Treatment of Postnasal Drip with Proton Pump Inhibitors: A Prospective, Randomized, Placebo-Controlled Study
| Autor: | Albert L. Merati, Timothy L. Smith, Todd A. Loehrl, Sachin S. Pawar, Matthew Gill, Hyun J. Lim, Robert J. Toohill |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Treatment outcome Placebo-controlled study Comorbidity Gastroenterology Gastro esophageal reflux law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans Prospective Studies 030223 otorhinolaryngology Prospective cohort study Aged Aged 80 and over Hoarseness business.industry Proton Pump Inhibitors Middle Aged Nasopharyngeal Diseases Treatment Outcome Cough Otorhinolaryngology 030220 oncology & carcinogenesis Gastroesophageal Reflux Infectious etiology Female Postnasal drip business |
| Zdroj: | American Journal of Rhinology. 21:695-701 |
| ISSN: | 1539-6290 1050-6586 |
| DOI: | 10.2500/ajr.2007.21.3098 |
| Popis: | Background Patients commonly present with complaints of postnasal drainage (PND) without objective evidence to support a sinonasal or infectious etiology. PND has been attributed to extra-esophageal reflux (EER), and an empiric trial of antireflux medication often is used to treat PND and associated symptoms. This study was performed to (1) evaluate the relationship between symptoms of EER and PND and (2) assess the efficacy of proton pump inhibitors (PPIs) in the management of PND. Methods Patients with a chief complaint of PND without objective evidence of sinonasal inflammatory disease were enrolled in a prospective, double-blinded, randomized placebo-controlled trial using rabeprazole, 20 mg, orally twice daily or placebo for 90 days. Subjects completed two-site 24-hour pharyngeal pH probe monitoring before treatment. Outcome measures included pre- and posttreatment visual analog scales for PND symptoms, reflux symptom index, and reflux finding score (RFS). Results Forty-seven patients were enrolled (mean age, 55 years)—21 patients in the PPI group and 26 in the placebo group. Fifty-six percent of subjects had pH probe confirmed EER using a cutoff of pH < 5.0. Baseline symptom measures between subjects with and without EER were not different. Compared with placebo, subjects receiving rabeprazole reported significant reduction in PND frequency (p = 0.0180), hoarseness (p = 0.0164), and chronic cough (p = 0.0204). The RFS decreased slightly in the placebo group (p = 0.1490) whereas it increased slightly in the PPI group (p = 0.5235). This difference between groups was significant (p = 0.0272). Conclusion Although 50% of subjects had evidence of EER, there was no difference in baseline symptoms between subjects with and without. Our findings support the potential benefit of PPI therapy for reducing PND frequency, hoarseness, and chronic cough, and confirm a placebo effect for other laryngopharyngeal reflux symptoms. The effect on laryngeal findings is mixed and patients may experience symptomatic improvement before changes in laryngoscopic appearance. |
| Databáze: | OpenAIRE |
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