
J P
JP
D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy; D003680:Deglutition Disorders / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D006356:Heartburn / Q000503:physiopathology; D006685:Hoarseness / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007827:Laryngitis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D017060:Patient Satisfaction; D010608:Pharyngeal Diseases / Q000188:drug therapy; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D009853:Omeprazole