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“Dropping Acid” Blog


Jamie A. Koufman, M.D., F.A.C.S.*


Background: Laryngopharyngeal reflux (LPR) is an expensive, high-prevalence disease with a high rate of medical treatment failure. In the past, it was mistakenly believed that pepsin was inactive above pH 4; however, human pepsin has been shown to be active across the pH range. In addition, it has been shown by Western blot analysis that patients with symptomatic LPR have tissue-bound pepsin in laryngeal biopsy samples. The impact of a low-acid diet on the therapeutic outcome in LPR, the focus of this study, has not been previously reported.

Objectives: To provide clinical data on the therapeutic benefits of a strict virtually acid-free diet on patients with recalcitrant, proton-pump inhibitor (PPI) resistant LPR.

Study Design: Prospective study of 20 LPR patients with persistent LPR symptoms despite twice-daily PPIs and an H2-antagonist at bedtime.

Methods: The reflux symptom index (RSI) and the reflux finding score (RFS) were compared pre- and post-diet. Each study subject was individually counseled by the author; all foods and beverages pH <5 were eliminated for a minimum two-week period. In addition, a detailed printed version of the diet was provided to each study subject. While it was not possible to objectively assess patient conformity, all 20 subjects claimed excellent compliance.

Results: There were 12 male and 8 female subjects with a mean age of 54.3 (range 24-72 years). The pre-diet mean RSI was 14.8 and the mean post-diet RSI was 8.6 (P= 0.023). The pre-diet mean RFS was 12.0 and the mean post-diet RFS was 8.3 (P< 0.001).

Conclusions: A strict low-acid diet appears to have beneficial effects on the symptoms and findings of recalcitrant (PPI-resistant) LPR. Further study is needed to asses the optimal duration of dietary acid-restriction, and to assess the potential role of low-acid diet as a primary treatment for LPR. This study may have implications for understanding reflux-related diseases, particularly LPR.

Key words: Pepsin, laryngopharyngeal reflux, LPR, gastroesophageal reflux disease, GERD, reflux diet, low acid diet, proton pump inhibitors, PPI, reflux symptom index, reflux finding score.

† Presented at the Annual Meeting of the American Broncho-Esophagological Association. Las Vegas, Nevada, April 29, 2010 (Submitted for publication to the Ann Otol Rhinol Laryngol, 2010)

* Author contact information: Jamie A. Koufman, M.D., F.A.C.S., Director, Voice Institute of New York, Professor of Clinical Otolaryngology, New York Medical College, 200 West 57th Street, Suite 1203, New York, NY 10019, Tel: (212) 463-8014 begin_of_the_skype_highlighting              (212) 463-8014      end_of_the_skype_highlighting begin_of_the_skype_highlighting              (212) 463-8014      end_of_the_skype_highlighting, Fax: (212) 757-0677, jamie@voiceinstituteny.com, www.voiceinstituteofnewyork.com