Laryngopharyngeal Reflux Disease - Do Prokinetic Drugs have any Role in Management?

Abstract

Abstract Objectives : 1. To diagnose laryngopharyngeal reflux disease (LPRD) clinically with the available subjective screening protocols (RefluxSymptomIndex and Reflux Finding Score) to categorize the disease based on its severity. 2. To evaluate the role of Prokinetic drugs in the treatment ofLPRDas a whole&in different disease severity groups.   Methods : A hospital-based interventional study was performed for a period of 5 months in patients presenting with symptoms suggestive of LPR in the outpatient department of R G Kar Medical College. The history was taken in detail and symptom scoring was done in terms of REFLUXSYMPTOMINDEX. Then fiber-optic laryngoscopic assessment was done in each patient and REFLUX FINDING SCORE was obtained. Reflux Finding Score over 7 was considered to be suggestive of LPR. The patients were then categorized to three severity groups. In each group, patients were randomly assigned to be treated with either pantoprazole with domperidone or with pantoprazole only. They were followed up at 1 &3 months from initiation of treatment&assessed for improvement by using same criteria, RSI&RFS.   Results : High female preponderance was noted for LPR. Mostly the middle aged (30-50 years) persons were affected. Disease severity was almost the same in both sexes but symptom scores were much higher in females, particularly in extremes of ages. The commonest presenting symptom of LPR was found to be lumpy or sticky sensation in throat and common signs were laryngeal erythema, edema & posterior commissure hypertrophy. Laryngeal erythema was not found to be a reliable marker of disease severity but laryngeal edema & posterior commissure hypertrophy were. Focal vocal fold edema was a more consistent marker of disease severity than diffuse edema, especially in lower symptom group. Addition of prokinetic drugs in the management of LPRD was found to be satisfactorily effective. In refractory cases, reflux inductiondiet was prescribed, which worked quite well.   Conclusions : Prokinetic drugs are effective adjunct to pantoprazole in the management of LPRD. Keywords: Laryngopharyngeal reflux; RFS; Prokinetic drugs; Induction reflux diet