PMID- 15128336
OWN - NLM
STAT- MEDLINE
DCOM- 20040618
LR  - 20131121
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 99
IP  - 5
DP  - 2004 May
TI  - Predictors of outcome in an open label, therapeutic trial of high-dose omeprazole 
      in laryngitis.
PG  - 777-85
AB  - BACKGROUND: Gastroesophageal reflux is implicated in some cases of laryngitis. 
      There are no established predictors of response to acid suppression therapy in 
      suspected reflux laryngitis. AIM: In a population with laryngitis, the aim is to 
      determine whether (a) omeprazole 20 mg tds (3 months) improves symptoms and 
      laryngitis, and (b) the outcome in response to potent acid suppression can be 
      predicted by esophageal and/or pharyngeal parameters during ambulatory pH 
      monitoring or by other pretreatment variables. METHODS: From the 70 consecutive 
      patients with laryngitis screened, 20 patients met the inclusion criteria 
      (dysphonia >3 months; laryngoscopically demonstrated laryngitis); and 50 patients 
      were excluded because of one or more criteria indicating alternative causes for 
      laryngeal injury. The primary outcome measure was improvement of at least one 
      level in a 4-point laryngitis grading at 3 months. Twenty-four-hour dual, 
      pharyngo-esophageal pH monitoring was performed at baseline. Secondary outcomes 
      (symptom questionnaire; computerized voice analysis) were measured at baseline, 
      and at 6 and 12 wk. RESULTS: Response rates at 6 and 12 wk were 47% and 63%, 
      respectively. GERD symptoms (heartburn (p= 0.03) and regurgitation (p= 0.0001)) 
      improved. However, neither baseline GERD symptoms nor endoscopic findings 
      predicted laryngoscopic or symptomatic response. Neither baseline laryngitis 
      grade (p= 0.46) nor esophageal acid exposure on pH testing (p= 0.3) predicted 
      outcome. Four of 20 patients demonstrated pharyngeal regurgitation on pH testing, 
      all four of whom responded to potent acid suppression (p= 0.2). Computerized 
      voice measures were not predictive of outcome, although fundamental frequency 
      (Fo) was inversely related to baseline laryngoscopic grade. CONCLUSION: In a 
      carefully defined population of patients with laryngitis (a) 63% have a 
      laryngoscopic response to 3 months of potent acid suppression without significant 
      improvement in laryngeal symptoms; (b) neither voice measures, esophageal acid 
      exposure time, symptoms nor severity of laryngitis predict outcome; and (c) 
      although numbers were small, all patients with a positive pharyngeal pH study 
      responded to therapy and pharyngeal pH-metry may prove useful; (4) available 
      evidence supports an empiric trial of high-dose proton pump inhibitors (PPI), for 
      at least 12 wk, as the initial diagnostic step for suspected reflux laryngitis.
FAU - Williams, R B H
AU  - Williams RB
AD  - Department of Gastroenterology, St George Hospital, University of New South 
      Wales, Sydney, Australia.
FAU - Szczesniak, M M
AU  - Szczesniak MM
FAU - Maclean, J C
AU  - Maclean JC
FAU - Brake, H M
AU  - Brake HM
FAU - Cole, I E
AU  - Cole IE
FAU - Cook, I J
AU  - Cook IJ
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - KG60484QX9 (Omeprazole)
SB  - IM
CIN - Am J Gastroenterol. 2004 May;99(5):786-8. PMID: 15128337
MH  - Administration, Oral
MH  - Adult
MH  - Aged
MH  - Analysis of Variance
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Follow-Up Studies
MH  - Gastroesophageal Reflux/*complications
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Laryngitis/diagnosis/*drug therapy/*etiology
MH  - Laryngoscopy/methods
MH  - Male
MH  - Middle Aged
MH  - Observer Variation
MH  - Omeprazole/*administration & dosage
MH  - Predictive Value of Tests
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Single-Blind Method
MH  - Treatment Outcome
EDAT- 2004/05/07 05:00
MHDA- 2004/06/24 05:00
CRDT- 2004/05/07 05:00
PHST- 2004/05/07 05:00 [pubmed]
PHST- 2004/06/24 05:00 [medline]
PHST- 2004/05/07 05:00 [entrez]
AID - AJG4151 [pii]
AID - 10.1111/j.1572-0241.2004.04151.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2004 May;99(5):777-85. doi: 10.1111/j.1572-0241.2004.04151.x.