Abstract
Objective: This study aimed to compare continuous and pro re nata (PRN) proton pump inhibitor (PPI) treatments for laryngopharyngeal reflux (LPR).
 Methods: This randomized clinical trial included 52 LPR patients with lingual tonsil hypertrophy (LTH). Those patients who showed LPR improvement with an initial PPI trial were randomly divided into continuous and PRN PPI treatment groups. The Reflux Symptom Index (RSI) score, Reflux Finding Score (RFS), and LTH grade were used to assess the treatment results.
 Results: The PPI treatment (30 mg of lansoprazole twice daily) for 6 mo resulted in a significantly decreasing RSI score (p<0.001). The PPI treatments for the first 8 w and the second 8 w also showed significant LPR improvement. However, there was no significant improvement after the third 8 w (p>0.05). After 6 mo, the PPI treatment also resulted in a continuous decrease in the RFS (p<0.001). There were no significant differences in the mean RSI scores (p=0.518) and mean RFSs (p=0.393) between the continuous and PRN PPI groups. In the grade II LTH cases, there was a significant improvement after 6 mo of PPI treatment (p<0.001), although there was no improvement after the first 2 mo in the treatment group. For the grade III LTH cases, there was no significant improvement after the first 2 mo and 6 mo of the PPI treatment.
 Conclusion: Six months of PPI treatment improved the RSI score, RFS, and LTH grade, although there was no difference between the continuous and PRN PPI treatment groups.
Highlights
Laryngopharyngeal reflux (LPR) disease is the backflow of extraesophageal gastric fluid into the larynx, pharynx, trachea, and bronchus, which may lead to various symptoms, such as a dry cough, globus sensation, dysphonia, throat clearing, postnasal drip, and dysphagia [1,2,3]
There were no significant differences between the continuous pump inhibitor (PPI) and pro re nata (PRN) PPI patient groups with regard
There were no significant differences between the improvements in the mean Reflux Symptom Index (RSI) score (p=0.518) and mean Reflux Finding Score (RFS) (p= 0.393) between the continuous PPI group and the PRN PPI group
Summary
Laryngopharyngeal reflux (LPR) disease is the backflow of extraesophageal gastric fluid into the larynx, pharynx, trachea, and bronchus, which may lead to various symptoms, such as a dry cough, globus sensation, dysphonia, throat clearing, postnasal drip, and dysphagia [1,2,3]. The LPR symptoms are different from typical gastroesophageal reflux disease (GERD) symptoms, which include esophagitis [1, 2]. Belafsky et al developed a 9-item Reflux Symptom Index (RSI) and an 8-item Reflux Finding Score (RFS) for the evaluation of laryngeal abnormalities caused by LPR [4, 5]. Empirical therapy using proton-pump inhibitors (PPIs) for both diagnostic testing and LPRD and GERD treatment has become widely accepted [6]. There have been no studies examining the PPI treatment efficacy in LPRD patients. This study was designed to ascertain the responses to continuous or pro re nata (PRN) PPI treatment based on the LPR improvement using the RSI and RFS results and the lingual tonsil hypertrophy (LTH) degree
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