s-1743 and Laryngopharyngeal-Reflux

Topics: Esomeprazole; Gastroesophageal Reflux; Humans; Laryngopharyngeal Reflux; Proton Pump Inhibitors

Factors predicting the efficacy of proton pump inhibitors (PPIs) in patients with suspected laryngopharyngeal reflux (LPR) are unclear. PPI treatment in patients without concomitant esophageal syndrome remains controversial. We investigated whether composite pH can predict PPI treatment response for LPR with or without concomitant typical reflux syndrome (CTRS).. Prospective, open-label therapeutic cohort study.. Patients with LPR in a tertiary center divided by presence (n = 65) and absence (n = 42) of CTRS underwent 24-hour esophagopharyngeal pH test and took esomeprazole (40 mg, twice daily) for 12 weeks. Positive composite pH was defined as the presence of 1) excessive pharyngeal acid reflux, and/or 2) excessive distal esophageal acid reflux. A responder was defined as a patient with ≥50% reduction in primary laryngeal symptoms. The change in reflux symptoms was determined using the reflux symptom index (RSI) questionnaire. Logistic regression and mixed model were used to evaluate the predictability of the composite pH parameter.. After 8 and 12 weeks of treatment, participants with positive composite pH were 10.3-fold (95% confidence interval [CI], 1.7-61.5; P = .01) and 7.9-fold (95% CI, 1.4-44.8; P = .02) more likely to respond, respectively, than participants with negative composite pH among patients without CTRS. However, no difference was found in those with CTRS. Weekly repeated measures of RSI yielded similar findings.. In patients with suspected LPR without CTRS, a composite pH parameter, which incorporates pharyngeal and distal esophageal acid reflux, may predict response to esomeprazole therapy.

Topics: Administration, Oral; Dose-Response Relationship, Drug; Double-Blind Method; Endoscopy, Gastrointestinal; Enzyme Inhibitors; Esomeprazole; Esophageal pH Monitoring; Female; Follow-Up Studies; Humans; Hydrogen-Ion Concentration; Laryngopharyngeal Reflux; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Severity of Illness Index; Syndrome; Treatment Outcome

To evaluate the efficacy of proton pump inhibitor (PPI) therapy with esomeprazole on laryngopharyngeal reflux (LPR) by pepsin immunoassay in the sputum.. From June 2009 to March 2010, patients in the ENT outpatient department of Nanfang hospital with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were selected. Their sputum was obtained in the morning for pepsin assay. Twenty-six patients with positive results of pepsin assay were enrolled and received esomeprazole 20 mg twice daily for two months. They paid return visits every two weeks. RSI, RFS and pepsin concentration in the sputum were assessed at baseline and after two months. Pepsin in the sputum was measured by enzyme linked immunoadsorbent assay.. After 8 weeks, 24 patients got symptom improvements except 2. All got improved results of laryngoscope exams. RSI and RFS scores before and after PPI treatment reached statistical signification by paired t-test (t= 8.152, P<0.01; t=9.704, P<0.01). 21 patients' pepsin concentrations decreased except 5. Nonparametric tests were used because the reduction of pepsin concentrations before and after PPI treatment were not normally distributed (Z=-3.213, P<0.01). Reductions of total RSI and RFS scores as well as pepsin concentrations were significantly higher after two months.. Twice-daily PPI treatment for two months demonstrated a significantly greater improvement in laryngeal appearance and LPR symptoms for most patients in this study, which can result in significantly decreased levels of pepsin in sputum.

Topics: Adolescent; Adult; Esomeprazole; Female; Humans; Laryngopharyngeal Reflux; Male; Middle Aged; Pepsin A; Prospective Studies; Proton Pump Inhibitors; Sputum; Treatment Outcome; Young Adult

Randomized, placebo-controlled studies have failed to demonstrate a significant treatment effect for laryngopharyngeal reflux (LPR) using traditional clinical endpoints. We compared the effect of esomeprazole 20 mg twice daily (b.i.d.) vs placebo on voice and acoustic-related measures in patients with LPR.. Patients with LPR underwent endoscopy and pH testing. Subsequently, patients underwent videostroboscopic recordings of the larynx, acoustic voice and speech analysis. A voice use and quality diary and oesophageal symptom diary were completed at baseline. Thereafter, patients were randomized to esomeprazole 20 mg twice daily vs placebo for 3 months. The voice use and quality diary and oesophageal symptom dairy were repeated during the last week of treatment. Videostroboscopy and acoustic voice and speech analysis were also performed at the end of treatment.. Twenty-four patients were randomized to the esomeprazole group and 17 to the placebo group. There was no significant difference in videostroboscopic reflux finding scores from baseline to post-treatment. Acoustic measures also failed to demonstrate significant differences within the same or between groups, even when a sub-group analysis of patients with endoscopically documented oesophageal inflammation at baseline was performed. Additionally, no significant differences were found between groups when using voice use and quality diary.. Use of more specific laryngeal functional parameters such as voice-related acoustic measures of pitch range, fundamental frequency and intensity also failed to demonstrate a significant response to proton pump inhibitor treatment as compared to placebo in patients with suspected LPR.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Double-Blind Method; Drug Administration Schedule; Endoscopy; Esomeprazole; Esophageal pH Monitoring; Female; Health Status; Humans; Laryngopharyngeal Reflux; Laryngoscopy; Larynx; Male; Middle Aged; Patient Selection; Proton Pump Inhibitors; Quality of Life; Speech Acoustics; Surveys and Questionnaires; Treatment Outcome; Voice Quality

