s-1743 and Syndrome

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

This article introduces a new case of Rowell's syndrome, a controversial entity defined by the association of lupus erythematosus and erythema multiforme.. A 43-year-old woman was diagnosed with lupus erythematosus induced by esomeprazole. Because her eruption did not improve after withdrawal of the drug, hydroxychloroquine was administered. Two weeks later, the patient described new annular lesions on her chest and arms, both erosive and crusted, and some had a target-like appearance. The oral mucosa was also affected. Histology revealed sub-epidermal blistering with keratinocytic necrosis, strongly suggesting erythema multiforme. Screening for other causes of erythema multiforme proved negative. A positive outcome was achieved with corticosteroids and hydroxychloroquine. One year later, the patient was in complete remission for both lupus erythematosus and erythema multiforme.. The association of lupus erythematosus and erythema multiforme first described in 1963 is known as Rowell's syndrome. While diagnostic criteria have been established in the literature, the reality of this entity is still contested. The annular lesions of subacute lupus erythematosus may be confused with the lesions of erythema multiforme. As suggested in the above section, other authors consider Rowell's syndrome to be a singular entity. Indeed, our patient developed lesions distinct from those initially suggesting subacute lupus erythematosus, in particular: the target-like aspect of the elementary lesions, mucosal involvement, a distinct histological aspect, and dissociated outcomes. Ultimately, the definition of Rowell's syndrome remains highly debated.

Topics: Adrenal Cortex Hormones; Adult; Anti-Ulcer Agents; Cheilitis; Diagnosis, Differential; Erythema Multiforme; Esomeprazole; Female; Humans; Hydroxychloroquine; Lupus Erythematosus, Cutaneous; Syndrome

Topics: Adult; Cross Reactions; Drug Hypersensitivity; Eosinophilia; Esomeprazole; Female; Glioblastoma; Humans; Patch Tests; Prednisolone; Proton Pump Inhibitors; Syndrome