The assortment of diagnostic tests that are currently available for detecting gastroesophageal reflux disease (GERD) are invasive, costly and not readily available to community-based physicians. In contrast, a short course of high-dose proton pump inhibitor (PPI) as an empirical trial is an attractive alternative. This simple diagnostic test has been demonstrated to be accurate and cost-effective in patients with symptoms suggestive of GERD and those with noncardiac chest pain. Early studies in patients with extraesophageal manifestations of GERD have yielded promising results. Cost assessment of the PPI empirical trial revealed significant cost savings, mainly due to a marked decrease in utilization of invasive diagnostic tests. Thus the PPI empirical trial should be considered as the initial diagnostic step in patients with the disease spectrum of GERD.
"Although H2-receptor antagonists, prokinetic agents, and mucosal cytoprotectants are still used, PPIs are the mainstay of medical treatment (15). A 3-month empirical trial of PPI is generally regarded as a cost-effective approach to initial assessment and management of LPR (16). However, there are some controversies regarding their efficacy as well as the length of the therapeutic trial (17). "
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to determine the benefits of short-term empirical proton pump inhibitor (PPI) medication on laryngopharyngeal reflux (LPR) and to determine whether scores on the reflux symptom index (RSI) and the reflux finding score (RFS) could be combined to identify subgroups of patients that will more likely to improve with this medication.
Fifty-one Korean Otolaryngology Board-certified specialists joined this prospective, multi-center, and open-label observational study. A total of 1,142 adult patients with LPR was enrolled for 12 weeks of rabeprazol medication. According to pre-treatment scores on RSI and RFS, patients were divided into 4 subgroups. RFS and RSI were measured repeatedly with a month interval along the treatment period. Changes of RSI and RFS were analyzed in an overall study cohort as well as in each subgroup.
Approximately 40% (n=455) of enrolled patients were followed up until 12 weeks of PPI treatment. Significant improvement in RSI was obtained in 29%, 58%, and 75% of patients after 4, 8, and 12 weeks of PPI medication. RFS was improved in 16%, 42%, and 57% of the patients with 4, 8, and 12 weeks of PPI medication. All subgroups showed improvement regardless of their pre-treatment scores on the RSI and RFS.
Even though RSI and RFS may be used as a general guideline for LPR management, pre-treatment RSI and RFS are not useful in predicting the patients' response to short-term PPI medication in the usual pattern of practice for LPR, which is mostly based on the physical evaluation and history taking.
[Show abstract][Hide abstract] ABSTRACT: Multichannel intraluminal impedance is a relatively new technology that allows detection of bolus movement in the gastrointestinal tract without the use of radiation. In clinical applica- tions it is combined with manometry, allowing a better evaluation of the functional characteristics (ie, bolus transit) of esophageal motility abnormalities. When combined with pH monitoring, it provides more comprehensive data on both acid and nonacid gastroesophageal reflux.
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