Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications ☆ Jin Yang a, ⁎, Salem Dehom b , Stephanie Sanders a , Thomas Murry c , Priya Krishna c , Brianna K. Crawley c a Loma Linda University School of Medicine, Loma Linda, CA, USA b Loma Linda University School of Public Health, Loma Linda, CA, USA c Voice and Swallowing Center-Loma Linda University Medical Center, Loma Linda, CA, USA abstract article info Article history: Received 3 September 2017 Available online xxxx Objective: To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone. Study design: Retrospective study. Setting: Tertiary care academic center. Subjects and methods: A database was populated with patients treated for LPR. Patients were included in the study group if they completed a two-week anti-reflux program (diet, alkaline water, medications, behavioral modifica- tions). Patients were included in the control group if they completed anti-reflux medications and behavioral modifications only. Patients completed the voice handicap index (VHI), reflux symptom index (RSI), cough se- verity index (CSI), dyspnea index (DI) and eating assessment tool (EAT-10) surveys and underwent laryngoscopy for examination and reflux finding score (RFS) quantification. Results: Of 105 study group patients, 96 (91%) reported subjective improvement in their LPR symptoms after an average 32-day first follow-up and their RSI and CSI scores improved significantly. No significant differences were found in VHI, DI, or EAT-10 scores. Fifteen study patients who had previously failed adequate high-dose medication trials reported improvement and their CSI and EAT-10 scores improved significantly. Ninety-five per- cent of patients with a chief complaint of cough reported improvement and their CSI scores improved significant- ly from 12.3 to 8.2. Among 81 controls, only 39 (48%) patients reported improvement after an average 62-day first follow-up. Their RSI scores did not significantly change. Conclusion: The anti-reflux program yielded rapid and substantial results for a large cohort of patients with LPR. It compared favorably with medication and behavioral modification alone. It was effective in improving cough and treating patients who had previously failed medications alone. © 2017 Published by Elsevier Inc. Keywords: Laryngopharyngeal reflux Cough Induction diet Proton pump inhibitors Reflux symptom index 1. Introduction The diagnosis of laryngopharyngeal reflux (LPR) is common in clin- ical practice. It was reported to be present in N 50% of patients with la- ryngeal complaints at an academic voice center [1]. In a recent survey, N 60% of a community-dwelling population had either GERD or laryn- geal symptoms and N 20% had both [2]. Symptoms caused by LPR in- clude chronic cough, dysphonia, dysphagia, post-nasal drip, globus, constant throat clearing, laryngospasm and a multitude of other extraesophageal maladies [3,4]. Empiric treatment of LPR with antireflux medication such as proton pump inhibitors (PPI) has increased in popularity over the past twenty years. Between 1990 and 2001, PPI prescription increased 14 fold, ac- counting for a significant percentage of healthcare costs [5,6]. A typical treatment for LPR in clinical practice is a course of twice daily PPI for at least 2 months [7]. Many studies have supported the effectiveness of PPIs in treating LPR-related symptoms. One meta-analysis of random- ized controlled trials showed that patients treated with a PPI had a sig- nificantly higher response rate and reflux symptom index (RSI) improvement than those who received placebo [8]. In a study by Jin et al., treatment with PPIs improved objective voice measures including jitter, shimmer, and harmonic-to-noise ratio after 1–2 months treat- ment, and maintained results even after 3–4 months [9]. Most studies agree that patients must continue their medication regimen for at least 2–6 months to achieve reduction in symptoms. However, these studies have been contradicted by others in the literature due to dis- crepancies in method of diagnosis, contributing factors, management regimens, and outcome measures that are often subjective and vary widely. American Journal of Otolaryngology–Head and Neck Medicine and Surgery xxx (2017) xxx–xxx ☆ Presented at Western Medical Research Conference, Carmel, California, USA on Jan. 27, 2017. ⁎ Corresponding author. E-mail address: jiyang@llu.edu (J. Yang). YAJOT-01923; No of Pages 6 https://doi.org/10.1016/j.amjoto.2017.10.014 0196-0709/© 2017 Published by Elsevier Inc. Contents lists available at ScienceDirect American Journal of Otolaryngology–Head and Neck Medicine and Surgery journal homepage: www.elsevier.com/locate/amjoto Please cite this article as: Yang J, et al, Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications, American Journal of Otolaryngology–Head and Neck Medicine and Surgery (2017), https://doi.org/10.1016/j.amjoto.2017.10.014