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11 results

  • Can vocal process granuloma location forecast the efficacy of anti-reflux treatment?

  • J Ding, Z Lou
  • Journal:
    The Journal of Laryngology & Otology / Volume 137 / Issue 2 / February 2023
    Published online by Cambridge University Press:
    09 February 2022, pp. 178-185
    Print publication:
    February 2023
    • Article
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  • Objective

    The objective of this study was to evaluate the efficacy of anti-reflux therapy on the idiopathic vocal process granulomas.

    Method

    This was a prospective case series study. The patients with vocal process granulomas who met the inclusion criteria were analysed. Proton pump inhibitors and vocal hygiene education were conducted for 8–20 weeks.

    Results

    Of the 16 patients with vocal process granulomas, 5 (31.25 per cent) patients achieved complete remission. The complete remission rate of granulomas was not significantly related to age (p = 1.000), sex (p = 0.296), side (p = 0.299), position (p = 0.100), endoscopic morphology (p = 0.263) or proton pump inhibitor treatment course (p = 0.543) but was significantly associated with granuloma location (p = 0.001) and granuloma size (p = 0.012).

    Conclusion

    Granulomas in the vocal cord and the margin of the vocal process had an excellent response to proton pump inhibitors, but granulomas on the surface of vocal process and arytenoid cartilage body had little response to proton pump inhibitors. The prolonged period of proton pump inhibitor treatment did not increase the complete remission rate of vocal process granulomas.

  • Genetic and drug-induced hypomagnesemia: different cause, same mechanism

  • Part of
  • Willem Bosman, Joost G. J. Hoenderop, Jeroen H. F. de Baaij
  • Journal:
    Proceedings of the Nutrition Society / Volume 80 / Issue 3 / August 2021
    Published online by Cambridge University Press:
    28 April 2021, pp. 327-338
    • Article
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      • Open access
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  • Magnesium (Mg2+) plays an essential role in many biological processes. Mg2+ deficiency is therefore associated with a wide range of clinical effects including muscle cramps, fatigue, seizures and arrhythmias. To maintain sufficient Mg2+ levels, (re)absorption of Mg2+ in the intestine and kidney is tightly regulated. Genetic defects that disturb Mg2+ uptake pathways, as well as drugs interfering with Mg2+ (re)absorption cause hypomagnesemia. The aim of this review is to provide an overview of the molecular mechanisms underlying genetic and drug-induced Mg2+ deficiencies. This leads to the identification of four main mechanisms that are affected by hypomagnesemia-causing mutations or drugs: luminal transient receptor potential melastatin type 6/7-mediated Mg2+ uptake, paracellular Mg2+ reabsorption in the thick ascending limb of Henle's loop, structural integrity of the distal convoluted tubule and Na+-dependent Mg2+ extrusion driven by the Na+/K+-ATPase. Our analysis demonstrates that genetic and drug-induced causes of hypomagnesemia share common molecular mechanisms. Targeting these shared pathways can lead to novel treatment options for patients with hypomagnesemia.

  • Proton pump inhibitors as a risk factor for norovirus infection

  • C. PRAG, M. PRAG, H. FREDLUND
  • Journal:
    Epidemiology & Infection / Volume 145 / Issue 8 / June 2017
    Published online by Cambridge University Press:
    22 March 2017, pp. 1617-1623
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      • Open access
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  • Norovirus causes viral gastroenteritis, which is a major problem in health care. The disease causes death in elderly and seriously ill patients, and results in significant health costs each year. Proton pump inhibitors (PPIs) reduce gastric acidity, which is an important protection against microorganisms. We hypothesised that treatment with PPIs increases the risk of contracting norovirus infection. This has not previously been studied. The study was a retrospective case–control study, in which 192 hospitalised patients positive for norovirus in Örebro County, Sweden, were identified as cases. For each case, a hospitalised patient who did not have the infection was selected as a control, and matched with respect to ward, gender, admission date and age. Details of exposure, i.e. treatment with PPIs, were retrieved from the patient records. Odds ratio (OR) with confidence intervals (CIs) and P-values were calculated using McNemar's test. There was a significantly increased risk of norovirus infection in patients treated with PPIs compared with patients without PPI treatment (OR 1·73, 95% CI 1·07–2·81; P = 0·02). PPIs appear to be a risk factor for norovirus infection, and our results motivate future studies to further examine this association.

  • The effect of anti-reflux treatment on subjective voice measurements of patients with laryngopharyngeal reflux

  • T J Beech, G Campbell, A L McDermott, A J Batch
  • Journal:
    The Journal of Laryngology & Otology / Volume 127 / Issue 6 / June 2013
    Published online by Cambridge University Press:
    03 May 2013, pp. 590-594
    Print publication:
    June 2013
  • Objective:

    To assess the impact of anti-reflux treatment and speech therapy on subjective voice measurements of patients with laryngopharyngeal reflux.

    Methods:

    This paper reports a prospective study of patients seen in a voice clinic over a three-year period who were being treated for laryngopharyngeal reflux. Patients were assessed at presentation using the reflux symptom index and voice symptom scale, and were reassessed at three months and six months post-treatment. Treatment entailed twice daily proton pump inhibitor therapy and speech therapy.

    Results:

    The study comprised 74 patients. The reflux symptom index and voice symptom scale scores significantly improved following treatment at both three and six months. There was a correlation between improved reflux symptom index scores and improved voice symptom scale scores.

    Conclusion:

    Treatment of laryngopharyngeal reflux with twice daily proton pump inhibitors and speech therapy resulted in improved subjective voice measurements for patients.

  • Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux

  • M Masaany, M B Marina, W P Sharifa Ezat, A Sani
  • Journal:
    The Journal of Laryngology & Otology / Volume 125 / Issue 5 / May 2011
    Published online by Cambridge University Press:
    28 February 2011, pp. 502-508
    Print publication:
    May 2011
  • Objective:

    To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.

    Study design:

    This was a prospective, double-blind study.

    Subjects and methods:

    Fifty-five patients with either a Reflux Symptom Index of more than 13 or a Reflux Finding Score of more than 7 were enrolled. All patients underwent 24-hour, double-probe pH monitoring before commencing pantoprazole 40 mg twice daily; both investigators and patients were blinded to pH monitoring results. The Reflux Symptom Index and Reflux Finding Score were reassessed during the second, third and fourth month of follow up.

    Results:

    The sensitivity of empirical pantoprazole treatment in diagnosing laryngopharyngeal reflux was 92.5 per cent. The specificity was 14.2 per cent, the positive predictive value 86 per cent and the negative predictive value 25 per cent. There was significant reduction in the total Reflux Symptom Index and Reflux Finding Score after the second, third and fourth month of treatment. There was no correlation between laryngopharyngeal reflux and body mass index.

    Conclusion:

    Our results suggest that intensive empirical treatment with proton pump inhibitors is effective in diagnosing laryngopharyngeal reflux.

  • Neck and back pain – spinal spondylitic syndromes

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 273-276

  • Summary

    Proton pump inhibitors (PPIs) are recommended as a first-line therapy when chest pain is thought to be caused by esophageal spasm. Both long- and short-acting nitrates have been shown to provide some relief of pain caused by esophageal spasm. Calcium channel blockers decrease the amplitude and duration of esophageal spasms, but their use does not consistently result in better analgesia than achieved with placebo. This chapter discusses the use of anticholinergic agents such as atropine, hyoscyamine, or propantheline bromide decrease peristaltic contractions and reduce esophageal sphincter tone. There is evidence supporting the use of antidepressants such as tricyclics, trazodone, and SSRIs for treating chest pain caused by esophageal spasm. Regardless of their possible utility in the long term, antidepressants are not likely to be of help in the acute management of esophageal spasm pain in the ED.

  • Bites and stings – terrestrial

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 124-132

  • Summary

    The NSAIDs and opioids figure prominently in the daily practice of EM. The gastrointestinal risks of NSAIDs are reduced by co-administration of gastroprotective therapy such as misoprostol or, preferably, proton pump inhibitors. The combination of NSAIDs and opioids fails to accrue additive (or synergistic) analgesic results. NSAIDs (and acetaminophen) will always claim one advantage over opioids: antipyresis. For most patients, the potential problems with opioids have little to do with efficacy in relieving pain. For short-term use as prescribed from the ED, the analgesic benefits of the opioids will counterbalance the risks foremost pregnant patients with pain uncontrollable by other means. Since most opioids are excreted to some degree in breast milk, opioids are best avoided in breastfeeding mothers. The controversy surrounding meperidine (pethidine) use in the ED is hard for acute care providers to avoid.

  • Neuropathy – HIV related

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 285-288

  • Summary

    Opioids such as morphine are often used early in patients subsequently diagnosed with gastroesophageal reflux disease (GERD). Antacids provide GERD relief by buffering the refluxed gastric contents. Antacids are readily available, relatively safe, and fast acting. Antacids constitute first-line GERD therapy in pregnancy. Proton pump inhibitors (PPIs) are a first-line treatment for non-cardiac chest pain, and for GERD in particular. H2-receptor antagonists such as ranitidine (150 mg PO as needed for GERD pain) have been shown in double-blinded trials to achieve better on-demand pain relief than antacids. Prokinetic drugs such as metoclopramide and cisapride are postulated to relieve GERD by increasing resting lower esophageal sphincter tone and increasing gastric emptying. The novel prokinetic agent itopride has promising preliminary results in an open-label GERD trial, but recommendation for its acute care use must await further data.

