Abstract
Background and Objectives
The association of gastroesophageal reflux disease (GERD) and laryngeal symptoms is not clear. We aimed to examine the symptomatic and endoscopic relations between GERD and laryngeal symptoms and also to evaluate the response to a 2-week proton pump inhibitor (PPI) trial.
Methods
Seventy-two patients experiencing persistent laryngeal symptoms ≥2/week were enrolled. The laryngeal symptoms using the 1-week laryngeal symptom score (LSS) and the typical reflux symptoms including heartburn and acid regurgitation were assessed. Transnasal-esophagogastroduodenoscopy (TN-EGD) and ambulatory 24-h esophageal pH monitoring were performed. The patients were classified into a GERD group and a non-GERD group. The GERD group was defined as the cases of the presence of typical reflux symptoms and/or reflux esophagitis and/or pathologic acid exposure. Patients were treated with 30 mg of lansoprazole bid for 14 days.
Results
Thirty-nine patients (54 %) were diagnosed with GERD on the basis of typical reflux symptoms, EGD, and/or pH testing. There was no significant association between the LSS and the presence of typical reflux symptoms. Also, the presence of laryngitis was not significantly related to reflux esophagitis. The 2-week PPI trial showed no significant difference in the improvement in laryngeal symptoms between the GERD and non-GERD groups.
Conclusions
There was no significant symptomatic and endoscopic association between GERD and laryngeal symptoms. Therefore, GERD does not appear to be the sole cause of these symptoms. Additionally, a 2-week PPI trial is not long enough to be a diagnostic tool in patients with laryngeal symptoms.
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References
Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101:1–78.
Graser AG. Gastroesophageal reflux and laryngeal symptoms. Aliment Pharmacol Ther. 1994;8:265–272.
Sinn DH, Kim JH, Kim S, et al. Response rate and predictors of response in a short-term empirical trial of high-dose rabeprazole in patients with globus. Aliment Pharmacol Ther. 2008;27:1275–1281.
Qua CS, Wong CH, Gopala K, Goh KL. Gastro-oesophageal reflux disease in chronic laryngitis: prevalence and response to acid-suppressive therapy. Aliment Pharmacol Ther. 2007;25:287–295.
Wong CH, Chua CJ, Liam CK, Goh KL. Gastro-oesophageal reflux disease in ‘difficult-to-control’ asthma: prevalence and response to treatment with acid suppressive therapy. Aliment Pharmacol Ther. 2006;23:1321–1327.
Fass R, Fennerty MB, Ofman JJ, et al. The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain. Gastroenterology. 1998;115:42–49.
Sen P, Georgalas C, Bhattacharyya AK. A systematic review of the role of proton pump inhibitors for symptoms of laryngopharyngeal reflux. Clin Otolaryngol. 2006;31:20–24.
Karkos PD, Wilson JA. Empiric treatment of laryngopharyngeal reflux with proton pump inhibitors: a systematic review. Laryngoscope. 2006;116:144–148.
Kim JH, Sinn DH, Son HJ, Kim JJ, Rhee JC, Rhee PL. Comparison of one-week and two-week empirical trial with a high-dose rabeprazole in non-cardiac chest pain patients. J Gastroenterol Hepatol. 2009;24:1504–1509.
Seo TH, Kim JH, Lee JH, et al. Clinical distinct features of noncardiac chest pain in young patients. J Neurogastroenterol Motil. 2010;16:166–171.
Williams RBH, Szczesniak MM, Maclean JC, Brake HM, Cole IE, Cook IJ. Predictors of outcome in an open label, therapeutic trial of high dose omeprazole in laryngitis. Am J Gastroenterol. 2004;85:778–788.
Wo JM, Grist WJ, Gussack G, Delgaudio JM, Waring JP. Empiric trial of high-dose omeprazole in patients with posterior laryngitis: a prospective study. Am J Gastroenterol. 1997;92:2160–2165.
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180.
Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol. 1992;87:1102–1111.
Preiss C, Charton JP, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD. Endoscopy 2003;35:641–646.
Andrus JG, Dolan RW, Anderson TD. Transnasal esophagoscopy: a high-yield diagnostic tool. Laryngoscope 2005;115:993–996.
Stroppa I, Grasso E, Paoluzi OA, et al. Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability. Dig Liver Dis. 2008;40:767–775.
Choe WH, Kim JH, Ko SY, et al. Comparison of transnasal small-caliber vs. peroral conventional esophagogastroduodenoscopy for evaluating varices in unsedated cirrhotic patients. Endoscopy 2011;43:649–656.
Wong WM. Use of proton pump inhibitor as a diagnostic test in NCCP. J Gastroenterol Hepatol. 2005;20:S14–S17.
Bruley des Varannes S. The proton-pump inhibitor test: pros and cons. Eur J Gastroenterol Hepatol. 2004;16:847–852.
Vaezi MF. Therapy Insight: gastroesophageal reflux disease and laryngopharyngeal reflux. Nat Clin Pract Gastroenterol Hepatol. 2005;2:595–603.
Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005;294:1534–1540.
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This work was supported by Kokuk University in 2012.
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Kim, J.H., Sung, IK., Hong, S.N. et al. Is the Proton Pump Inhibitor Test Helpful in Patients with Laryngeal Symptoms?. Dig Dis Sci 58, 1663–1667 (2013). https://doi.org/10.1007/s10620-012-2540-6
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DOI: https://doi.org/10.1007/s10620-012-2540-6