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Treatment of postnasal drip with proton pump inhibitors: A prospective, randomized, placebo-controlled study

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Background: Patients commonly present with complaints of postnasal drainage (PND) without objective evidence to support a sinonasal or infectious etiology. PND has been attributed to extra-esophageal reflux (EER), and an empiric trial of antireflux medication often is used to treat PND and associated symptoms. This study was performed to (1) evaluate the relationship between symptoms of EER and PND and (2) assess the efficacy of proton pump inhibitors (PPIs) in the management of PND.

Methods: Patients with a chief complaint of PND without objective evidence of sinonasal inflammatory disease were enrolled in a prospective, double-blinded, randomized placebo-controlled trial using rabeprazole, 20 mg, orally twice daily or placebo for 90 days. Subjects completed two-site 24-hour pharyngeal pH probe monitoring before treatment. Outcome measures included pre- and posttreatment visual analog scales for PND symptoms, reflux symptom index, and reflux finding score (RFS).

Results: Forty-seven patients were enrolled (mean age, 55 years)—21 patients in the PPI group and 26 in the placebo group. Fifty-six percent of subjects had pH probe confirmed EER using a cutoff of pH < 5.0. Baseline symptom measures between subjects with and without EER were not different. Compared with placebo, subjects receiving rabeprazole reported significant reduction in PND frequency (p = 0.0180), hoarseness (p = 0.0164), and chronic cough (p = 0.0204). The RFS decreased slightly in the placebo group (p = 0.1490) whereas it increased slightly in the PPI group (p = 0.5235). This difference between groups was significant (p = 0.0272).

Conclusion: Although 50% of subjects had evidence of EER, there was no difference in baseline symptoms between subjects with and without. Our findings support the potential benefit of PPI therapy for reducing PND frequency, hoarseness, and chronic cough, and confirm a placebo effect for other laryngopharyngeal reflux symptoms. The effect on laryngeal findings is mixed and patients may experience symptomatic improvement before changes in laryngoscopic appearance.
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Keywords: Extra-esophageal reflux; gastro-esophageal reflux; pepsin; postnasal drip; proton pump inhibitors; reflux; reflux finding score; reflux symptom index

Document Type: Research Article

Affiliations: 1: Medical College of Wisconsin, Milwaukee Wisconsin 2: Department of Biostatistics, Medical College of Wisconsin, Milwaukee Wisconsin 3: Department of Otolaryngology–Head and Neck Surgery, Louisiana State University, Shreveport, Louisiana 4: Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland Oregon 5: Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Washington 6: Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, Wisconsin

Publication date: 2007-11-01

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