To determine the incidence of Helicobacter pylori (HP) stool antigen (HPSA) in patients with laryngopharyngeal reflux disease (LPRD), and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD.. Randomized controlled study.. Suez Canal University Hospital, Ismalia, Egypt.. A total of 212 patients with symptoms of LPRD.. Patients were evaluated by laryngoscopy, ambulatory pH monitoring for 24 hours, and HPSA testing. Esomeprazole magnesium as a monotherapy was evaluated vs triple therapy in patients with HP infection.. To determine the incidence of HPSA in patients with LPRD, and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD.. Persistent dry cough and a feeling of a lump in the throat (globus sensation) were the most frequent symptoms of LPRD, while posterior laryngeal inflammation was the main laryngoscopic finding. Results from the HPSA test were positive in 57% of the studied group. Patients with negative HPSA were treated with esomeprazole as single modality with a reported improvement score of 96.6%. Patients with positive HPSA test results were divided into 2 groups: 1 received only esomeprazole, with reported improvement in 40%, whereas the second group was treated with esomeprazole, plus amoxicillin sodium and clarithromycin (triple therapy) and reported a 90% incidence of symptom improvement.. The incidence of HP infection in patients with LPRD in our study was 57%. Triple therapy showed a higher cure rate in patients with HPSA-positive test results.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Clarithromycin; Drug Therapy, Combination; Egypt; Esomeprazole; Female; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Laryngopharyngeal Reflux; Laryngoscopy; Male

Topics: Adult; Esomeprazole; Female; Fumarates; Humans; Laryngopharyngeal Reflux; Male; Middle Aged; Retrospective Studies

To explore the relevance between nasal symptoms and laryngopharyngeal reflux disease in patients with allergic rhinitis.. Thirty patients of laryngopharyngeal reflux disease were diagnosed in ENT outpatient department in our hospital. All patients have symptoms of sneeze, nasal discharge as chief complaint and they responded no effect for other normal treatment for nasal-sinusitis at least three months. Orally before meals, a dose of 5 mg Mosapride citrate each time, three times a day for 7 days. Orally before meals, a dose of 20 mg Esomeprazole each time, two times a. day for 2-3 months. Nasal spray, one spray of azelastine hydrochloride once, two times a day for 2 month.. Laryngopharyngeal reflux symptom scores at four time points (the first visit, post treatment 15 days, 45 days, 75 days) were analyzed by repeated measures analysis of variance. There is a significant difference in four time points.. Laryngopharyngeal reflux disease has a strong association with allergic rhinitis. Patients who has allergic rhinitis nasal symptoms as chief complaint must be exclude, the laryngopharyngeal reflux disease first.

Topics: Benzamides; Esomeprazole; Humans; Laryngopharyngeal Reflux; Morpholines; Phthalazines; Pilot Projects; Rhinitis, Allergic

Different end-point measures may contribute to inconsistent therapeutic responses in relief of laryngopharyngeal reflux (LPR) symptoms.. We aimed to determine an a priori responder definition for a patient-reported outcome instrument, the Reflux Symptom Index (RSI), using an anchor-based method, to interpret individual treatment benefit in patients with LPR, on the basis of the US Food and Drug Administration guidance.. Patients with chronic laryngeal symptoms suggestive of LPR underwent twice-daily 40 mg esomeprazole treatment for 12 weeks. We used a 50% or more reduction in the primary laryngeal symptom at week 12, an empirical criterion, as an anchor to dichotomize the participants into two groups, and to establish a responder definition of the RSI score change. The optimal cutoff point of the RSI score change was determined on the basis of the maximal Youden index of the receiver operating characteristic analysis.. The mean reduction in the RSI score was significantly greater in subjects with a 50% or more reduction in the primary laryngeal symptom than in those without (-11.0 ± 7.8 vs. -3.1 ± 8.3, P < 0.0001). A reduction of six points or more in the RSI score at week 12 was considered to be the responder definition with a sensitivity of 0.79 and a specificity of 0.70.. We propose an a priori responder definition derived from an empirical criterion according to the Food and Drug Administration guidance: a reduction of six points or more in the RSI score at week 12. This preliminary estimate provides a clinically meaningful change at an individual level, although additional studies and validations across various languages are required.

