title: Composite pH predicts esomeprazole response in laryngopharyngeal reflux without typical reflux syndrome.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Lien
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Wen-Miin
authors.initials: WM
authors.lastname: Liang
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.forename: Jeng-Yuan
authors.initials: JY
authors.lastname: Hsu
authors.forename: Hong-Zen
authors.initials: HZ
authors.lastname: Yeh
authors.forename: Kareen
authors.initials: K
authors.lastname: Chong
authors.forename: Chi-Sen
authors.initials: CS
authors.lastname: Chang
mesh_terms: D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D004791:Enzyme Inhibitors; D064098:Esomeprazole