Proton pump inhibitor therapy improves symptoms in postnasal drainage.
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.
Vaezi
Michael F
MF
Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5280, USA. michael.vaezi@vanderbilt.edu
Hagaman
David D
DD
Slaughter
James C
JC
Tanner
S Bobo
SB
Duncavage
James A
JA
Allocco
Christine T
CT
Sparkman
Christy
C
Clement
Lynn E
LE
Wasden
Cynthia M
CM
Wirth
Dana
D
Goutte
Marion
M
McCafferty
Barbara A
BA
Lanza
Donald C
DC
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
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole