Clinical Profiles and Proton Pump Inhibitor Discontinuation Outcomes in Laryngopharyngeal Reflux Disease.

Abstract

To investigate the clinical presentation and weaning of patients with chronic proton pump inhibitor (PPI) therapy and laryngopharyngeal reflux disease (LPRD). Prospective controlled study. Patients with LPRD symptoms despite ongoing PPI therapy were prospectively recruited from two centers. LPRD diagnosis required >1 pharyngeal reflux event on hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) or reflux symptom score (RSS) > 13 with reflux sign assessment (RSA) > 14. A control group with primary LPRD diagnosis was established. All patients received diet modifications, lifestyle changes, and alginate/antacid therapy for 3 months while discontinuing PPIs. Clinical presentations and treatment responses were compared between groups using RSS and RSA. PPI weaning success rates and rebound effects were evaluated. Fifty-three patients with PPI therapy and 53 subjects with a primary LPRD diagnosis were consecutively recruited. PPIs were successfully discontinued in 66.0% of patients, with rebound effects occurring in 20.0% of weaned cases. Long-term PPI users (mean duration: 142.3 ± 153.9 months) exhibited significantly higher otolaryngological and respiratory symptoms than primary LPRD patients, while both groups showed comparable digestive symptoms. Only 5.7% of patients met criteria for long-term PPI therapy. Both groups demonstrated significant improvement in symptoms and signs following treatment. The PPI group showed greater reduction in reflux sign assessment scores (P = .001) compared to primary LPRD patients. The chronic PPI consumption was not supported by clinical guidelines in most patients with LPRD. Most long-term PPI users with LPRD can successfully discontinue therapy when replaced with appropriate anti-reflux treatment alternatives.