Treatment for Laryngopharyngeal Reflux Disease: A Systematic Review of Controlled Studies

Importance Proton pump inhibitors (PPIs) do not demonstrate superiority over placebo in laryngopharyngeal reflux disease (LPRD). While poorly used, many alternative medical treatments exist for controlling the gastroduodenal and gastro-pharyngeal reflux processes. Objective To investigate the clinical findings of controlled studies comparing therapeutic regimens for treating LPRD. Design PubMED, Scopus, and Cochrane Library systematic review without meta-analysis using the PRISMA statements. Setting Review of prospective or retrospective cohort studies comparing 2 medical regimens in patients with suspected or confirmed LPRD. Participants Patients with suspected or confirmed LPRD. Intervention Comparison of PPI therapy to other therapeutic regimens for LPRD. Outcomes Symptom, sign changes, and therapeutic responses were considered from pre- to posttreatment. Bias analysis was conducted with Methodological Index for Non-Randomized Studies (MINORS). Implications for practice were summarized with a focus on the pharmacological and biological findings of all drug classes in the LPRD pathophysiology. Results Fourteen studies met the inclusion criteria, including 1269 patients. There were 675 females (59.6%) and 458 males (40.4%). The mean age of patients was 49.1 years. Substantial variability was observed among studies regarding both pharmacological interventions and participant selection criteria. Two of the four comparative studies demonstrated superior therapeutic efficacy with prokinetic-PPI combination therapy compared with PPI monotherapy. The alginate-PPI combination yielded enhanced symptom amelioration compared with PPI alone. The mean MINORS score of 9.1 ± 1.2 indicated an important heterogeneity between randomized and non-randomized controlled studies for inclusion and exclusion criteria, LPRD diagnosis, therapeutic regimens, and outcomes. Recommendations are provided for future randomized controlled studies. Conclusion To date, only a few studies investigated the effectiveness of alternative medications to PPIs in the treatment for LPRD, which represents an important gap with the gastroesophageal reflux disease literature. Although the limited number of studies and their heterogeneity preclude definitive conclusions, the preliminary findings from this review support the need for future randomized controlled trials examining the therapeutic potential of alginates and prokinetics in patients with primary or refractory LPRD.