Anonymous User
Login / Registration

a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2019; 73(1): 56–61. doi:10.14735/amgh201956.

Therapeutic trial of proton pump inhibitors for management of patients with laryngopharyngeal reflux

Lenka Nosáková1, Martin Ďuriček  2, Peter Bánovčin Jr2, Denisa Gburová1, Peter Lipták2, Rudolf Hyrdel  2

+ Affiliation


Laryngopharyngeal reflux (LPR) is according to the current conception responsible for extraesophageal symptoms of gastroesophageal reflux disease. It is manifested by non-specific problems like cough, excess throat mucus, globus and others. The diagnosing is complicated as currently there is no diagnostic test which could definitely establish the association of LPR and emerged troubles. The therapeutic trial with proton pump inhibitors (PPIs) is a common clinical practice. In this study we have evaluated its efficiency in patients classified on the basis of symptoms. At the first visit patients filled in a reflux symptom index (RSI) questionnaire. In case of RSI positivity (RSI > 13) the PPI therapy twice daily was used during the next 3 months. Then we invited the patients for a check-up during which they filled in the RSI questionnaire again. We have found significant moderation of symptoms after the 3 months’ PPI treatment and the normalization of RSI (RSI ≤ 13) was achieved by 50% of patients. When assessing the treatment efficiency on the individual questions in the questionnaire we have ascertained the significant influence on the cough reduction after eating and in a lying position, troublesome cough, breathing difficulties and choking episodes. Therapeutic trial seems to be an effective way of initial management of patients with anticipated LPR which can be used after the cause of the problems is ruled out by other specialists.


proton pump inhibitors, laryngopharyngeal reflux, reflux symptom index, gastroesophageal reflux disease

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users


1. Martinucci I, de Bortoli N, Savarino E et al. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chronic Dis 2013; 4 (6): 287–301. doi: 10.1177/2040622313503485.
2. Campagnolo AM, Priston J, Thoen RH et al. Laryngopharyngeal reflux: diagnosis, treatment, and latest research. Int Arch Otorhinolaryngol 2014; 18 (2): 184–191. doi: 10.1055/s-0033-1352504.
3. Varechova S, Mikler J, Murgas D et al. Cough reflex sensitivity in children with suspected and confirmed gastroesophageal reflux disease. J Physiol Pharmacol 2007; 58 Suppl 5 (Pt 2): 717–727.
4. Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002; 16 (2): 274–277.
5. Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001; 111 (8): 1313–1317. doi: 10.1097/00005537-200108000-00001.
6. Vailati C, Mazzoleni G, Bondi S et al. Oropharyngeal pH monitoring for laryngopharyngeal reflux: is it a reliable test before therapy? J Voice 2013; 27 (1): 84–89. doi: 10.1016/j.jvoice.2012.08. 006.
7. Zerbib F, des Varannes SB, Roman S et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 2005; 22 (10): 1011–1021. doi: 10.1111/j.1365-2036.2005.02677.x.
8. Zelenik K, Matousek P, Tedla M et al. Extraesophageal reflux: what is the best parameter for ph-monitoring data analysis from the perspective of patient response to proton pump inhibitors? Gastroenterol Res Pract 2013; 2013: 736486. doi: 10.1155/2013/736486.
9. Johnston N, Dettmar PW, Strugala V et al. Laryngopharyngeal reflux and GERD. Ann N Y Acad Sci 2013; 1300: 71–79. doi: 10.1111/nyas.12237.
10. Duricek M, Banovcin P, Halickova T et al. Acidic pharyngeal reflux does not correlate with symptoms and laryngeal injury attributed to laryngopharyngeal reflux. Dig Dis Sci 2018. doi: 10.1007/s10620-018-5372-1.
11. Social Science Statistics. [online]. Dostupné z:  http: // whitney/.
12. Wei C. A meta-analysis for the role of proton pump inhibitor therapy in patients with laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2016; 273 (11): 3795–3801. doi: 10.1007/s00405-016-4142-y.
13. Leite LP, Johnston BT, Just RJ et al. Persistent acid secretion during omeprazole therapy: a study of gastric acid profiles in patients demonstrating failure of omeprazole therapy. Am J Gastroenterol 1996; 91 (8): 1527–1531.
14. Park W, Hicks DM, Khandwala F et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope 2005; 115 (7): 1230–1238. doi: 10.1097/01.MLG.0000163746.81766.45.
15. Waxman J, Yalamanchali S, Valle ES et al. Effects of proton pump inhibitor therapy for laryngopharyngeal reflux on posttreatment symptoms and hypopharyngeal pH. Otolaryngol Head Neck Surg 2014; 150 (6): 1010–1017. doi: 10.1177/0194599814525577.
16. Lechien JR, Finck C, Khalife M et al. Change of signs, symptoms and voice quality evaluations throughout a 3-to 6-month empirical treatment for laryngopharyngeal reflux disease. Clin Otolaryngol 2018; 43 (5): 1273–1282. doi: 10.1111/coa.13140.
17. Lam PK, Ng ML, Cheung TK et al. Rabeprazole is effective in treating laryngopharyngeal reflux in a randomized placebo-controlled trial. Clin Gastroenterol Hepatol 2010; 8 (9): 770–776. doi: 10.1016/j.cgh.2010.03.009.
18. Duricek M, Nosakova L, Zatko T et al. Cough reflex sensitivity does not correlate with the esophageal sensitivity to acid in patients with gastroesophageal reflux disease. Respir Physiol Neurobiol 2018; 257: 25–29. doi: 10.1016/j.resp.2018.03.011.

Credited self-teaching test