Combination drug therapy for laryngopharyngeal reflex


  • Raj Tajamul Hussain Department of ENT, SHKM Government Medical College, Nuh, Haryana, India
  • Owais Makhdoomi Department of ENT, Government Medical College, Srinagar, J and K, India
  • Showkat Ahmad Showkat Department of ENT, Government Medical College, Srinagar, J and K, India



Laryngopharyngeal reflux, Gastroesophageal reflux disease, Reflux symptom index, Reflux finding score, Proton-pump inhibitors, H2 receptor antagonists


Background: We sought to evaluate the combination of high-dose prebreakfast proton pump inhibitors (PPIs) (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing as a surrogate and rational regimen for LPR.

Methods: 60 subjects that presented to ENT and HNS OPD with symptoms of laryngopharyngeal reflux (LPR) were prospectively evaluated and underwent a comprehensive otolaryngological examination. All subjects were treated sequentially and outcomes recorded using reflux finding score (RFS) and reflux symptom index (RSI).  

Results: The mean age of the cohort was 35±06.51 (age range, 8-55). Mean RSI of all patients was 24.8 before treatment with combination of PPIs and H2 receptor antagonists. Significant change in RSI were observed after the first 8 weeks of therapy and no further significant changes were observed over the next 16 weeks. Mean RFS of the patients was 12 before starting the treatment and there was a significant response in mean RFS at 16 weeks of therapy.

Conclusions: A surrogate high-dose prebreakfast PPI (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing regimen is effective in improving RSI and RFS in majority of cases who present with LPR.


Author Biography

Raj Tajamul Hussain, Department of ENT, SHKM Government Medical College, Nuh, Haryana, India




Serag EHB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2007;5:17-26.

Altman KW, Stephens RM, Lyttle CS, Weiss KB. Changing impact of gastroesophageal reflux in medical and otolaryngology practice. Laryngoscope. 2005;115:1145-53.

Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011;120:281-7.

Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142-6.

Koufman JA, Johnston N. Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease. Ann Otol Rhinol Laryngol. 2012;121:431-4.

Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development laryngeal injury. Laryngoscope. 1991;101(52):1-78.

Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg. 2000;123:385-8.

Modlin IM, Moss SF, Kidd M, Lye KD. Gastroesophageal reflux disease: then and now. J Clin Gastroenterol. 2004;38(5):390-402.

Knol KEC. Otolaryngologic manifestations of gastro-oesophageal reflux disease. Scand J Gastroenterol Suppl. 1998;225:24-8.

Hawkins BL. Laryngopharyngeal reflux: a modern day “great masquerader”. J Ky Med Assoc. 1997;95(9):379-85.

Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005;294:1534-40.

Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16: 274-7.

Belfasky PC, Postma GN. The validity and reliability of reflux finding score. The laryngoscope. 2001;111:1313-7.

Lechien JR, Schindler A, Marrez DLG, Hamdan AL, Karkos PD, Harmegnies B, et al. Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review. Laryngoscope. 2018.

Branski RC, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease. Laryngoscope. 2002;112:1019-24.

Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology - Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127:32-5.

Leite LP, Johnston BT, Just RJ, Castell DO. Persistent acid secretion during omeprazole therapy: a study of gastric acid profiles in patients demonstrating failure of omeprazole therapy. Am J Gastroenterol. 1996;91:1527-31.

Berardi RR. A critical evaluation of proton pump inhibitors in the treatment of gastroesophageal reflux disease. Am J Manag Care. 2000;6:491-505.

Carroll TL, Werner A, Nahikian K, Dezube A, Roth DF. Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease. Laryngoscope. 2017;127(6):1-13.

Park W, Hicks DM, Khandwala F, Richter JE, Abelson TI, Milstein C, et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope. 2005;115:1230-8.

Yang J, Dehom S, Sanders S, Murry T, Krishna P, Crawley BK. Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications. Am J Otolaryngol. 2018;39:50-5.

Suzuki M, Yokota M, Matsumoto T, Nakayama M, Takemura M, Kanemitsu Y, et al. Proton Pump Inhibitor Ameliorates Taste Disturbance among Patients with Laryngopharyngeal Reflux: A Randomized Controlled Study. Tohoku J Exp Med. 2019;247:19-25.

Axford SE, Sharp N, Ross PE. Cell biology of laryngeal epithelial defenses in health and disease: preliminary studies. Ann Otol Rhinol Laryngol. 2001;110:1099-108.

Hogan W, Shaker R. Medical treatment of supraesophageal complications of gastroesophageal reflux disease. Am J Med. 2001;111(l-8A):197-201.

Xue S, Katz P, Banerjee P, Tutuian R, Castell D. Bedtime H2 blockers improve nocturnal gastric acid control in GERD patients on proton pump inhibitors. Aliment Pharmacol Ther. 2001;15:1351-6.

Scarpignato C, Pelosini I, Mario DF. Acid suppression therapy: where do we go from here. Dig Dis. 2006;24:11-4.

Peghini PL, Katz PO, Bracy NA. Nocturnal recovery of gastric acid secretion with twice-daily dosing of proton pump inhibitors. American J Gastroenterology. 1998;93:763-67.

Reimer C. Safety of long-term PPI therapy. Best Pract Res Clin Gastroenterol. 2013;27:443-54.

Fass R. Alternative therapeutic approaches to chronic proton pump inhibitor treatment. Clin Gastroenterol Hepatol. 2012;10:338-45.

Guo H, Ma H, Wang J. Proton pump inhibitor therapy for the treatment of laryngopharyngeal reflux: A meta-analysis of randomized controlled trials. J Clin Gastroenterol. 2016;50:295-300.

Issing WJ, Karkos PD, Perreas K, Folwaczny C, Reichel O. Dual-probe 24 hours ambulatory pH monitoring for diagnosis of laryngopharyngeal reflux. J Laryngol Otol. 2004;118:845-8.

Bilgen C, Ogut F, Dinc KH, Kirazli T, Bor S. The comparison of an empiric proton pump inhibitor trial vs 24 hours double-probe Ph monitoring in laryngopharyngeal reflux. J Laryngol Otol. 2003;117:386-90.

Mesallam TA, Stemple JC, Sobeih TM, Elluru RG. Reflux symptom index versus reflux finding score. Ann Otol Rhinol Laryngol. 2007;116:436-40.

Toros SZ, Toros AB, Yuksel OD, Ozel L, Akkaynak C, Naiboglu B, et al. Association of laryngopharyngeal manifestations and gastroesophageal reflux. Eur Arch Otorhinolaryngol. 2009;266:403-9.

Patigaroo SA, Hashmi SF, Hasan SA, Ajmal MR, Mehfooz N. Clinical manifestations and role of proton pump inhibitors in the management of laryngopharyngeal reflux. Indian J Otolaryngol Head Neck Surg. 2011;63:182-9.

The Gallup Organization. The 2000 study of consumers’ use of stomach relief products. Princeton, NJ: The Gallup Organization; 2000.

Koufman J, Sataloff RT, Toohill R. Laryngopharyngeal reflux: consensus conference report. J Voice. 1996;10(3):215-6.






Original Research Articles