Why do Proton Pump Inhibitors get used for LPR?

Before the midnight service last week I was sat talking to a relation of one of one of the sides people who was staying over Christmas and had come along to the service. As is often the case we got onto my ongoing medical issues – it often comes up when they find out that I’m usually in the choir and ask why I’m not at whatever service it is we’re attending. This time the conversation was more interesting because the person I was speaking to was from a medical background.

First off she hadn’t heard of laryngopharyngeal reflux, so I explained what my symptoms were and what had been diagnosed, we then got onto the treatment I was on, in this case 30mg of Lansoprazole daily. Although she didn’t say it outright, she seemed somewhat concerned at the fact it had been prescribed, and also how long I had been taking it.

Anyway, after that I’ve had a bit of a look at some of the discussion about the use of Lansoprazole, and Proton Pump Inhibitors in general for the treatment of laryngopharyngeal reflux.

Probably the most interesting is one that comes up in Google pretty easily, a paper written by Christina Reimer and Peter Bytzer of the Department of Medical Gastroenterology, Køge University Hospital, Denmark entitled “Management of laryngopharyngeal reflux with proton pump inhibitors”. The interesting part is when it gets on to reviewing the number of medical trials, in particular the double blind studies, the first paragraph of their summary makes the point pretty clearly:

Data from controlled treatment trials convincingly show that PPI therapy is no more effective than placebo in producing symptom relief in patients suspected of laryngo-pharyngeal reflux disease. Furthermore, neither symptoms, nor laryngoscopic findings or abnormal findings on pH monitoring will predict response to PPI therapy. A reliable diagnostic test for LPR or one that might predict response to a PPI does not exist.

When you actually look at the figures, in some of the trials the placebo group had a greater symptom relief than those on the drugs, and of the studies reviewed only one showed a statistically significant higher rate for the group taking the drug. As the paper says, given these results, why do patients still get put on a PPI as a first course of action?

Certainly that was what happened in my case, and I’ve been on it since September, more than three months. Both my ENT and my GP have very matter-of-factly suggested that I could be on them long term if when I come off them symptoms return – this then was rather interesting when I pointed out to the GP that there is a well known (though not to him it seems) rebound effect from PPI use.

In my case, although it changed what was happening, the Lansoprazole certainly didn’t stop me refluxing, if anything I was refluxing more, and pretty consistently over the past couple of weeks within an hour or so of taking the pill. Since my throat has apparently healed the thought was that it changed the pH of what was refluxing, without actually addressing the underlying problem of what was causing me to reflux. Anyway, the latest run of pills finished over the holiday, and since my ENT has now declared that I am better I’ve tried coming off the Lansoprazole, and thus far I’ve not had any real problems, indeed although there have only been a couple of repeats of the nasty tasting reflux the pill used to induce they have been less than I was getting. It’s just a question now of waiting for my digestive system to recover from the long term effects of the PPI…

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