Less nasal resistance, congestion seen after treating laryngopharyngeal reflux

Last Updated: 2017-03-16

By David Douglas

NEW YORK (Reuters Health) - Use of an oral proton pump inhibitor in patients with laryngopharyngeal reflux (LPR), a manifestation of gastroesophageal reflux disease (GERD), is associated with reduced nasal symptoms, according to Turkish researchers.

As Dr. Elif Dagli explained in an email to Reuters Health, he and his colleagues had “observed an improvement in complaints such as fullness in the nose, and postnasal drainage in patients with LPR" after PPI treatment. They conducted the new study to see "if the subjective improvement really correlated with objective findings."

In a paper online March 9 in JAMA Otolaryngology - Head and Neck Surgery, Dr. Dagli of Kecioren Training and Research Hospital in Ankara and colleagues note that it is still unclear whether reflux and nasal diseases are linked.

The team conducted a prospective observational study of 50 patients with LPR and 50 controls with no history of LPR or nasal disease.

The LPR group showed "classic GERD symptoms such as heartburn and regurgitation." They had a Reflux Symptom Index of more than 13 and a Reflux Finding Score higher than 7. They were prescribed pantoprazole 40 mg twice daily for 12 weeks.

Following treatment, the median total nasal resistance (TNR) score in the LPR group fell from 0.29 to 0.19, a significant difference. The median TNR score in the control group was 0.20.

The median Nasal Obstruction Symptom Evaluation (NOSE) score had identical numerical results, falling from 0.29 at baseline to 0.19 after treatment. The median NOSE score in the control group was 0.20.

"The study results showed that patients with LPR had higher nasal resistances and there is a statistically significant decrease in the nasal resistance of patients after treatment,” said Dr. Dagli. “Moreover the nasal resistance levels of patients are the same as controls after treatment."

In an accompanying editorial, Drs. Stacey T. Gray and Ahmad R. Sedaghat of Harvard Medical School in Boston note, "The finding that treatment of LPR with a PPI alone - and no treatment directed at nasal symptoms - was sufficient to reduce nasal obstruction in patients with LPR suggests that LPR at the very least has the ability to contribute to nasal symptoms."

However, they add, "It is not yet clear whether treatment of LPR for nasal obstruction in patients with other comorbid nasal conditions would be beneficial. Given the recent concerns about potential adverse effects of long-term PPI use, these issues need to be further studied before treatment recommendations are made."

Dr. Nicola de Bortoli of the University of Pisa, Italy, who has conducted research in the field, questioned whether the patients in fact did have GERD.

“Lower esophageal sphincter dysfunction does not meet any criteria of GERD diagnosis," she told Reuters Health by email, adding that details of other defining characteristics appear to be lacking.

Dr. de Bortoli also observed that more statistical information should have been provided.

"Regarding symptom perception," she concluded, "it is only perception and the effect of the PPI trial in the LPR group may be due to a placebo effect as well."

SOURCE: http://bit.ly/2nri4as and http://bit.ly/2n369i1

JAMA Otolaryngol Head Neck Surg 2017.