Reflux and Laryngitis—a Complicated Relationship

Results from a large clinical trial show that proton pump inhibitors relieve some, but not all the symptoms of chronic laryngitis.

One type of laryngitis, laryngopharyngeal reflux (LPR), is characterized by hoarseness, chronic cough, frequent throat clearing, and the feeling of something in the throat. Because it is believed to be a consequence of gastroesophageal reflux disease, it is frequently treated with acid suppression. However, there is conflicting data about whether these chronic throat symptoms are a true consequence of GERD and how effective PPIs are for this condition.

To study the relationship between LPR and GERD, as well as the effects of acid suppressive medications, Paul K.Y. Lam et al. gave 82 patients suspected to have LPR either the proton pump inhibitor rabeprazole or placebo for 12 weeks; they were followed for another 6 weeks after therapy ended. In the September issue of Clinical Gastroenterology and Hepatology, Lam et al. report that rabeprazole reduced the symptoms related to reflux, such as heartburn, chest pain, indigestion, post-nasal drip, and the sensation of something in the throat. However, there were no differences between groups in hoarseness, throat clearing, or cough. Reflux did not therefore seem to be the major cause of the patients’ laryngeal irritation.

In an accompanying editorial, Michael Vaezi concludes that acid suppression is not likely to provide a significant benefit to patients with chronic laryngeal symptoms—these drugs improve the heartburn, but not the throat symptoms. Lam et al. also observed that reflux symptoms relapsed 6 weeks after treatment was stopped, so patients that do respond to proton pump inhibitors require long treatment duration.

Reflux symptom index of patients given rabeprazole vs. placebo.

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Read the article online:
Lam PKY, Ng ML, Cheung TK et al. Rabeprazole is effective in treating laryngopharyngeal reflux in a randomized placebo-controlled trial. Clin Gastroenterol Hepatol 2010;8:770–776.

Read the accompanying editorial:
Vaezi MF. Benefit of acid-suppressive therapy in chronic laryngitis: the devil is in the details. Clin Gastroenterol Hepatol 2010;8:741-742.

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