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Reprinted by permission of Arch Otolaryngol Head Neck Surg. 2010; 136(11):1089-1092.

ORIGINAL ARTICLE

O NLINE F IRST

Treatment of Clinically Diagnosed Laryngopharyngeal Reflux Disease

Tarek Fouad Youssef, MD; Mohamed Rifaat Ahmed, MD

Objectives : To determine the incidence of Helicobac- ter pylori (HP) stool antigen (HPSA) in patients with la- ryngopharyngeal reflux disease (LPRD), and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. Design : Randomized controlled study. Setting : Suez Canal University Hospital, Ismalia, Egypt. Patients : A total of 212 patients with symptoms of LPRD. Intervention : Patients were evaluated by laryngoscopy, ambulatory pH monitoring for 24 hours, and HPSA test- ing. Esomeprazolemagnesiumas amonotherapywas evalu- ated vs triple therapy in patients with HP infection. Main Outcome Measures : To determine the inci- dence of HPSA in patients with LPRD, and tomake a com- parison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in pa- tients with LPRD .

Results : Persistent dry cough and a feeling of a lump in the throat (globus sensation) were the most frequent symptoms of LPRD, while posterior laryngeal inflamma- tion was the main laryngoscopic finding. Results from the HPSA test were positive in 57% of the studied group. Patients with negative HPSA were treated with esomepra- zole as single modality with a reported improvement score of 96.6%. Patients with positive HPSA test results were divided into 2 groups: 1 received only esomeprazole, with reported improvement in 40%, whereas the second group was treated with esomeprazole, plus amoxicillin so- dium and clarithromycin (triple therapy) and reported a 90% incidence of symptom improvement. Conclusion : The incidence of HP infection in patients with LPRD in our studywas 57%. Triple therapy showed a higher cure rate in patients with HPSA-positive test results. Arch Otolaryngol Head Neck Surg. 2010;136(11):1089-1092. Published online September 20, 2010. doi:10.1001/archoto.2010.165

G ASTROESOPHAGEAL RE - flux disease (GERD) is defined as a backward flow of gastric contents into the esophagus. 1 Bea- ver et al 2 suggested that laryngopharyn- geal reflux disease (LPRD) means a back- ward flow of the stomach contents up to the throat. The clinical symptoms usu- ally occur secondary to a refluxate of hy- drochloric acid and pepsin. 3 The gastric refluxate in the larynx might be the caus- ative factor in posterior laryngeal inflam- mation, laryngeal contact ulcers, and la- ryngeal granuloma formation. 3,4 It is associated with many otolaryngology dis- orders, such as reflux laryngitis, cervical dysphagia, globus pharyngeus, chronic cough, laryngeal or tracheal stenosis, and laryngeal carcinoma. 4 The incidence of la- ryngopharyngeal symptoms is greater than expected. 5

There is a complex multifactor set of pathophysiologiccharacteristicsofLPRDbe- sides simple acid reflux. 6 Helicobacter pylori (HP)isagram-negative,microaerophilicbac- teriumthat can cause infectionof the stom- ach and is also strongly linked to the devel- opment of duodenal and gastric ulcers. 7,8 A relationshipbetween the rates anddegreeof refluxesophagitiswithHPinfectionhasbeen reported, but toour knowledge, no relation- ship with reflux laryngitis has been re- ported. 9,10 TheHPstool antigen(HPSA) test is a rapid, noninvasive diagnostic method basedon a sandwich enzyme immunoassay withantigendetection,whichhasahighsen- sitivity and specificity. 11,12 No standard guidelines are available for treatment of LPRD; proton pump inhibi- tors, twice daily for 8 weeks, have been rec- ommended 13 if HP is present. However, clinical guidelines may consider revision to add a triple therapy regimen.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, Suez Canal University, Ismalia, Egypt.

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