Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms.
OBJECTIVE
Predicting response to proton pump inhibitor (PPI) therapy in patients with laryngeal symptoms is challenging. The Restech Dx-pH probe is a transnasal catheter that measures oropharyngeal pH. In this study, we aimed to investigate the prognostic potential of oropharyngeal pH monitoring to predict responsiveness to PPI therapy in patients with laryngeal symptoms.


METHODS
We conducted a physician-blinded prospective cohort study at a single academic institution between January 2013 and October 2014. Adult patients with Reflux Symptom Index scores (RSI) ≥13 off PPI therapy were recruited. Patients underwent video laryngoscopy and 24-h oropharyngeal pH monitoring, followed by an 8- to 12-week trial of omeprazole 40 mg daily. Prior to and following PPI therapy, patients completed various symptom questionnaires. The primary outcome was the association between PPI response and oropharyngeal pH metrics. PPI response was separated into three subgroups based on the post-treatment RSI score and % RSI response: non-response=RSI ≥13; partial response=post-treatment RSI <13 and change in RSI <50%; and complete response=post-treatment RSI <13 and change in RSI ≥50%. The primary analysis utilized a multinomial logistic regression controlling for the pre-treatment RSI score. A secondary analysis assessed the relationship between the change in RSI (post-pre) and oropharyngeal pH metrics via ordinary least square regression.


RESULTS
Thirty-four patients completed the study and were included in final analysis. Symptom response to PPI therapy was as follows: 50% no response, 15% partial response, and 35% complete response. Non-responders had a higher pre-treatment RSI (P<0.01). There were no significant differences in oropharyngeal acid exposure (below pH of 4.0, 5.0, 5.5, 6.0, and RYAN scores) between responder types. The secondary analysis noted a trend between lower PPI response and a greater total percent time below pH of 5.0 (P=0.03), upright percent time below pH of 5.0 (P=0.07), and RYAN supine (corrected; P=0.03), as well as an association between PPI response and greater decreases in the Anxiety Sensitivity Inventory (P<0.01), Brief Symptom Inventory-18 (P<0.01), and Negative Affect Scale (P<0.01).


CONCLUSIONS
Oropharyngeal pH testing did not predict laryngeal symptom response to PPI therapy. Contrary to hypothesis, our study signaled that the degree of oropharyngeal acid exposure is inversely related to PPI response. In addition, reduction in negative affect and psychological distress parallels PPI response.
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Rena
R
Yadlapati
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
John E
JE
Pandolfino
University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA.
Alcina K
AK
Lidder
University of Indiana School of Medicine, Indianapolis, Indiana, USA.
Nadine
N
Shabeeb
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Diana-Marie
DM
Jaiyeola
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Christopher
C
Adkins
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Neelima
N
Agrawal
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Andrew
A
Cooper
Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Caroline P E
CP
Price
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Jody D
JD
Ciolino
Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA.
Andrew J
AJ
Gawron
Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Stephanie S
SS
Smith
Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Michiel
M
Bove
Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Bruce K
BK
Tan
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003371:Cough / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007828:Laryngoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D009960:Oropharynx; D010612:Pharyngitis / Q000209:etiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D009853:Omeprazole