Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T20:49:15.520Z Has data issue: false hasContentIssue false
  • English
  • Français

Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux

Published online by Cambridge University Press:  28 February 2011

M Masaany ,
M B Marina ,
W P Sharifa Ezat  and
A Sani
M Masaany*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
M B Marina
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
W P Sharifa Ezat
Affiliation:
Department of Public Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
A Sani
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
*
Address for correspondence: Dr Masaany Mansor, Department of ORL-HNS, Hospital Sultanah Bahiyah, 05460, Alor Setar, Malaysia Fax: 604 7407335 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.

Study design:

This was a prospective, double-blind study.

Subjects and methods:

Fifty-five patients with either a Reflux Symptom Index of more than 13 or a Reflux Finding Score of more than 7 were enrolled. All patients underwent 24-hour, double-probe pH monitoring before commencing pantoprazole 40 mg twice daily; both investigators and patients were blinded to pH monitoring results. The Reflux Symptom Index and Reflux Finding Score were reassessed during the second, third and fourth month of follow up.

Results:

The sensitivity of empirical pantoprazole treatment in diagnosing laryngopharyngeal reflux was 92.5 per cent. The specificity was 14.2 per cent, the positive predictive value 86 per cent and the negative predictive value 25 per cent. There was significant reduction in the total Reflux Symptom Index and Reflux Finding Score after the second, third and fourth month of treatment. There was no correlation between laryngopharyngeal reflux and body mass index.

Conclusion:

Our results suggest that intensive empirical treatment with proton pump inhibitors is effective in diagnosing laryngopharyngeal reflux.

Keywords

LaryngitisLaryngopharyngeal RefluxProton Pump InhibitorsTherapeutics
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 5 , May 2011 , pp. 502 - 508
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Koufman, JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101(4 Pt 2 Suppl 53):1–78CrossRefGoogle Scholar
2Carrau, RL, Khidr, A, Crawley, JA, Hillson, EM, Davis, JK, Pashos, CL. The impact of laryngopharyngeal reflux on patient-reported quality of life. Laryngoscope 2004;114:670–4CrossRefGoogle ScholarPubMed
3Fraser, AG. Gastroesophageal reflux and laryngeal symptoms. Aliment Pharmacol Ther 1994;8:265–72CrossRefGoogle ScholarPubMed
4Belafsky, PC, Postma, GN, Koufman, JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274–7CrossRefGoogle ScholarPubMed
5Qadeer, MA, Swoger, J, Milstein, C, Hicks, DM, Ponsky, J, Richter, JE et al. Correlation between symptom and laryngeal signs in laryngopharyngeal reflux. Laryngoscope 2005;115:1947–52CrossRefGoogle ScholarPubMed
6Belafsky, PC, Postma, GN, Koufman, JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001;111:1313–17CrossRefGoogle ScholarPubMed
7Hickson, C, Simpson, CB, Falcon, R. Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 2001;111:1742–5CrossRefGoogle ScholarPubMed
8Dobhan, R, Castell, DO. Normal and abnormal proximal esophageal acid exposure: results of ambulatory dual-probe pH monitoring. Am J Gastroenterol 1993;88:25–9Google ScholarPubMed
9Panetti, M, Pearson, JP, Dettmar, PW, Koufman, JA. Active pepsin in airway secretions: possible evidence for new supraesophageal pH criteria. Gut 2001;120:A118–A119Google Scholar
10Locke, GR 3rd, Talley, NJ, Fett, SL, Zinsmeister, AR, Melton, LJ 3rd.Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmstead County, Minnesota. Gastroenterology 1997;112:1448–56CrossRefGoogle Scholar
11Metz, DC, Childs, ML, Ruiz, C, Weinstein, GS. Pilot study of the oral omeprazole test for reflux laryngitis. Otolaryngol Head Neck Surg 1997;116:41–6Google ScholarPubMed
12Habermann, W, Kiesler, K, Eherer, A, Friedrich, G. Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux. J Voice 2002;16:425–32CrossRefGoogle ScholarPubMed
13Belafsky, PC, Rees, CJ. Identifying and managing laryngopharyngeal reflux. Hosp Physician 2007;27:15–20Google Scholar
14Brett, S. Science review: the use of proton pump inhibitors for gastric acid suppression in critical illness. Crit Care 2005;9:45–50CrossRefGoogle ScholarPubMed
15Goh, KL, Benamouzig, R, Sander, P, Schwan, T. Efficacy of pantoprazole 20 mg daily compared with esomeprazole 20 mg daily in the maintenance of healed gastroesophageal reflux disease: a randomized, double-blind comparative trial – the EMANCIPATE study. Eur J Gastroenterol Hepatol 2007;19:205–11CrossRefGoogle ScholarPubMed
16Ho, K, Spence, J, Murphy, MF. Review of pain-measurement tools. Ann Emerg Med 1996;27:427–32CrossRefGoogle ScholarPubMed
17Lam, P, Wei, WI, Hui, Y, How, K. Prevalence of pH-documented laryngopharyngeal reflux in Chinese patients with clinically suspected reflux laryngitis. Am J Otolaryngol 2006;27:186–9CrossRefGoogle ScholarPubMed
18Koufman, JA, Amin, MR, Panetti, M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2000;123:385–8CrossRefGoogle ScholarPubMed
19Pan, GZ, Xu, GM, Ke, MY, Han, SM, Guo, HP, Li, ZS et al. Epidemiological study of symptomatic gastroesophageal reflux disease in China: Beijing and Shanghai. Chinese Journal of Digestive Diseases 2000;1:2–8Google Scholar
20Goh, KL, Chang, CS, Fock, KM, Ke, M, Park, HJ, Lam, SK. Gastro-oesophageal reflux disease in Asia. J Gastroenterol Hepatol 2000;15:230–8CrossRefGoogle ScholarPubMed
21Shaker, R, Castell, DO, Schoenfeld, PS, Spechler, SJ. Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association. Am J Gastroenterol. 2003;98:1487–93CrossRefGoogle Scholar
22Ho, KY, Lee, HJ, Wong, WY. Curry promotes significant acid reflux in patients with gastroesophageal reflux disease. J Gastroenterol Hepatol 2001;16(Suppl):A112Google Scholar
23Gasiorowska, A, Fass, R. The proton pump inhibitor (PPI) test in GERD: does it still have a role? J Clin Gastroenterol 2008;42:867–74CrossRefGoogle ScholarPubMed
24Lind, T, Havelund, T, Carlsson, R, Anker-Hansen, O, Glise, H, Hernqvist, H et al. Heartburn without esophagitis: efficacy of omeprazole therapy and features determining therapeutic response. Scand J Gastroenterol 1997;32:974–9CrossRefGoogle ScholarPubMed
25Park, W, Hicks, DM, Khandala, F, Richter, JE, Abelson, TI, Milstein, C et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope 2005;115:1230–8CrossRefGoogle ScholarPubMed
26Belafsky, PC, Postma, GN, Koufman, JA. Laryngopharyngeal reflux symptoms improve before changes in physical findings. Laryngoscope 2001;111:979–81CrossRefGoogle ScholarPubMed
27Ruhl, CE, Everhart, JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I epidemiologic follow-up study. First National Health and Nutrition Examination Survey. Ann Epidemiol 1999;9:424–5CrossRefGoogle Scholar
28Halum, SL, Postma, GN, Johnston, C, Belafsky, PC, Koufman, JA. Patients with isolated laryngopharyngeal reflux are not obese. Laryngoscope 2005;115:1042–5CrossRefGoogle Scholar