Study of the empirical role of proton pump inhibitor therapy on laryngopharyngeal reflux


  • Nitin Chhabra Department of ENT, GMC, Patiala, Panjab, India
  • Ankita Aggarwal Department of ENT, GMC, Patiala, Panjab, India
  • Sanjeev Bhagat Department of ENT, GMC, Patiala, Panjab, India
  • Khushboo Goel Department of ENT, GMC, Patiala, Panjab, India





Background: Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist’s office. Study to evaluate the presentation of different signs and symptoms of LPR along with evaluating the role of empiric PPI (proton pump inhibitor) in the management of LPR by observing its effect on RFS and RSI.

Methods: A prospective observational study was conducted on 100 cases having different symptoms of LPR. Reflux symptom index (RSI) and Reflux finding score (RFS) were used to diagnose LPR. Patients were put on PPI (Pantoprazole 40 mg OD for 12 weeks) and followed up at 4,8 and 12 weeks and successive RSI and RFS scores were evaluated. The results were compiled and analyzed statistically.

Results: Among all symptoms, most common presenting symptom of LPR was foreign body/sensation of something sticking in throat (80%). Upon pharmacological therapy with PPIs (Pantoprazole), the mean RSI score changed from 22.94±5.83 to 11.19±2.97 at 12 weeks of PPI therapy. The mean RFS score changed from 12.93±3.55 to 6.86±2.86 at 12 weeks of PPI therapy. The change in the RFS and RSI score was highly significant (p=0.001).

Conclusions: LPR is a common condition presenting in ENT settings, the symptoms and signs of which may be complex. RFS and RSI score are valuable tools for diagnosing LPR. PPIs are proven to be effective therapy for LPR, more studies are encouraged to affirm the efficacy of PPIs over other management options.


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

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 of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2,53):1-78.

Johnston N, Knight J, Dettmar PW, Lively MO, Koufman J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope. 2004;114:2129-34.

Samuels TL, Johnston N. Pepsin as a causal agent of inflammation during nonacidic reflux. Otolaryngol Head Neck Surg. 2009;141(1):559-63.

Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274-7.

Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111(8):1313-7.

Bove MJ, Rosen C. Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg. 2006;14(3):116-23.

Dobhan R, Castell DO. Normal and abnormal proximal esophageal acid exposure: results of ambulatory dual-probe pH monitoring. Am J Gastroenterol. 1993;88(1):25-9.

Bytzer P. Introduction: pharmacodynamic and pharmacokinetic properties of proton pump inhibitors and their clinical impact-focus on rabeprazole. Aliment Pharmacol Ther Symp Ser. 2006;2:311-3.

Sachs G, Shin JM, Munson K. Review article: the control of gastric acid and Helicobacter pylori eradication. Aliment Pharmacol Ther. 2000;14:1383-401.

Reimer C, Bytzer P. Management of laryngopharyngeal reflux with proton pump inhibitors. Ther Clin Risk Manag 2008;4:225–33

Lechien JR, Saussez S, Schindler A, Karkos PD, Hamdan AL, Harmegnies B et al. Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta-analysis. Laryngoscope. 2019;129:1174.

Akst LM, Haque OJ, Clarke JO, Hillel AT, Best SR, Altman KW (2017) The changing impact of gastroesophageal reflux disease in clinical practice. Ann Otol Rhinol Laryngol. 2017;126:229.

Somashekhra KG, Kamath GJ. Clinical evaluation of cases of Laryngopharyngeal frflux. Ind J App Res. 2015;5(12):336-8.

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.

Kavitha Y, Dutta A, Sabarigirish K, Upendra Kumar J. A clinical study of symptomatic profile and response in objective and subjective parameters to proton pump inhibitor in laryngopharyngeal reflux. Int J Otorhinolaryngol Head Neck Surg. 2016;2:238-43.

Iqbal I, Masoodi ZA, Chiesti LA, Kadla SA. Laryngopharyngeal Reflux Disease; How to Evaluate. Open Sci J Clin Med. 2013;1(1):5-11.

Hicks DM, Ours TM, Abelson TI, Vaezi MF, Richter JE. The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice. 2002;16(4):564-79.

Wo JM, Koopman J, Harrell SP. Double-blind, placebo-controlled trial with single-dose pantoprazole for laryngopharyngeal reflux. Am J Gastroenterol 2006;101(9):1972-8.

Eherer AJ, Habermann W, Hammer HF. Effect of pantoprazole on the course of refl ux-associated laryngitis: a placebo-controlled double-blind crossover study. Scand J Gastroenterol. 2003;38(5):462-7.

Semmanaselvan K, Mukaddam QI, Naik M. An Open Label, Prospective, Single Centre Study to Evaluate the Efficacy and Safety of Fixed Dose Combination of Rabeprazole (Enteric-Coated, EC) 20 mg + Domperidone (Sustained Release, SR) 30 mg Capsule in Treatment of Patients with Laryngopharyngeal Reflux Disease. J Assoc Physicians India. 2015;63(7):27-32.






Original Research Articles