Clin Exp Otorhinolaryngol.  2023 Aug;16(3):259-274. 10.21053/ceo.2023.00409.

Predictors of Early and Late Response to Esomezol and Lifestyle Modification in Adults With Laryngopharyngeal Reflux Disease: A Prospective, Multicenter, Open-Label Cohort Study

• Kwon SK
• Park SJ
• Chung EJ
• Sohn JH
• Sun DI
• Jin SM
• Lee BJ
• Park IS
• Cho JG
• Park YH

• KMID: 2545265
• DOI: http://doi.org/10.21053/ceo.2023.00409

Abstract

Objectives
. This study aimed to assess predictors of the response to varying durations of proton pump inhibitor (PPI) use and lifestyle modification treatment for laryngopharyngeal reflux disease (LPRD).
Methods
. Between October 2014 and June 2016, a prospective, multicenter, open-label, single-cohort, intention-to-treat, observational study was conducted at eight referral hospitals across the Republic of Korea to examine predictors of early and late response to treatment in adult patients (age ≥19 years) with LPRD. Participants underwent standard treatment (PPI [Esomezol] and lifestyle modification) for 3 months. Response to treatment was defined as greater than 50% improvement in reflux symptom index score. The primary outcome was potential predictors of treatment response at 1 and 3 months. The secondary outcome was potential predictors distinguishing early from late responders.
Results
. In total, 394 patients were enrolled. Improved sleep habits was a positive predictor (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.06–3.007; P=0.029), while initial alcohol consumption (OR, 0.587; 95% CI, 0.355–0.969; P=0.037) and past medication history (OR, 0.438; 95% CI, 0.215–0.891; P=0.005) were negative predictors of response after 1 month of treatment. High pre-reflux finding score was a positive predictor (OR, 1.187; 95% CI, 1.049– 1.344; P=0.007), while male sex (OR, 0.516; 95% CI, 0.269–0.987; P=0.046), higher depression score (OR, 0.867; 95% CI, 0.784–0.958; P=0.005), and past thyroid hormone medication history (OR, 0.161; 95% CI, 0.033–0.788; P=0.024) were negative predictors of response after 3 months of treatment. Past medication history (OR, 0.438; 95% CI, 0.215–0.891; P=0.023) was the only negative predictor for early responders compared to late responders.
Conclusion
. Adult patients with LPRD and a history of prior medication use may require longer treatment durations to achieve a therapeutic response. Future research should explore the incorporation of diverse treatment approaches to improve treatment outcomes for patients exhibiting negative prognostic indicators.

Keyword

Laryngopharyngeal Reflux; Proton Pump Inhibitors; Life Style Modification; Predictive Factor; Patient Compliance; Patient Medical History; Medication History

Figure

• 

  Fig. 1. Detailed information on recruitment and participant flow. During the study period, 394 participants were enrolled. However, 106 participants had dropped out by the 1-month follow-up, and an additional 51 participants had dropped out by the 3-month follow-up. Therefore, data on 288 participants were utilized for predictor analysis of early response to treatment after 1 month, and data on 237 participants were utilized for predictor analysis of overall response to treatment after 3 months, as well as for predicting early responders compared to late responders. LPRD, laryngopharyngeal reflux disease.

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