Binu Raju George1, Ajayan P.V.2, Saify Samad3
BACKGROUND
Laryngopharyngeal reflux (LPR) is found to be a common disease encountered in
Otolaryngology practice. LPR presents clinically with symptoms of laryngeal
irritation, frequent throat clearing, cough, and hoarseness of voice. The main
diagnostic methods currently used are Fiber-optic laryngoscopy and in some
centers pH monitoring. Proton pump inhibitors (PPIs) are used and found to be
cost-effective and useful for the treatment of LPR. The main objective of this study
was to study the effectiveness of PPIs in alleviating the symptoms assessed using
Reflux Symptom Index (RSI) score and Reflux Finding Scores (RFS).
METHODS
A prospective study was carried out on 100 patients attending the ENT OPD of
Government Medical College and Hospital, Thrissur, Kerala. Patients were
evaluated for improvement in symptoms of Laryngopharyngeal reflux disease
following use of proton pump inhibitors, using Reflux symptom index and Reflux
finding scores using 70 degree / flexible nasopharyngolaryngoscopy. Patients with
clinical findings of LPRD with RSI score > 13 and RFS score > 7 were given a
standard treatment protocol followed in our ENT department using Tab.
Pantoprazole 40 mg twice daily before food and the treatment response was
assessed by proper follow up at 6 weeks and 12 weeks. On each follow up visit,
improvement in RSI and RFS scores with Proton pump inhibitor therapy was
assessed. Data collected was then tabulated and analysed.
RESULTS
The study was conducted in 100 patients, 59 % of whom were females and 41 %
males. Mean RSI score changed from 18.9 at the beginning to 14.5 at 6 weeks of
treatment and 9.0 at 12 weeks of treatment with Proton pump inhibitor. Mean RFS
score changed from 10.7 at the beginning to 8.7 at 6 weeks of treatment and to
5.9 at 12 weeks of treatment. Comparison of mean Reflux Symptom Index and
mean Reflux Finding Scores before and after treatment revealed improvement and
the result was statistically significant (p value < 0.001).
CONCLUSIONS
The use of RSI and RFS scores in the assessment of PPIs at fixed intervals is cost
effective and avoids time consuming and cost intensive examinations. These
scores also help in early diagnosis and long term follow up of LPR patient. Fixed
time interval PPI treatment significantly improved RSI and RFS scores in LPR
patients. The mean RSI score changed from 18.9 at the beginning of treatment to
14.5 at 6 weeks after treatment (p value < 0.001) and 9.0 after 12 weeks of
treatment; (p value < 0.001) The mean RFS score changed from 10.7 at the
beginning of treatment to 8.7 at 6 weeks after treatment (p value < 0.001) and
5.9 after 12 weeks of treatment; (p value < 0.001).
