PILOT-STUDY OF THE ORAL OMEPRAZOLE TEST FOR REFLUX LARYNGITIS

BACKGROUND: Gastroesophageal reflux disease occasionally presents with laryngeal symptoms. Such patients are often referred for a gastroente rology evaluation. This study was designed to determine whether an emp iric trial of high-dose omeprazole therapy could reliably identify pat ients with reflux laryngitis and thus obviate the need for a gastroent erology workup. METHODS: Patients were evaluated with a history, physi cal examination, esophageal manometry, upper endoscopy and 24-hour pH- metry for determination of the presence or absence of underlying gastr oesophageal reflux disease and then received an empiric trial of oral omeprazole therapy (20 mg twice daily for 1 month). A positive omepraz ole test result was defined as resolution of all laryngeal symptoms on completion of the empiric trial of therapy, RESULTS: Two patients wer e classified as having no reflux, and eight were classified as having reflux. Omeprazole test results were positive in six patients. Five of six had reflux, but one patient had no evidence for reflux, Omeprazol e test results were negative in four patients. Three of four had reflu x, and one did not. Despite the absence of antisecretory therapy, lary ngeal symptoms did not recur in either patient without reflux during f ollow-up. Laryngeal symptoms were managed in two of the three patients with reflux who had negative omeprazole test results and who were usi ng inhalers in combination with histamine H-2 receptor antagonist ther apy for their reflux disease. One patient with reflux who had a negati ve omeprazole test result responded to higher doses of omeprazole, and the five patients with reflux who had positive omeprazole test result s all responded to continuation of omeprazole. CONCLUSIONS: The omepra zole test may be useful in confirming the suspicion of reflux laryngit is in patients suspected of having this disease after an otolaryngolog y evaluation. However, there is a potential for false-positive and fal se-negative test results. A gastroenterology evaluation may aid in the identification of false-positive test results by documenting the abse nce of reflux in certain responders.