Efficacy of super high dose proton pump inhibitor administration in refractory laryngopharyngeal reflux: a pilot study.
OBJECTIVE
Proton pump inhibitors (PPIs) are the mainstay of current medical management for laryngopharyngeal reflux (LPR) but may be insufficient in managing some patients' disease. This study was designed to investigate the effectiveness of superdose PPI therapy in the improvement of 24-hour pH impedance studies and stroboscopy findings in patients with LPR refractory to standard dosing (BID PPI).


METHODS
Retrospective chart review.


METHODS
This study examined 35 patients ranging from 20 to 76 years diagnosed with refractory LPR who were treated with super high dose PPIs. Reflux finding scores (RFS) obtained by three blinded raters and 24-hour pH impedance study scores were compared for patients on standard and then super high dose PPI regimens.


RESULTS
Statistical analysis of the stroboscopy evaluation revealed a modest but statistically significant decrease in the RFS scores for those patients on super high dose therapy, with good intrarater reliability. The DeMeester score showed no significant change between standard and super high dose regimens. The results of the 24-hour pH impedance monitoring showed no statistically significant decrease in acid reflux episodes despite an average of 7.6 fewer proximal acid reflux episodes.


CONCLUSIONS
Super high dose therapy seems to improve laryngeal signs of irritation as reflected by RFS. This improvement was not reflected in our patient population's severity of reflux while on super high dose therapy when compared with standard LPR therapy as measured by 24-hour pH impedance monitoring, although this finding may reflect selection bias. RFS and 24-hour pH impedance may be insufficiently sensitive to detect improvements in LPR with adequate treatment.
Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Voice and Swallowing Center, ENT and Allergy Associates, Lake Success, New York.
Joel E
JE
Portnoy
Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
Naomi D
ND
Gregory
Drexel University College of Medicine, Philadelphia, Pennsylvania.
Claudia E
CE
Cerulli
Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Mary J
MJ
Hawkshaw
Department of Mathematics, St. Joseph's University, Philadelphia, Pennsylvania.
Deborah
D
Lurie
Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
Philip O
PO
Katz
Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: RTSataloff@PhillyENT.com.
Robert T
RT
Sataloff
D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D005260:Female; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000188:drug therapy*; D007828:Laryngoscopy; D007830:Larynx / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies; D049489:Stroboscopy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D054328:Proton Pump Inhibitors
Impedance testing; LPR; Laryngopharyngeal reflux; Proton pump inhibitor; Reflux finding score; Super high dose proton pump inhibitor