Does PPI Therapy Normalize pH in Laryngopharyngeal Reflux Patients?

Abstract

Objectives:

Laryngopharyngeal reflux (LPR) is commonly treated with twice-daily proton pump inhibitor (PPI) therapy. However, a significant number of patients do not achieve complete resolution of symptoms. In this study, we aimed to assess the effect of twice-daily PPI treatment on the oropharyngeal pH environment in patients with pH-probe confirmed LPR.

Methods:

LPR was identified in 56 symptomatic patients using 24 hour Dx-pH probe monitoring at a single center. Following a period of treatment with twice-daily PPI, a second 24 hour pH monitoring study was performed. Compliance was determined by self-report. Outcomes included supine and upright Ryan scores, number of patients with normal Ryan scores post-treatment, and reflux severity index. Reflux severity index (RSI) was assessed pre- and post-treatment.

Results:

34 women and 22 men were assessed pre- and post-treatment, with age of 51.9 ± 16.8 years and BMI of 30.8 ± 7.0 kg/m² (mean ± SD). Pre-treatment upright and supine Ryan scores were 142.3±161.9 and 14.21 ± 17.14, respectively (mean ±SD). Patients were treated with twice-daily PPIs for a duration of 105.7 ± 88.2 days (mean ± SD). Post-treatment upright and supine Ryan scores were 72.66±140.5 and 12.27 ± 21.1, respectively (mean ±S D). Paired T-tests showed a significant decrease in mean post-treatment upright Ryan scores (P = 0.0003). However, post-treatment Ryan scores normalized in only 26 subjects (46.4%). RSI scores were higher in non-responders.

Conclusions:

While PPI therapy resulted in a significant decrease in mean upright Ryan score, the Ryan score was normalized in only 46.4% of patients. This suggests that twice-daily PPIs may be insufficient to completely eliminate reflux and symptoms of LPR.