  • Neuropathy – diabetic

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 280-284

  • Summary

    This chapter groups the clinically distinct, but similarly treated, entities of gastritis and peptic ulcer disease (GPUD). It focuses on patients with organic disease, with some concluding notes on the challenging management of functional dyspepsia. The most basic treatment for patients with GPUD is administration of antacids. A typical trial finds that administration of colloidal bismuth subcitrate provides significant pain relief in just over half of patients with either gastritis or duodenitis. The reason that agents such as antacids and bismuth salts are reserved for occasional symptomatic relief is that more consistent success is achieved with newer agents such as the proton pump inhibitors (PPIs). The PPIs also relieve symptoms better than does the gastroprotective agent sucralfate when altered gastroduodenal motility is a postulated occasional cause of gastritis, the prokinetic drugs have been employed to treat GPUD.

  • Predictors of response to short-term proton pump inhibitor treatment in laryngopharyngeal reflux patients

  • N Siupsinskiene, K Adamonis, R J Toohill, R Sereika
  • Journal:
    The Journal of Laryngology & Otology / Volume 122 / Issue 11 / November 2008
    Published online by Cambridge University Press:
    11 March 2008, pp. 1206-1212
    Print publication:
    November 2008
  • Objectives:

    To assess benefit from one and three months' empirical proton pump inhibitor treatment in patients with suspected laryngopharyngeal reflux, and to define pre-therapy factors which may predict success with short-term proton pump inhibitor treatment.

    Study design:

    Prospective, open clinical study.

    Materials and methods:

    One hundred adult out-patients with suspected laryngopharyngeal reflux were enrolled in the study. Laryngopharyngeal reflux patients underwent endoscopy and received omeprazole for three months. Efficacy of treatment was assessed at one and three months. Patients were classified as responders if their total symptom score had improved at least 50 per cent, their videolaryngoscopic score had improved by at least two points, and they were satisfied with the results. Pre-therapy factors assessed for an effect on omeprazole outcomes included: patient demographics, reflux symptoms, videolaryngoscopic scores, endoscopic findings, overall vocal dysfunction degree, self-rated voice handicap index, hospital anxiety and depression scale scores, and general well-being score.

    Results:

    Fifty-six per cent of patients were classified as responders at one month of treatment; this proportion rose to 92 per cent at three months. Those patients entering the study with a higher heartburn score showed a significant response after one month of omeprazole treatment. Non-responders were found to have significantly more anxiety than responders. Logistic regression analysis revealed these factors, plus the medication dose, as being relevant for faster response prediction. No significant association was found between pre-therapy factors and three-month response to proton pump inhibitor treatment.

    Conclusion:

    Three months of proton pump inhibitor treatment twice daily is warranted for confirming suspicion of laryngopharyngeal reflux. Baseline anxiety levels and heartburn scores, and the medication dose, may be relevant factors when predicting faster response to proton pump inhibitor treatment in carefully selected patients.

  • Acid reflux management: ENT perspective

  • Ijaz Ahmad, A. J. G. Batch
  • Journal:
    The Journal of Laryngology & Otology / Volume 118 / Issue 1 / January 2004
    Published online by Cambridge University Press:
    08 March 2006, pp. 25-30
    Print publication:
    January 2004

  • Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms; and the constellation of symptoms has been called laryngopharyngeal reflux.

    This is a prospective study in a cohort of patients with various throat symptoms suggestive of laryngopharyngeal reflux (LPR) who underwent flexible oesophago-gastroscopy, as a principal investigation. The aims were to look at the most reliable symptom(s) and sign(s), the diagnostic role of flexible oesophago-gastroscopy and the treatment response in these patients.

    The endoscopy score of 0 to 3 was based on endoscopic findings and the treatment response was measured from 0 to 100 per cent improvement of symptoms, as described by the patients.

    There were a total of 303 patients, 174 females and 129 males with ages ranging from 19 to 88 years. Seventy-five per cent had had symptoms for more than a year. Fifteen per cent were smokers. Globus, voice change, sore throat, dysphagia and cough were the predominant symptoms. Most patients, however, presented with a complex of various other secondary symptoms.

    The endoscopic findings were abnormal in 98 per cent of patients. Apart from the finding of non-specific hyperaemia, usually of the posterior larynx (13 per cent), lesions of the larynx and vocal folds were surprisingly uncommon.

    Proton pump inhibitors (PPI) were prescribed in 90 per cent of patients. A total of 233 (76.8 per cent) responded to treatment. The improvement of symptoms ranged from 25 per cent in 36 (23 per cent), 50 per cent in 60 (20 per cent), 75 per cent in 59 (19 per cent) and 100 per centin 78 (26 per cent) patients.

    Accumulative analysis of variance showed a significant difference between treatment responders and non-responders (p <0.04). In a logistic regression model patients with globus, voice change and gastric prolapse were more likely to respond to treatment (p <0.04).

    It can be concluded that voice change, sore throat, globus and cough choking are the most reliable symptoms of laryngopharyngeal reflux. Voice change and globus symptoms can be of predictive value in terms of successful treatment response. Flexible oesophago-gastroscopy (FOG) isa simple, safe and reliable way of assessment in these cases and treatment with PPI can be effective in the majority of patients.