The Efficacy of PPI in the Treatment of Laryngopharyngeal Reflux

Heba Ahmed Osman, Nehad Hassan Abd Elrhman, Mohamed Abdel Shafy


BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux (LPR) is an inflammation affect large number of patients, it caused by the retrograde flow of gastric contents into the pharynx and larynx, causing a variety of symptoms. Therefore, the present study aimed to evaluate the efficacy of PPI in the treatment of LPR by both clinical & endoscopic follow up.

PATIENTS AND METHODS: This prospective observational study was conducted on 61 Consecutive patients attending the Otorhinolaryngology Clinic, Qena University Hospital from January 2018 to July 2018; patients were screened for symptoms of laryngitis. Patients were considered suitable for study if they had persistent laryngeal symptoms for at least 2 months. Laryngoscopic examination was performed using a flexible naso-pharyngoscope. The frequency and severity of patients’ laryngeal symptoms were assessed by both reflux symptoms index & reflux finding score. All patients underwent an esophagogastroduodenoscopy before starting treatment, then 2 months and 6 months later (at the end of treatment). The degree of oesophagitis noted during EGD was graded according to Los Angeles classification.

RESULTS: This study included 61 patients with persistent laryngeal symptoms with their mean ages were 31.62 ± 5.16; 21 females (34.43%) and 40 males (65.57%) and their mean body mass index for male and female were 20 ± 4.2 and 23 ± 3.9 respectively. sensation of lump in throat was the most common symptoms found in 54 patient (88.52%) while breathing difficulties was the least presenting symptom detected in 21 patient (34.43%). Patients treated with pantoprazole 20 mg twice daily for 6 months. There was significant post treatment improvement of all presenting symptoms 2 months of regular therapy. (p = 0.0001), with complete disappearance of symptoms by 6 months of therapy. Erythema is the most common laryngeal finding detected in 54 patients (88.52%) However, pseudosulcus was present in 12 patients (19.67%). Marked improvement in reflux signs were detected at the end of 6 months of therapy, (p = 0.0001). Endoscopic partial ventricular obliteration, mild vocal cord edema, mild laryngeal edema and persistence of granuloma were still detected 6 months post regular acid suppression therapy. Follow up esophagogastroduodenoscopy after 2 and 6 months of regular treatment reviles completely apparent healthy mucosa.

CONCLUSIONS: Pantoprazole 20mg twice daily for 6 months was associated with significant improvement of laryngopharyngeal reflux symptoms and signs.


Proton Pump Inhibitors; Laryngopharyngeal Reflux; GERD

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