[Repeated Dual-probe PH Monitoring As a Diagnostic Tool to Control Therapy for Laryngopharyngeal Reflux]

Overview

Journal HNO

Specialty Otorhinolaryngology

Date 2007 Apr 14

PMID 17431571

Citations 5

Authors

O Reichel

F Durst

G Rasp

A Berghaus

Affiliations

Soon will be listed here.

Abstract

Objectives: The most effective current treatment option for patients suffering from laryngopharyngeal reflux (LPR) is the use of proton pump inhibitors (PPIs). Compared to other PPIs, esomeprazole seems to provide best 24-h control of intragastric acid. However, some patients remain resistant to medical acid suppression with PPIs. The aim of this investigation was to identify the number of non-responders among patients suffering from LPR being treated by esomeprazole 40 mg once daily (officially approved maximum dosage).

Patients And Methods: Between June 2004 and January 2006, 27 patients suffering from LPR diagnosed by dual-probe pH monitoring were treated with esomeprazole 40 mg once daily. After 13-54 days (mean 28 days) while still under PPI-treatment, the 24-h pH-study was repeated in order to control the effectiveness of therapy. Patients with at least a reduction of the reflux area index (RAI) compared to the result before treatment were categorized as responders. Furthermore, the number of patients with a measurable reduction of proximal reflux episodes under PPI-treatment was quantified.

Results: Repeated pH monitoring during PPI therapy revealed a reduction of the RAI in 22 of 27 patients. Five patients, however, showed a higher RAI despite medical treatment (19%). In 13 patients (48%), treatment with 40 mg esomeprazole once daily reduced the RAI to a normal value (<6.3). In 18 of 27 patients, the number of proximal reflux episodes has decreased (67%).

Conclusion: In a number of patients suffering from LPR, treatment with esomeprazole 40 mg once daily did not provide any measurable proximal acid reduction. Repeated pH monitoring during treatment is an adequate diagnostic tool to control the therapeutic effect of PPIs objectively and to identify non-responders at an early point.

Citing Articles

[Importance of cellular tight junction complexes in the development of periprosthetic leakage after prosthetic voice rehabilitation].

Lorenz K, Kraft K, Graf F, Propper C, Steinestel K HNO. 2014; 63(3):171-2, 174-8, 180-1.

PMID: 25515126 DOI: 10.1007/s00106-014-2951-0.

Gastroesophageal reflux disease and postlaryngectomy tracheoesophageal fistula.

Cocuzza S, Bonfiglio M, Chiaramonte R, Aprile G, Mistretta A, Grosso G Eur Arch Otorhinolaryngol. 2012; 269(5):1483-8.

PMID: 22298249 DOI: 10.1007/s00405-012-1938-2.

[Laryngectomised patients with voice prostheses: influence of supra-esophageal reflux on voice quality and quality of life].

Lorenz K, Grieser L, Ehrhart T, Maier H HNO. 2010; 59(2):179-87.

PMID: 21181392 DOI: 10.1007/s00106-010-2222-7.

[Prosthetic voice restoration after laryngectomy: the management of fistula complications with anti-reflux medications].

Lorenz K, Grieser L, Ehrhart T, Maier H HNO. 2010; 58(9):919-26.

PMID: 20563542 DOI: 10.1007/s00106-010-2127-5.

[Coincidence of fistula enlargement and supra-oesophageal reflux in patients after laryngectomy and prosthetic voice restoration].

Lorenz K, Ehrhart T, Grieser L, Maier H HNO. 2009; 57(12):1253-61.

PMID: 19727628 DOI: 10.1007/s00106-009-1956-6.

