• Title/Summary/Keyword: Laryngopharyngeal reflux

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Clinical Study for Efficacy and Safety of Rabeprazole Sodium(Pariet) in the Treatment of Laryngopharyngeal Reflex(LPR) Disease (인후두위산역류증(Laryngopharyngeal Reflux: LPR)의 치료에 대한 RabeprazoleSodium(Parietd)의 임상효과와 안전성 검토)

  • Jung, K.W.;Jun, B.S.;Ko, S.H.;Kwon, K.H.;Kwon, S.Y.;Kwon, J.K.;Kim,, D.Y.;Kim,, S.C.;Kim,, S.W.;Kim,, Y.M.;Kim,, Y.H.;Kim,, Y.H.;Kim,, J.M.
    • Korean Journal of Bronchoesophagology
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    • v.10 no.2
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    • pp.35-42
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    • 2004
  • Background and objective : Rabeprazole is a new generation proton pump inhibitor, which has a rapid onset after first dose, predictable efficacy in all patients regardless of CYP2C19 genotype status, and less nocturnal acid breakthrough. The aim of the study is to investigate clinical efficacy and safety of rabeprazole sodium (Pariet 10mg qd)when administered once daily to patients with laryngopharyngeal reflux(LPR) disease. Methods : Among the patients who had visited the Department of Otolaryngology, those with LPR symptoms, had undergone laryngoscopy. Symptoms and endoscopic laryngeal sings were recorded initially, at 1 month, 2 months, 3 months, and more than 3 months, All patients were evaluated for clinical efficacy on the basis of symptom scores, reflux finding score(RFS), and side effects. Results : In general, most symptom scores and RFS improved over the time. Efficacy of the Pariet on LPR-related symptoms were $63.2\%,\;77.5\%,\;78.7\%,\;and\;90.9\%$ before 4 weeks, 4 to 8 weeks, 8 to 12 weeks, and after 12 weeks respectively. Efficacy on the RFS were $61.8\%,\;78.4\%,\;82.9\%,\;and\;85.5\%$ before 4 weeks, 4 to 8 weeks, 8 to 12 weeks, and after 12 weeks respectively. Pariet was well tolerated and was associated with few drug-related side effects. Conclusion Because of its efficacy and safety, Pariet may prove to be an alternative to currently available proton pump inhibitors.

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Current Trends in Diagnosis and Management of Laryngopharyngeal Reflux Disease; A Survey of Korean Otolaryngologists (인후두역류질환의 진단 및 치료 경향; 이비인후과 전문의 설문조사 결과)

  • Lee, Jae-Kwon;Kim, Tae-Wook;Son, Young-Ik
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.20 no.2
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    • pp.141-147
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    • 2009
  • Background and Objectives: Although laryngopharyngeal reflux disease (LPRD) is a widely recognized disease in the field of otolaryngology, controversies still exist regarding the diagnosis and treatment for it. The purpose of this survey was to find out current trends in diagnosis and management of LPRD among Korean otolaryngologists. Materials and Method: Questionnaires were obtained from 26 Korean otolaryngology specialists by electronic balloting, and 46 members of the Korean Society of Head and Neck Surgery (KSHNS) bye-mail. Survey participants were asked about their preferences in diagnostic policy, duration/dosage of antireflux treatment, and their familiarity to the reflux symptom index (RST) and the reflux finding scores (RFS). Results: The majority of the survey participants (64%) preferred empiric therapy trial with proton pump inhibitors (PPIs) based on patients' symptoms and their laryngeal findings. PPIs alone (27%) or PPIs with prokinetics (32%) were usually prescribed as a first line treatment mostly with once daily schedule in the morning before meal and for less than 4 months of duration (86%). More than 90% of participants were aware of the RSI and RFS, but less than 50% of them were actually using those items in the clinics. Conclusion: Most of Korean otolaryngologists who participated in this survey answered that they prefer starting empirical treatments with proton pump inhibitors mainly based on the patient's symptoms and their laryngeal findings.

