Paper
Are persistent throat symptoms atypical features of gastric reflux and should they be treated with proton pump inhibitors?
Published Oct 9, 2014 · J. Powell, J. O’Hara, J. Wilson
BMJ : British Medical Journal
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Influential Citations
Abstract
Persistent throat symptoms are common in adults. Globus pharyngeus (a feeling of a lump in the throat), dysphonia, throat clearing, cough, excessive phlegm, throat pain, and postnasal secretions are present in up to 25% of primary care attenders, and more than 60 000 people are referred to secondary otolaryngological care annually.1 Treating persistent throat symptoms with gastric acid suppression has been in vogue for more than a decade, on the basis that they represent “atypical” manifestations of gastro-oesophageal reflux disease (GORD).2 So called extraoesophageal reflux or laryngopharyngeal reflux is internationally acknowledged as a separate GORD subcategory from “typical” oesophageal reflux disease.3 However, the relation between gastric reflux and persistent throat symptoms, and the role of proton pump inhibitor (PPI) treatment remains controversial.4 5 More than half of UK otolaryngologists prescribe PPIs for persistent throat symptoms.6 The message has also filtered through to primary care that PPIs are a reasonable “empirical” treatment. PPI treatment is a substantial expense for healthcare systems and increasingly treatment of persistent throat symptoms is adding to this. The cost of PPI treatment to the National Health Service in England for all conditions, including persistent throat symptoms, was £425m (€540m; $694m) in 2006 and the global bill was £7bn.7 On 25 June 2014 we searched Medline and Embase databases and the Cochrane Library for studies dealing with persistent throat symptoms, gastric reflux, and treatment with PPIs. We used the search terms “throat symptoms” or “laryngopharyngeal reflux” or “extra-oesophageal reflux” or “extra-esophageal reflux” or “gastro-oesophageal reflux disease” or “gastro-esophageal reflux disease” or “proton pump inhibitors”. ### Are persistent throat symptoms atypical features of gastric reflux? The pathogenesis of persistent throat symptoms in gastric reflux is hypothesised to be through retrograde flow of gastric contents (particularly acid, bile, and pepsin) that affect the laryngopharynx by direct mucosal contact, or by a secondary mechanism.8 …
Systematic Review
Very Rigorous JournalPersistent throat symptoms may not be atypical features of gastric reflux and may not benefit from proton pump inhibitor treatment.
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