PMID- 27091320 OWN - NLM STAT- MEDLINE DCOM- 20170612 LR - 20190320 IS - 1572-0241 (Electronic) IS - 0002-9270 (Print) IS - 0002-9270 (Linking) VI - 111 IP - 11 DP - 2016 Nov TI - Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms. PG - 1517-1524 LID - 10.1038/ajg.2016.145 [doi] AB - OBJECTIVES: Predicting response to proton pump inhibitor (PPI) therapy in patients with laryngeal symptoms is challenging. The Restech Dx-pH probe is a transnasal catheter that measures oropharyngeal pH. In this study, we aimed to investigate the prognostic potential of oropharyngeal pH monitoring to predict responsiveness to PPI therapy in patients with laryngeal symptoms. METHODS: We conducted a physician-blinded prospective cohort study at a single academic institution between January 2013 and October 2014. Adult patients with Reflux Symptom Index scores (RSI) >/=13 off PPI therapy were recruited. Patients underwent video laryngoscopy and 24-h oropharyngeal pH monitoring, followed by an 8- to 12-week trial of omeprazole 40 mg daily. Prior to and following PPI therapy, patients completed various symptom questionnaires. The primary outcome was the association between PPI response and oropharyngeal pH metrics. PPI response was separated into three subgroups based on the post-treatment RSI score and % RSI response: non-response=RSI >/=13; partial response=post-treatment RSI <13 and change in RSI <50%; and complete response=post-treatment RSI <13 and change in RSI >/=50%. The primary analysis utilized a multinomial logistic regression controlling for the pre-treatment RSI score. A secondary analysis assessed the relationship between the change in RSI (post-pre) and oropharyngeal pH metrics via ordinary least square regression. RESULTS: Thirty-four patients completed the study and were included in final analysis. Symptom response to PPI therapy was as follows: 50% no response, 15% partial response, and 35% complete response. Non-responders had a higher pre-treatment RSI (P<0.01). There were no significant differences in oropharyngeal acid exposure (below pH of 4.0, 5.0, 5.5, 6.0, and RYAN scores) between responder types. The secondary analysis noted a trend between lower PPI response and a greater total percent time below pH of 5.0 (P=0.03), upright percent time below pH of 5.0 (P=0.07), and RYAN supine (corrected; P=0.03), as well as an association between PPI response and greater decreases in the Anxiety Sensitivity Inventory (P<0.01), Brief Symptom Inventory-18 (P<0.01), and Negative Affect Scale (P<0.01). CONCLUSIONS: Oropharyngeal pH testing did not predict laryngeal symptom response to PPI therapy. Contrary to hypothesis, our study signaled that the degree of oropharyngeal acid exposure is inversely related to PPI response. In addition, reduction in negative affect and psychological distress parallels PPI response. FAU - Yadlapati, Rena AU - Yadlapati R AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Pandolfino, John E AU - Pandolfino JE AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Lidder, Alcina K AU - Lidder AK AD - University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA. FAU - Shabeeb, Nadine AU - Shabeeb N AD - University of Indiana School of Medicine, Indianapolis, Indiana, USA. FAU - Jaiyeola, Diana-Marie AU - Jaiyeola DM AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Adkins, Christopher AU - Adkins C AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Agrawal, Neelima AU - Agrawal N AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Cooper, Andrew AU - Cooper A AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Price, Caroline P E AU - Price CP AD - Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Ciolino, Jody D AU - Ciolino JD AD - Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Gawron, Andrew J AU - Gawron AJ AD - Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA. FAU - Smith, Stephanie S AU - Smith SS AD - Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Bove, Michiel AU - Bove M AD - Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Tan, Bruce K AU - Tan BK AD - Division of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. LA - eng GR - K12 HS023011/HS/AHRQ HHS/United States GR - T32 DK101363/DK/NIDDK NIH HHS/United States GR - UL1 TR001422/TR/NCATS NIH HHS/United States PT - Journal Article PT - Observational Study DEP - 20160419 PL - United States TA - Am J Gastroenterol JT - The American journal of gastroenterology JID - 0421030 RN - 0 (Proton Pump Inhibitors) RN - KG60484QX9 (Omeprazole) SB - IM CIN - Am J Gastroenterol. 2016 Nov;111(11):1525-1527. PMID: 27808149 CIN - Am J Gastroenterol. 2017 May;112(5):812-813. PMID: 28469219 CIN - Am J Gastroenterol. 2017 May;112(5):811-812. PMID: 28469223 CIN - Z Gastroenterol. 2018 Aug;56(8):967-969. PMID: 30103229 MH - Adult MH - Chronic Disease MH - Cohort Studies MH - Cough/etiology MH - Deglutition Disorders/etiology MH - Female MH - Hoarseness/etiology MH - Humans MH - *Hydrogen-Ion Concentration MH - Laryngopharyngeal Reflux/complications/diagnosis/*drug therapy MH - Laryngoscopy MH - Logistic Models MH - Male MH - Middle Aged MH - Omeprazole/*therapeutic use MH - *Oropharynx MH - Pharyngitis/etiology MH - Prospective Studies MH - Proton Pump Inhibitors/*therapeutic use MH - Treatment Outcome PMC - PMC5071144 MID - NIHMS809451 COIS- Disclosures/Conflicts of Interest: The authors do not have any disclosures or potential conflicts of interest EDAT- 2016/11/04 06:00 MHDA- 2019/03/21 06:00 PMCR- 2017/02/01 CRDT- 2016/04/20 06:00 PHST- 2016/01/01 00:00 [received] PHST- 2016/03/01 00:00 [accepted] PHST- 2016/11/04 06:00 [pubmed] PHST- 2019/03/21 06:00 [medline] PHST- 2016/04/20 06:00 [entrez] PHST- 2017/02/01 00:00 [pmc-release] AID - ajg2016145 [pii] AID - 10.1038/ajg.2016.145 [doi] PST - ppublish SO - Am J Gastroenterol. 2016 Nov;111(11):1517-1524. doi: 10.1038/ajg.2016.145. Epub 2016 Apr 19.