Empiric trial of high-dose omeprazole in patients with posterior laryngitis: A prospective study

John Wo, W. J. Grist, G. Gussack, J. M. Delgaudio, J. P. Waring

Research output: Contribution to journalArticle

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Abstract

The optimal management of patients suspected with gastroesophageal reflux-related posterior laryngitis is unclear. History, physical examination, and ambulatory pH monitoring all have significant limitations in identifying patients who will respond to antireflux therapy. Objective: To evaluate the merit of empiric omeprazole therapy in patients with posterior laryngitis. Methods: Twenty-two patients (11 men/11 women, median age 58 yr) with newly diagnosed posterior laryngitis were enrolled. All had persistent laryngeal symptoms for at least 1 month. An empiric trial of omeprazole at 40 mg q.h.s. was given for 8 wk. Four laryngeal symptoms (hoarseness, throat burning/pain, throat clearing, and cough) and four esophageal symptoms (heartburn, regurgitation, dysphagia, and odynophagia) were scored from 0 to 3. Symptom scores were obtained before, 4 wk after, and 8 wk after the start of omeprazole. Patients were classified as responders if they were symptom free or satisfied with results. Omeprazole was stopped in the responders to look for relapse. Ambulatory pH monitoring was performed in patients who did not respond. Results: One patient discontinued omeprazole and withdrew from the study. In the remaining 21 patients, the total laryngeal and esophageal symptom scores significantly improved after empiric omeprazole. Fourteen patients (67%) were classified as responders. Eight patients (38%) had a relapse when omeprazole was stopped. Six patients (29%), interestingly, did not relapse and did not require long-term antireflux therapy. Seven patients (33%) were classified as nonresponders. Ambulatory pH monitoring was abnormal in four of the five patients who agreed to have this test. Increasing the dose of omeprazole to 40 mg b.i.d. provided no additional benefit in the nonresponders. Conclusions: Empiric omeprazole therapy is a reasonable, initial approach to patients with suspected gastroesophageal reflux-related posterior laryngitis. A significant number of patients do well with a short course of antireflux therapy. Additionally, a third of the patients may not completely respond to intensive medical therapy despite the fact that reflux is documented.

Original languageEnglish (US)
Pages (from-to)2160-2165
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume92
Issue number12
StatePublished - 1997
Externally publishedYes

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Laryngitis
Omeprazole
Prospective Studies
Ambulatory Monitoring
Gastroesophageal Reflux
Pharynx
Recurrence
Therapeutics
Hoarseness
Heartburn

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wo, J., Grist, W. J., Gussack, G., Delgaudio, J. M., & Waring, J. P. (1997). Empiric trial of high-dose omeprazole in patients with posterior laryngitis: A prospective study. American Journal of Gastroenterology, 92(12), 2160-2165.

Empiric trial of high-dose omeprazole in patients with posterior laryngitis : A prospective study. / Wo, John; Grist, W. J.; Gussack, G.; Delgaudio, J. M.; Waring, J. P.

In: American Journal of Gastroenterology, Vol. 92, No. 12, 1997, p. 2160-2165.

Research output: Contribution to journalArticle

Wo, J, Grist, WJ, Gussack, G, Delgaudio, JM & Waring, JP 1997, 'Empiric trial of high-dose omeprazole in patients with posterior laryngitis: A prospective study', American Journal of Gastroenterology, vol. 92, no. 12, pp. 2160-2165.
Wo, John ; Grist, W. J. ; Gussack, G. ; Delgaudio, J. M. ; Waring, J. P. / Empiric trial of high-dose omeprazole in patients with posterior laryngitis : A prospective study. In: American Journal of Gastroenterology. 1997 ; Vol. 92, No. 12. pp. 2160-2165.
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abstract = "The optimal management of patients suspected with gastroesophageal reflux-related posterior laryngitis is unclear. History, physical examination, and ambulatory pH monitoring all have significant limitations in identifying patients who will respond to antireflux therapy. Objective: To evaluate the merit of empiric omeprazole therapy in patients with posterior laryngitis. Methods: Twenty-two patients (11 men/11 women, median age 58 yr) with newly diagnosed posterior laryngitis were enrolled. All had persistent laryngeal symptoms for at least 1 month. An empiric trial of omeprazole at 40 mg q.h.s. was given for 8 wk. Four laryngeal symptoms (hoarseness, throat burning/pain, throat clearing, and cough) and four esophageal symptoms (heartburn, regurgitation, dysphagia, and odynophagia) were scored from 0 to 3. Symptom scores were obtained before, 4 wk after, and 8 wk after the start of omeprazole. Patients were classified as responders if they were symptom free or satisfied with results. Omeprazole was stopped in the responders to look for relapse. Ambulatory pH monitoring was performed in patients who did not respond. Results: One patient discontinued omeprazole and withdrew from the study. In the remaining 21 patients, the total laryngeal and esophageal symptom scores significantly improved after empiric omeprazole. Fourteen patients (67{\%}) were classified as responders. Eight patients (38{\%}) had a relapse when omeprazole was stopped. Six patients (29{\%}), interestingly, did not relapse and did not require long-term antireflux therapy. Seven patients (33{\%}) were classified as nonresponders. Ambulatory pH monitoring was abnormal in four of the five patients who agreed to have this test. Increasing the dose of omeprazole to 40 mg b.i.d. provided no additional benefit in the nonresponders. Conclusions: Empiric omeprazole therapy is a reasonable, initial approach to patients with suspected gastroesophageal reflux-related posterior laryngitis. A significant number of patients do well with a short course of antireflux therapy. Additionally, a third of the patients may not completely respond to intensive medical therapy despite the fact that reflux is documented.",
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N2 - The optimal management of patients suspected with gastroesophageal reflux-related posterior laryngitis is unclear. History, physical examination, and ambulatory pH monitoring all have significant limitations in identifying patients who will respond to antireflux therapy. Objective: To evaluate the merit of empiric omeprazole therapy in patients with posterior laryngitis. Methods: Twenty-two patients (11 men/11 women, median age 58 yr) with newly diagnosed posterior laryngitis were enrolled. All had persistent laryngeal symptoms for at least 1 month. An empiric trial of omeprazole at 40 mg q.h.s. was given for 8 wk. Four laryngeal symptoms (hoarseness, throat burning/pain, throat clearing, and cough) and four esophageal symptoms (heartburn, regurgitation, dysphagia, and odynophagia) were scored from 0 to 3. Symptom scores were obtained before, 4 wk after, and 8 wk after the start of omeprazole. Patients were classified as responders if they were symptom free or satisfied with results. Omeprazole was stopped in the responders to look for relapse. Ambulatory pH monitoring was performed in patients who did not respond. Results: One patient discontinued omeprazole and withdrew from the study. In the remaining 21 patients, the total laryngeal and esophageal symptom scores significantly improved after empiric omeprazole. Fourteen patients (67%) were classified as responders. Eight patients (38%) had a relapse when omeprazole was stopped. Six patients (29%), interestingly, did not relapse and did not require long-term antireflux therapy. Seven patients (33%) were classified as nonresponders. Ambulatory pH monitoring was abnormal in four of the five patients who agreed to have this test. Increasing the dose of omeprazole to 40 mg b.i.d. provided no additional benefit in the nonresponders. Conclusions: Empiric omeprazole therapy is a reasonable, initial approach to patients with suspected gastroesophageal reflux-related posterior laryngitis. A significant number of patients do well with a short course of antireflux therapy. Additionally, a third of the patients may not completely respond to intensive medical therapy despite the fact that reflux is documented.

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