Diagnostic test for laryngopharyngeal reflux: results of short–term omeprazole therapy

Abstract

The aim was to evaluate the merit of empiric omeprazole therapy in patients with suspected laryngopharyngeal reflux (LPR), to determine the optimal dose and duration of diagnostic test. 120 out–patients with posterior laryngitis and more than one atypical symptom of LPR aged 14 — 68 years randomized to the study received different doses of omeprazole for 4 weeks (clinical group, n=100) or only life style modification and diet (dietary group, n=20). Prior to the study a symptom questionnaire, well being in general on 100–mm VAS scale, videolaryngoscopy, upper endoscopy, and voice assessment (vocal dysfunction degree (VDD) calculated from 4 voice range profile parameters) were completed. Normal values of efficacy parameters were obtained from 113 healthy voice subjects (control group). Patients were evaluated twice: after 1–2 weeks and after 4–5 weeks. According to our data 1st control assessment showed significant improvements in all efficacy parameters only for clinical group of patients (p<0.05). 2nd control assessment showed significantly better results for clinical group patients in comparison to 1st: 65.0% of responders vs. 36% (p<0.05). Patients receiving omeprazole more than 20 mg daily obtained the better results. Erosive esophagitis was found in 21% (21/100) of clinical group of patients, 85.7% (18) of them were responders to omeprazole 4 weeks test. We concluded that short–term therapy with omeprazole might be useful in confirming the clinically based diagnosis of laryngopharyngeal reflux. 4 weeks omeprazole test was significantly superior to 2 weeks, as well as omeprazole not less than 20 mg twice–daily was more effective than 20 mg once a day.