The bottom line may be to treat patients with LPR with the same approach now recommended for patients with chronic sinusitis and antibiotics: Assess the situation for whether the medication is needed, prescribe when symptoms truly warrant it, and provide an endpoint where possible once symptoms have resolved.
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October 2016Overall, PPIs are considered very safe medications,” said Dr. O’Dell, “but because of those potential side effects I think if patients don’t need to be on the medication long term, it’s better to wean them off of it.”
Amy E. Hamaker is a freelance medical writer based in California.
Common Adverse Effects of PPIs
- Headache
- Nausea
- Diarrhea
- Abdominal pain
- Fatigue
For Further Reading: Abstracts from The Laryngoscope
pH Impedance and high-res manometry in LPR disease high-dose pPI failures
Objectives: Laryngopharyngeal reflux disease (LPRD) patients often fail empiric treatment with high-dose, twice-daily (BID) proton pump inhibitors (PPIs). Further testing is warranted to rule in or out nonacid reflux (NAR) or breakthrough acid reflux (BAR) as the etiology of the symptoms. Results of coordinated multichannel intraluminal pH impedance (MII) and high-resolution esophageal manometry (HRM) testing while patients are on high-dose BID PPIs is lacking in the LPRD population. The objective of this study is to evaluate if coordinated MII and HRM aid in the management of patients with persistent LPRD symptoms despite high dose BID PPIs.
Methods: MII and HRM were administered while on medication to 23 persistent LPRD subjects who had failed three months of high-dose BID PPIs. Number and pH of total and proximal reflux episodes, DeMeester score, reflux symptom correlation, and motility/physiology findings were recorded. Subjects were grouped into significant NAR, BAR, or nonsignificant NAR.
Results: Fifty-two percent of subjects had significant NAR and 22% had BAR despite high-dose BID PPIs. Statistically significant differences were found between groups for the MII outcomes of DeMeester score, number of total and proximal reflux events, and nonacid reflux events. HRM demonstrated dysmotility in five subjects.
Conclusions: For recalcitrant LPRD subjects who fail empiric high-dose BID PPI therapy, this study demonstrated significant NAR or BAR in 74% of subjects. Evaluation by MII and HRM performed on PPI therapy proved useful for diagnosis and further management (Laryngoscope. 2012;122:2473-2481).
Effect of PPI Pantoprazole on Growth and Morphology of Oral Lactobacillus Strains
Objectives: Proton pump inhibitors (PPI) used to suppress acid secretion in the stomach are among the most widely prescribed medications. There is emerging evidence of proton secretion elsewhere in the aerodigestive tract, and acidic microenvironments are integral to oral flora such as Lactobacillus. The hypothesis of this study is that the growth rate and morphology of oral Lactobacillus strains are effected by PPIs.