Topics: Adult; Esomeprazole; Female; Follow-Up Studies; Humans; Laryngopharyngeal Reflux; Male; Middle Aged; Patient Outcome Assessment; Practice Guidelines as Topic; Prospective Studies; Proton Pump Inhibitors; Self Report; Treatment Outcome; United States; United States Food and Drug Administration

To seek a deeper and more comprehensive understanding of two major diagnostic methods for laryngopharyngeal reflux by exploring whether and how differences exist before and after treatment between patients diagnosed by either Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) or 24-hour pH monitoring.. Two groups of patients who confirmed laryngopharyngeal reflux disease (LPRD) by either a combination of RSI and RFS (Questionnaire group, 35 patients) or 24-hour multichannel intraluminal impedance (MII) pH monitoring (pH Group, 23 patients) were recruited. All patients were prescribed esomeprazole 20 mg twice a day for 1 month. RSI, RFS, and acoustic parameters before and after treatment were compared between the two groups. Intrinsic correlations involving multiple parameters were investigated as well.. Except for excess throat mucus (P = 0.019) and subglottic edema (P = 0.042), most RSI and RFS items before treatment were not significantly different between the Questionnaire and pH Groups, and nearly all such items in both groups exhibited distinct remission after therapy (P < 0.05). Absolute value of remission in RSI after treatment was more prominent in pH Group than in the Questionnaire group (P = 0.007). Jitter (P = 0.252), shimmer (P = 0.815), and harmonics-to-noise ratio (P = 0.117) descended to normal value after treatment. Moderate to high levels of correlation were found between the patient's original status and the absolute value of remission in most items of RSI and RFS as well as voice parameters.. The 24-hour MII pH monitoring and a combination of RSI and RFS are quite competitive with each other in selecting LPRD patients. Although treatment worked out on nearly all the symptoms, laryngeal images and voice parameters, 24-hour MII pH seems to be more promising in a greater symptom relief. The extent of relief that can take place in most of the measurements is considerably determined by their initial status.

Topics: Acoustics; Adult; Electric Impedance; Esomeprazole; Esophageal pH Monitoring; Female; Humans; Hydrogen-Ion Concentration; Laryngopharyngeal Reflux; Laryngoscopy; Larynx; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Proton Pump Inhibitors; Remission Induction; Severity of Illness Index; Surveys and Questionnaires; Time Factors; Treatment Outcome; Voice Quality

Although most patients with gastroesophageal reflux disease (GERD) achieve substantial symptom relief with acid suppression, many have some residual symptoms. We evaluated the responsiveness of regurgitation, characterized by the reflux disease questionnaire (RDQ) to potent acid suppression.. We analyzed data from 2 randomized controlled trials of AZD0865 (a potassium-competitive acid blocker) 25-75 mg/day vs esomeprazole 20-40 mg/day for the treatment of nonerosive reflux disease (NERD, n = 1460) or reflux esophagitis (RE, n = 1514). Inclusion criteria for both studies were high-severity substernal burning (≥4 days per week of at least moderate intensity) during the week before enrollment. Pooled data from all treatment arms were used to ascertain the response of the reflux disease questionnaire regurgitation items to potent acid suppression during the fourth week of treatment.. When the study began, 93% of patients with NERD or RE had either "acid taste in the mouth" (regurgitation-taste) or "unpleasant movement of material upwards from the stomach" (regurgitation-movement). Either or both symptoms were present and severe in 53% of NERD (n = 717) and 54% of RE patients (n = 751) for the main study outcome. During week 4 of therapy, patients with severe "regurgitation-taste" and "regurgitation-movement" responded significantly less well than patients with NERD and high severity "substernal burning" (34% and 26% vs 49%) or those with RE (44% and 33% vs 55%). There were no differences in symptom response between patients with healed and nonhealed RE.. Regurgitation was less responsive to acid suppression than heartburn in patients with gastroesophageal reflux disease, indicating that persistent regurgitation is a common cause of incomplete treatment response.

Topics: Anti-Ulcer Agents; Esomeprazole; Gastroesophageal Reflux; Heartburn; Humans; Imidazoles; Laryngopharyngeal Reflux; Pyridines; Randomized Controlled Trials as Topic; Treatment Outcome