The occurrence of relative proton pump inhibitor (PPI) drug resistance in the treatment of laryngopharyngeal reflux (LPR)

Laryngopharyngeal reflux (LPR) is a relatively common problem encountered by the otolaryngologist.  Diagnosis is often based on a history of chronic throat irritation, globus sensation, chronic cough, or chronic hoarseness combined with findings of laryngeal edema or erythema. Oftentimes, clinicians rely on an empirical trial of medications to establish a diagnosis. The gold standard for diagnosis, however, has remained 24-hour ambulatory double-probe pH testing. This test allows accurate detection of the presence of acid in the pharynx and therefore is a direct measure of LPR.

The treatment for LPR currently consists of dietary and lifestyle modification along with proton pump inhibitor (PPI) therapy. Results from treatment with PPIs have generally been excellent; improvement has been measured both in eradication of symptoms and improvement in laryngeal findings. Unfortunately, not all patients respond as expected to PPIs. Some patients require higher doses of medication, a change in their PPI, or antireflux surgery to control LPR. This report reviews our experience with the treatment of LPR with PPIs, and defines the relative failure rate of this class of
medication in treating this problem.

Read more: Proton pump inhibitor resistance in the treatment of laryngopharyngeal reflux
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MILAN R. AMIN, MD, GREGORY N. POSTMA, MD, PAUL JOHNSON, MD, NICHOLAS DIGGES, MD, and JAMIE A. KOUFMAN, MD, Philadelphia, Pennsylvania, Winston-Salem, North Carolina, and Omaha, Nebraska

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