title: Proton pump inhibitor therapy improves symptoms in postnasal drainage.
abstract: OBJECTIVE
  Gastroesophageal reflux is common among patients with postnasal drainage. We investigated whether proton pump inhibitor therapy improved symptoms in patients with postnasal drainage without sinusitis or allergies.
  
  
  METHODS
  In a parallel-group, double-blind, multi-specialty trial, we randomly assigned 75 participants with continued symptoms of chronic postnasal drainage to groups that were given 30 mg of lansoprazole twice daily or placebo. Participants were followed up for 16 weeks. Symptoms were assessed at baseline and after 8 and 16 weeks. Ambulatory pH and impedance monitoring assessed presence of baseline reflux. The primary objective of the study was to determine if acid suppressive therapy improved postnasal drainage symptoms. The secondary objective was to assess if pH and impedance monitoring at baseline predicted response to treatment.
  
  
  RESULTS
  Postnasal drainage symptoms improved significantly among patients given lansoprazole compared with placebo. After 8 and 16 weeks, participants given lansoprazole were 3.12-fold (1.28-7.59) and 3.50-fold (1.41-8.67) more likely to respond, respectively, than participants given placebo. After 16 weeks, median (interquartile) percent symptom improvements were 50.0% (10.0%-72.0%) for participants given lansoprazole and 5.0% (0.0%-40.0%) for participants given placebo (P = .006). Neither baseline presence of typical reflux symptoms nor esophageal physiologic parameters predicted response to therapy.
  
  
  CONCLUSIONS
  Among participants with chronic postnasal drainage without evidence of sinusitis and allergies, twice-daily therapy with proton pump inhibitors significantly improved symptoms after 8 and 16 weeks. The presence of heartburn, regurgitation, abnormal levels of esophageal acid, or nonacid reflux did not predict response to therapy.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5280, USA. michael.vaezi@vanderbilt.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Vaezi
authors.forename: David D
authors.initials: DD
authors.lastname: Hagaman
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.forename: S Bobo
authors.initials: SB
authors.lastname: Tanner
authors.forename: James A
authors.initials: JA
authors.lastname: Duncavage
authors.forename: Christine T
authors.initials: CT
authors.lastname: Allocco
authors.forename: Christy
authors.initials: C
authors.lastname: Sparkman
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Clement
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Wasden
authors.forename: Dana
authors.initials: D
authors.lastname: Wirth
authors.forename: Marion
authors.initials: M
authors.lastname: Goutte
authors.forename: Barbara A
authors.initials: BA
authors.lastname: McCafferty
authors.forename: Donald C
authors.initials: DC
authors.lastname: Lanza
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000328:Adult; D002908:Chronic Disease; D004502:Education, Medical, Continuing; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000378:metabolism; D009297:Nasal Mucosa / Q000187:drug effects* / Q000378:metabolism; D054328:Proton Pump Inhibitors; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole