Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

Am J Otolaryngol. Jan-Feb 2018;39(1):50-55. doi: 10.1016/j.amjoto.2017.10.014. Epub 2017 Oct 31.


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 modifications). 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 severity 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 percent of patients with a chief complaint of cough reported improvement and their CSI scores improved significantly 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.

Keywords: Cough; Induction diet; Laryngopharyngeal reflux; Proton pump inhibitors; Reflux symptom index.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • California
  • Cognitive Behavioral Therapy / methods*
  • Cohort Studies
  • Combined Modality Therapy
  • Databases, Factual
  • Diet Therapy / methods*
  • Female
  • Humans
  • Laryngopharyngeal Reflux / diagnosis
  • Laryngopharyngeal Reflux / therapy*
  • Laryngoscopy / methods
  • Male
  • Middle Aged
  • Prognosis
  • Proton Pump Inhibitors / therapeutic use*
  • Quality of Life
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome


  • Proton Pump Inhibitors