Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: Laryngopharyngeal reflux (LPR) is the backflow of stomach contents into the throat. The current standard of care is to treat patients with a proton pump inhibitor (PPI) twice daily for up to 6 months or longer. Two meta-analyses were completed in 2006 and found no evidence PPI therapy is better than placebo for chronic laryngitis. Since that time new tools have been created to measure outcomes in this field of research, the Reflux Finding Score (RFS) and Reflux Symptom Index (RSI). Using these standardized measures are researchers able to demonstrate PPI therapy is efficacious in the treatment of LPR?

Method: An exhaustive literature search using the Medline, EBMRM, and CINAHL search engines was conducted from 2006-present with the following search terms: laryngopharyngeal reflux, proton pump inhibitors, extraesophageal, laryngitis, globus, throat clearing, and chronic cough. Randomized controlled trials comparing PPI to placebo for the treatment of laryngopharyngeal reflux in adults were included. Trials were excluded if completed before 2006 or if they were previously evaluated in a meta-analysis. Studies were evaluated for quality using the GRADE criteria. Results: Three studies met inclusion criteria and were evaluated in this systematic review. A double-blind, randomized, placebo-controlled trial with 82 participants demonstrated a statistically significant reduction in the total RSI scores after 12 weeks of treatment, this effect disappeared once treatment was stopped. Another double-blind, randomized, placebo-controlled trial with 41 participants found no difference from baseline in any of their outcome measures. Finally a double-blind, randomized, placebo-controlled trial found statistically significant reduced RSI at week 12. This was the only study able to demonstrate improvement in the RFS after 12 weeks of treatment.

Conclusion: The use of proton pump inhibitors for LPR continues to be a topic surrounded with controversy. Current research supports a trial of twice daily PPI for at least 3 months if the patient is also experiencing symptoms of GERD. Patients with throat symptoms alone are unlikely to find relief from PPI therapy and should be evaluated for other possible etiologies. The purpose of this review is to evaluate the latest placebo controlled RCT using the RFS1and RSI2to evaluate the efficacy of PPI therapy for LPR.

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