References

Jecker P, Schuon R, Mann W . [The need for 24-h double probe pH monitoring in the diagnosis of laryngo-pharyngeal reflux]. HNO. 2003; 51(9):704-9. DOI: 10.1007/s00106-002-0801-y. View

Richter J . Medical management of patients with esophageal or supraesophageal gastroesophageal reflux disease. Am J Med. 2003; 115 Suppl 3A:179S-187S. DOI: 10.1016/s0002-9343(03)00221-3. View

Amin M, Postma G, Johnson P, Digges N, Koufman J . Proton pump inhibitor resistance in the treatment of laryngopharyngeal reflux. Otolaryngol Head Neck Surg. 2001; 125(4):374-8. DOI: 10.1067/mhn.2001.118691. View

Issing W, Karkos P, Perreas K, Folwaczny C, Reichel O . Dual-probe 24-hour ambulatory pH monitoring for diagnosis of laryngopharyngeal reflux. J Laryngol Otol. 2005; 118(11):845-8. DOI: 10.1258/0022215042703660. View

Vaezi M . CON: Treatment with PPIs should not be preceded by pH monitoring in patients suspected of laryngeal reflux. Am J Gastroenterol. 2006; 101(1):8-10. DOI: 10.1111/j.1572-0241.2006.00448_3.x. View

Belafsky P, Postma G, Koufman J . The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001; 111(8):1313-7. DOI: 10.1097/00005537-200108000-00001. View

Noordzij J, Khidr A, Evans B, Desper E, Mittal R, Reibel J . Evaluation of omeprazole in the treatment of reflux laryngitis: a prospective, placebo-controlled, randomized, double-blind study. Laryngoscope. 2002; 111(12):2147-51. DOI: 10.1097/00005537-200112000-00013. View

Vincent Jr D, Garrett J, Radionoff S, Reussner L, Stasney C . The proximal probe in esophageal pH monitoring: development of a normative database. J Voice. 2000; 14(2):247-54. DOI: 10.1016/s0892-1997(00)80033-8. View

Miner Jr P, Katz P, Chen Y, Sostek M . Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study. Am J Gastroenterol. 2003; 98(12):2616-20. DOI: 10.1111/j.1572-0241.2003.08783.x. View

10.

Tezer M, Kockar M, Kockar O, Celik A . Laryngopharyngeal reflux finding scores correlate with gastroesophageal reflux disease and Helicobacter pylori expression. Acta Otolaryngol. 2006; 126(9):958-61. DOI: 10.1080/00016480500529314. View

11.

Karkos P, Wilson J . Empiric treatment of laryngopharyngeal reflux with proton pump inhibitors: a systematic review. Laryngoscope. 2006; 116(1):144-8. DOI: 10.1097/01.mlg.0000191463.67692.36. View

12.

Schlottmann A, Wilke W, PAHN J . [24 hour pH monitoring of the hypopharymx]. HNO. 1999; 47(2):112-6. DOI: 10.1007/s001060050367. View

13.

Hamdan A, Sharara A, Younes A, Fuleihan N . Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. Acta Otolaryngol. 2001; 121(7):868-72. DOI: 10.1080/00016480152602357. View

14.

Tasker A, Dettmar P, Panetti M, Koufman J, Birchall J, Pearson J . Is gastric reflux a cause of otitis media with effusion in children?. Laryngoscope. 2002; 112(11):1930-4. DOI: 10.1097/00005537-200211000-00004. View

15.

Ford C . Evaluation and management of laryngopharyngeal reflux. JAMA. 2005; 294(12):1534-40. DOI: 10.1001/jama.294.12.1534. View

16.

Harding S, Richter J, Guzzo M, Schan C, Alexander R, Bradley L . Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome. Am J Med. 1996; 100(4):395-405. DOI: 10.1016/S0002-9343(97)89514-9. View

17.

Sittel C . [Laryngopharyngeal reflux: change in paradigm or diagnostic catchall?]. HNO. 2003; 51(9):690-3. DOI: 10.1007/s00106-003-0941-8. View

18.

Reichel O, Hagedorn H, Berghaus A . [Diagnosis and treatment of laryngopharyngeal reflux]. Laryngorhinootologie. 2006; 85(12):919-24. DOI: 10.1055/s-2006-925445. View

19.

Kleemann D, Nofz S, Plank I, Schlottmann A . [Prolonged healing process after endonasal nasal sinus surgery. Gastroesophageal reflux as a cause?]. HNO. 2004; 53(4):333-6. DOI: 10.1007/s00106-004-1108-y. View

20.

Koufman J, Aviv J, Casiano R, Shaw G . Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002; 127(1):32-5. DOI: 10.1067/mhn.2002.125760. View