Presumed laryngo-pharyngeal reflux: investigate or treat?

A review of a combined gastroenterology and laryngology clinic was conducte d to determine the effectiveness of treatment and the predictive value of c linical findings and investigations. Data were collected prospectively. Investigations were performed according to clinical criteria. Patients with symptoms suspected to be due to laryngo pharyngeal reflux (based on a positive oesophageal pH test and/or changes o n videolaryngoscopy consistent with posterior laryngitis) were treated with omeprazole for at least two to three months, There were 87 patients; the most common symptoms were cough (38 per cent) a nd hoarseness (36 per cent); 77 per cent had some symptoms suggestive of ga stro-oesophageal reflux. Sixty-seven patients were given omeprazole. A good response to laryngo-pharyngeal symptoms was seen in 37 patients (55 per ce nt). The presence of reflux symptoms was nor a predictor of a good response . Increasing severity of oesophageal acid exposure over the 24 hours of pH testing was associated with a better symptom response (Spearman rank correl ation, p = 0.01), Posterior laryngitis was not associated with the response to treatment, although there was a trend towards an association between im provement in laryngitis (after treatment) and improvement in symptoms (p = 0.08). The response to proton pump inhibitors was lower than other published resul ts. Oesophageal pH monitoring may have a role in predicting which patients will respond to proton pump inhibitors. This study does not support the dec ision to treat with anti-secretory therapy, based only on the presence of p osterior laryngitis.