title: Proton Pump Inhibitors Versus Solitary Lifestyle Modification in Management of Laryngopharyngeal Reflux and Evaluating Who is at Risk: Scenario in a Developing Country.
abstract: BACKGROUND
  Laryngopharyngeal reflux disease can present with a varied symptomatology because of the involvement of multiple sub-sites of the upper aero-digestive tract. It is a very common disease to be encountered in routine practice by both medical and ENT personnel. Its association with multiple pathologies including malignancy warrants an early diagnosis and management. The lack of cost effective and non-invasive tests constitutes a major hurdle in its early management.
  
  
  OBJECTIVE
  1. To define the "at risk" population, prone to developing laryngopharyngeal reflux. 2. To formulate major and minor risk factors for the clinical diagnosis of patients with laryngopharyngeal reflux. 3. To evaluate the efficacy of lifestyle management alone as a treatment option. 4. To formulate a treatment protocol for the management of patients and to prevent recurrence.
  
  
  METHODS
  We performed a prospective analysis of 234 patients diagnosed with laryngopharyngeal reflux. Patients were randomized into study and control groups based on the treatment protocol, using a computer generated randomization table and were single blinded to the type of therapy received. A complete analysis of the possible risk factors, symptoms, and signs was performed with statistical analysis.
  
  
  CONCLUSIONS
  The data has helped us define the "at risk" population and formulate the criteria to diagnose cases of laryngopharyngeal reflux, clinically. The results emphasize the non-requirement of invasive or costly investigations for all patients and indicate the probable protocol to be followed prior to considering further investigation. The role of long term proton pump inhibitor treatment along with lifestyle modification in the initial phase of treatment, as mentioned in the literature, was re-confirmed by our study. However, in addition to the initial treatment, the study establishes the need for continuing lifestyle modification further for at least six months after the cessation of proton pump inhibitor therapy to prevent early recurrence of symptoms.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India.
authors.forename: Preetam
authors.initials: P
authors.lastname: Chappity
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Deka
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Venkatakarthikeyan
authors.initials: V
authors.lastname: Chokkalingam
authors.affiliation: Department of Gastroenterology, AIIMS, New Delhi, India.
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraya
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sikka
keywords: extraesophageal reflux; extraesophageal symptoms; laryngopharyngeal reflux; reflux laryngitis