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Relationship between Ambulatory 24-hour Double Probe pH Monitoring and Reflux Finding Score in Patients with LPR (인후두 역류환자에서 이동성 24시간 이중 탐침 산도 검사와 인후두 역류 소견 점수와의 상관관계)

  • Park, Young-Dae;Kang, Dae-Woon;Lee, Jin-Choon;Lee, Byung-Joo;Wang, Soo-Geun;Kim, Gwang-Ha
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.19 no.2
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    • pp.136-141
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    • 2008
  • Background and Objectives: Laryngopharyngeal reflux (LPR) is a very common disease among outpatients of department of otorhinolaryngology. Although there are several diagnostic tools for LPR disease and ambulatory 24-hour double-probe pH monitoring is gold standard method, empirical diagnosis by reflux symptom index and reflux finding score (RFS) are mainly used. So we analyzed the relationship between ambulatory 24-hour double-probe pH monitoring and RFS in patients with LPR. Subjective and Method: Fifty patients with LPR symptoms and abnormal RFS and ambulatory 24-hour double probe monitoring were enrolled. Each items and sum of laryngeal reflux score were compared the results of ambulatory 24-hour double-probe pH monitoring in upper (UES) and lower (LES) esophageal sphincter. Results: There were no significant correlation between the results of ambulatory 24-hour double-probe pH monitoring in UES (pH<4 and pH<5) and each item and sum of RFS. However, supine time and reflux number of UES (pH<5) were showed the partial correlations with diffuse laryngeal edema and thick endolaryngeal mucus (p=0.03, p=0.01). Although there were no relationship between the results of ambulatory 24-hour double-probe pH monitoring in LES and sum of RFS, the significant correlations presented between granuloma and total time (p=0.008), upright time (p=0.008, reflux number (p=0.049) of LES. Conclusion: Although granuloma among items of RFS showed significantly correlation with the results of ambulatory 24-hour double-probe pH monitoring in LES, there were no significant correlation between the results of ambulatory 24-hour double-probe pH monitoring in UES and LES and items and sum of RFS.

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Endoscopic Assessment of Esophagitis with Transnasal Esophagoscopy in the Prediction of Treatment Response

  • Chung, Eun-Jae;Park, Min-Woo;Jung, Kwang-Yoon
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.25 no.1
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    • pp.27-30
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    • 2014
  • Objectives : The purpose of this study was to investigate the endoscopic evidence of esophagitis in laryngopharyngeal reflux disease (LPRD) patients using transnasal esophagoscopy (TNE) and to correlate these findings with treatment response. Methods : Fifty patients underwent TNE at Korea University Anam Hospital from July 2007 to Feb 2009. Participants were selected from patients that presented with various laryngeal symptoms. One experienced otolaryngologist assessed esophagitis according to the Los Angeles classification system using the TNE findings. Results : Fifteen of 50 LPR patients (30%) were found to have esophagitis (12 patients with Grade A, 3 patients with Grade B, no patients with grade C/ D esophagitis). Among the 15 patients positive for esophagitis based on the endoscopic findings, 12 (80%) showed symptom improvement after pharmacological therapy. Symptom improvement was correlated with evidence of esophagitis (p=0.002) but not with RFS (p=0.749). Conclusion : Endoscopic evaluation of esophagitis using TNE is a potentially valuable tool for predicting treatment response in LPRD patients.

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Dysphonia : Vocal Fold Mucosal Lesions Easily Missed in Laryngoscopy (발성장애: 후두내시경 검사에서 놓치기 쉬운 성대점막질환)

  • Kim, Han-Su
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.21 no.1
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    • pp.17-21
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    • 2010
  • Dysphonia is a medical terminology for voice disorders characterized by hoarseness, harshness, weakness, or even loss of voice ; any impairment in ability to produce voice sounds using the vocal organs, larynx, The causes of dysphonia can be classified into two groups, organic and functional. Functional dysphonia includes spasmodic dysphonia, muscle tension dysphonia, mutational dysphonia and conversion dysphonia, etc, The findings of laryngoscopy in these dysphonia are almost normal. Therefore, physicians should diagnosis these diseases from careful history taking and abundant understandings about the phonation pattern, Organic dysphonia is caused by anatomical problems in the larynx, especially on the vocal fold, Some lesions, however, are not easily found because these lesions are too small, or located on the lower lip of vibrating vocal fold. Laryngopharyngeal reflux induced laryngitis, vascular lesions, sulcus vocalis, vocal atropy including presbylaryngis, and mucosal tears are common lesions easily missed in laryngoscopy, Therefore, a high index of suspicion is necessary to avoid missing vocal fold mucosal lesions, and the strobovideolaryngoscopy is indispensable in making the diagnosis,

