The efficacy of a personalised treatment depending on the characteristics of reflux at multichannel intraluminal impedance‐pH monitoring in patients with acid, non‐acid and mixed laryngopharyngeal reflux

• Published in: Clinical otolaryngology Vol. 46; no. 3; pp. 602 - 613
• Main Authors: Lechien, Jérôme R., Bobin, Francois, Muls, Vinciane, Mouawad, Francois, Dequanter, Didier, Horoi, Mihaela, Thill, Marie‐Paule, Rodriguez Ruiz, Alexandra, Saussez, Sven
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2021
• Subjects: acid; Acids; Alginates; Alginic acid; Belgium; Customization; Electric Impedance; Endoscopy, Gastrointestinal; Esophageal pH Monitoring; Esophagus; Evolution; Female; France; Gastroesophageal reflux; Health services; Humans; Impedance; laryngitis; laryngopharyngeal; Laryngopharyngeal Reflux - therapy; Male; Middle Aged; Monitoring; non‐acid; Patients; pH effects; Precision Medicine; Prospective Studies; reflux; Severity of Illness Index; Success; Telemedicine; Belgium; France; acid; laryngitis; mixed; reflux; non-acid; laryngopharyngeal
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.13722

Objective To assess the evolution of symptoms and findings of laryngopharyngeal reflux (LPR) patients according to the type of reflux (acid, non‐acid, mixed and gastro‐oesophageal (GERD)). Design Prospective uncontrolled multicentre study. Methods One hundred and six patients with LPR have been recruited from 3 European Hospitals. According to the reflux characteristics at the impedance‐pH monitoring (acid, non‐acid, mixed, GERD), patients received a personalised treatment based on the association of diet, pantoprazole, alginate or magaldrate for 3 months. Reflux Symptom Score (RSS) was assessed at baseline, 6 and 12 weeks post‐treatment. Reflux Sign Assessment (RSA) has been used to rate laryngeal and extra‐laryngeal findings at baseline and 12 weeks post‐treatment. Overall success rate and the evolution of symptoms and findings were evaluated according to the LPR types. Results One hundred and two LPR patients (42 acid, 33 non‐acid, 27 mixed, including 49 with LPR and GERD) completed the study. RSS and RSA total scores significantly improved from baseline to post‐treatment time in acid, mixed and non‐acid groups. The presence of GERD in addition to LPR did not impact the clinical improvement. The 3‐month success rates of treatment ranged from 62% to 64%, and there were no significant differences between groups. The success rate of patients with non‐acid LPR was similar to those of patients with mixed and acid LPR. Conclusion MII‐pH is useful to specify the type of LPR and the related most adequate therapeutic regimen. Non‐acid or mixed LPR similarly respond to treatment than acid LPR but require a treatment based on alginate or magaldrate covering the non‐acid proximal reflux events.