Lansoprazole Treatment of Patients for Chronic Idiopathic Laryngitis
Source: El-Serag HB, et al. Am J Gastroenterol. 2001;96:979-983.
Many physicians accept the notion that gastroesophageal reflux disease (GERD) can underlie a number of extraesophageal syndromes, including laryngitis. Epidemiological data support this concept in a Veterans Administration setting with a high prevalence of laryngeal disorders associated with the diagnosis of erosive esophagitis.1 Additionally, it is widely taught that patients with GERD-related laryngitis often do not have heartburn or erosive esophagitis. It seems reasonable that anti-reflux treatment might be beneficial for treatment of reflux-related laryngitis. However, up to now, no controlled studies have assessed the value of such treatment. This paper describes 22 patients with symptoms and laryngoscopic signs of chronic laryngitis receiving either lansoprazole 30 mg bid or placebo for 3 months. Some had heartburn and some did not. Only a few had erosive esophagitis (3 on lansoprazole and 1 receiving placebo). Twenty patients completed the study (11 on lansoprazole, 9 on placebo). Of lansoprazole recipients, 58% had complete or partial resolution of laryngeal findings vs. 30% of those on placebo (NS). However, lansoprazole led to symptom relief in 55% vs. only 1 patient (11%) on placebo. Initial diagnostic test results such as pH exposure did not predict response. It is suggested that these results support empirical treatment of suspected GERD-related laryngitis with aggressive acid suppressive therapy.
Comment by Malcolm Robinson, MD, FACP, FACG
This study is far too small and too heterogeneous to answer any basic questions regarding the proper evaluation, identification, or treatment of patients suspected to have GERD-related laryngitis. Nevertheless, I would agree with El-Serag and Sonnenburg that laryngitis might be related to proximal esophageal reflux. If so, it should respond to acid suppression. As this paper also comments, further larger studies should be undertaken to help define the appropriate identification of patients most likely to respond to such management. At present, there is still little justification for large-scale use of empirical aggressive antisecretory treatment for primary care patients presenting with unexplained chronic laryngitis.
Dr. Robinson is Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine Oklahoma City, Okla.
1. El-Serag HB, Sonnenburg A. Gastroenterology. 1997;113:755-760.