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Analysis of Relationship between Reflux Symptom Index and Psychiatric Problems (역류증상지수와 정신과적 질환과의 상관관계 분석)

  • Park, In-Jun;Kang, Jun-Myung;Seo, Jae-Hyun;Hwang, Se-Hwan;Youn, Ho-Young;Jin, Ho-Jun;Kang, Ha-Ram;Joo, Young-Hoon
    • Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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    • v.61 no.12
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    • pp.692-696
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    • 2018
  • Background and Objectives This study investigated the relationship between reflux symptom index (RSI) and psychiatric problems such as depression, somatization, and anxiety. Subjects and Method We prospectively analyzed 231 patients with symptoms with laryngopharyngeal reflux (LPR) using the RSI and the reflux finding score. Results Seventy nine patients (34.2%) were diagnosed with LPR. A significant correlation was detected between the RSI and depression ($18.4{\pm}8.3$ vs. $12.3{\pm}7.0$, p<0.001), anxiety ($19.5{\pm}8.5$ vs. $13.0{\pm}7.3$, p<0.001), and somatization ($19.2{\pm}9.1$ vs. $13.6{\pm}7.5$, p<0.001). A multivariate analysis confirmed a significant association between heartburn and depression [odds ratio (OR): 1.241, 95% confidence interval (CI): 1.003-1.537, p=0.047], choking and anxiety (OR: 1.747, 95% CI: 1.297-2.352, p<0.001), and choking and somatization (OR: 1.707, 95% CI: 1.248-2.336, p=0.001). Conclusion Our preliminary results suggest that patients with high RSI may need to be carefully evaluated for psychiatric problems.

The clinical effects of Rabeprazole sodium (Pariet$\circledR$) in the treatment of Laryngopharyngeal Reflux (인후두역류질환 ( Laryngopharyngeal Reflux Disease. LPRD )에서 Rabeprazole Sodium (Pariet$\circledR$)의 임상효과)

  • 최홍식;김한수;최현승
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 2002.12a
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    • pp.9-9
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    • 2002
  • 이비인후과 영역에 있어서 위산 역류에 의한 질환의 진단은 쉽지 않고 분명하지 않은 점이 많지만, 병변의 영향은 광범위하며, 실제로 역류에 의한 증상을 가지고 내원하는 환자도 증가하는 추세이다. 인후두역류질환의 치료는 크게 생활습관의 변경, 약물복용, 항역류수술로 나눌 수 있으며, 사용약제는 크게 두 부류로 나누는데, 제산제, H2 수용체 차단제, PPI(Proton Pump Inhibitor) 제제와 같은 산억제 약물군과 Prokinetic 약물군이다. Rabeprazole sodium(Pariet(R))은 PPI 제제에 해당하는 약제로 기존의 omeprazole, lansoprazole, pantoprazole과는 달리 대사 과정 중 CYP2C19에 대한 의존도가 낮아, 개체 간 차이가 적고 빠르고 일정하게 산분비 억제 효과를 나타내는 것으로 알려져 있은 약물이다. 2001년 5월부터 2002년 4월까지 32개 병원에서 Pariet(R) 를 복용한 2166명의 환자를 대상으로 분석하였다. 복용기간에 따라 4군(1군;1-14일, 2군;15-28일, 3군;29-56일, 4군:57일 이상)으로 나누었으며, 8가지 증상(Heart burn, Regurgitation, Chronic cough, Hoarseness, Globus sensation, Chronic throat clearing, Sore throat, Dysphagia)에 대한 호전 여부 및 후두내시경상 개선 정도, 의사에 의한 유용도 평가, 부작용 발생 여부에 대해 연구하였다. 증상개선율 50%이상을 치료 반응군으로 했을때 전체 2166명중 1627명(75.1%)에서 증상의 호전을 보았으며, 이는 복용기간이 길수록 증가하였다. 후두 내시경상 개선 정도는 현저한 개선이 32.9%, 중등도 개선이 38.7%로 대부분 환자에서 객관적인 병변의 호전을 보였으며, 유용도 평가에서는 매우 유용이 37.6%, 유용이 50.3%로 치료효과에 대한 만족도도 높은 것을 알수 있었다. PPI 제제의 부작용으로 보고되고 있는 두통, 오심, 설사, 복통. 변비, 어지럼증. 피곤 중. 소수의 환자가 두통을 호소하였으나, 그다지 심각한 정도는 아니었다. 인후두역류증 치료제로서 Pariet(R) 는 비교적 안전하고 효과가 높은 약물임이 임상 연구 결과 밝혀졌기에 보고하는 바이다.

