Treatment of laryngopharyngeal reflux
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Overview of Laryngopharyngeal Reflux (LPR) Treatment Strategies
Laryngopharyngeal reflux (LPR) is a condition where stomach contents flow back into the throat, causing symptoms like chronic cough, throat clearing, hoarseness, and pain. There is no single gold-standard treatment, and management often requires a combination of approaches tailored to the patient’s needs 134.
Medical Therapy for LPR: Proton Pump Inhibitors and Alternatives
Proton pump inhibitors (PPIs) are the most commonly used medications for LPR, often prescribed once or twice daily for periods ranging from 4 to 24 weeks. However, their effectiveness varies widely, with reported success rates between 18% and 87% . Some studies and reviews question the superiority of PPIs over placebo, suggesting that while some patients experience symptom improvement, others do not see significant benefits, especially in terms of objective findings 89. Other medications, such as H2 receptor antagonists, alginates, prokinetics, and mucosal protectors, are sometimes used alone or in combination with PPIs, especially for patients who do not respond to PPIs alone 234.
Lifestyle and Dietary Modifications in LPR Management
Lifestyle changes and dietary modifications are key components of LPR treatment. These include avoiding trigger foods, reducing meal size, not eating before bedtime, weight management, and stress reduction. Studies show that combining dietary changes with mucosal protectors can significantly improve symptoms and objective measures, such as pepsin concentration in saliva and nasal secretions 145. Health education and patient counseling are also important to support these changes 13.
Non-Pharmacological and Surgical Options
For patients who do not respond to medication and lifestyle changes, other options are available. These include external upper esophageal sphincter compression devices, which are a novel noninvasive approach, and surgical interventions such as antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication 137. These options are generally reserved for drug-resistant or intolerant cases.
Duration and Personalization of LPR Treatment
The optimal duration of LPR treatment varies. About one-third of patients may respond within one month, while others may require up to nine months of therapy. The severity of symptoms at baseline can predict how quickly a patient will respond to treatment . Recent guidelines recommend starting with the shortest effective treatment duration (at least two months) and reducing medication as symptoms improve. For refractory cases, changing the medication class is preferred over simply increasing the dose 46.
Emerging Consensus and Need for Personalized Approaches
Recent European guidelines emphasize the importance of personalized therapy based on the type of reflux (acidic, nonacidic, or mixed) and recommend using diagnostic tools like multichannel intraluminal impedance-pH monitoring to guide treatment. Empirical therapy should focus on diet, stress reduction, and alginates or antacids, reserving PPIs for patients with confirmed acidic reflux .
Conclusion
The treatment of laryngopharyngeal reflux is multifaceted, involving medications (primarily PPIs), lifestyle and dietary changes, and, in some cases, non-pharmacological or surgical interventions. The effectiveness of PPIs is variable, and combined approaches, especially those including dietary modifications and mucosal protectors, show promise. Personalized treatment plans and further research are needed to optimize outcomes for all LPR patients 12345689.
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