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Analysis of High-Resolution Manometry Results in LPRD Patients Who Do Not Response to PPI Medication (양자펌프 억제제에 반응을 보이지 않은 인후두 역류질환 환자에서 고해상도 식도 내압검사의 분석)

  • Lee, Chang-Hee;Lee, Hyun-Sub;Jin, Sung-Min;Lee, Sang-Hyuk
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.23 no.1
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    • pp.43-47
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    • 2012
  • Background and Objectives : Laryngopharyngeal reflux disease (LPRD) originates from regurgitation of gastric contents to the laryngopharynx, and it is relatively common disease in otolaryngology. Proton-pump inhibitor (PPI) medication is frequently using treatment method in present time, but controversies exist regarding treatment for it. High-resolution manometry (HRM) system is a newly developed device that using 36 channels and pressure topography plotting program, checking the function and status of esophagus. The aim of this study was to evaluate clinical usefulness of HRM in LPRD patients who do not response to PPI medication. Materials and Method : From July 2009 to July 2010, a total of 99 patients who were suspected LPRD according to symptoms (Reflux Symptom Index >13) and laryngoscopic findings (Reflux Finding Score >7) were retrospectively enrolled in this study. Patients were consisted of 31 men and 68 women, the mean age was 51.8 years, the mean BMI was 22.46. Patients have taken PPI medication for 2 months, after medication, they performed HRM. Comparative analysis was performed with results of the difference in symptoms. Results : In 99 patients, 37 patients (37.4%) show not improvement of LPRD symptoms after PPI medication. Among them, 18 patients (48.6%) showed abnormal findings that were classified as Peristaltic dysfunction (38.9%), Diffuse esophageal spasm (11.1%), Relaxation impairment of LES (11.1%), Achalasia (5.6%), Hypotensive LES (11.1%), Relaxation impairment of UES (11.1%), Nutcracker esophagus (5.6%), Decreased resting pressure (5.6%). Other 62 patients (62.6%) show improvement of LPRD symptoms, 23 patients (37.1%) showed abnormal findings. Most common finding was Peristaltic dysfunction (43.4%) More prevalent abnormal findings of HRM were found in patients who revealed no response to PPI medication (48.6% vs. 37.1%), but it does not reach the statistical significance. Conclusion : Although statistical significances is not showed, the difference observed in the frequency of HRM abnormal finding between response and no response for PPI medication. It has been estimated that HRM may be used to determine differential diagnosis in patients with LPRD. Further studies in lager population containing normal controls will be needed to prove clinical usefulness.

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Analysis of High-Resolution Manometry Results in LPRD Patients who do not Response to PPI Medication (양자펌프 억제제에 반응을 보이지 않은 인후두 역류질환 환자에서 고해상도 식도 내압검사의 분석)

  • Lee, Chang-Hee;Lee, Hyun-Sub;Jin, Sung-Min;Lee, Sang-Hyuk
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.22 no.2
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    • pp.151-155
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    • 2011
  • Background and Objectives : Laryngopharyngeal reflux disease (LPRD) originates from regurgitation of gastric contents to the laryngopharynx, and it is relatively common disease in otolaryngology. Proton-pump inhibitor (PPI) medication is frequently using treatment method in present time, but controversies exist regarding treatment for it. High-resolution manometry (HRM) system is a newly developed device that using 36 channels and pressure topography plotting program, checking the function and status of esophagus. The aim of this study was to evaluate clinical usefulness of HRM in LPRD patients who do not response to PPI medication. Subjects and Method : From July 2009 to July 2010, a total of 99 patients who were suspected LPRD according to symptoms (Reflux Symptom Index >13) and laryngoscopic findings (Reflux Finding Score >7) were retrospectively enrolled in this study. Patients were consisted of 31 men and 68 women, the mean age was 51.8 years, the mean BMI was 22.46. Patients have taken PPI medication for 2 months, after medication, they performed HRM. Comparative analysis was performed with results of the difference in symptoms. Results : In 99 patients, 37 patients (37.4%) show not improvement of LPRD symptoms after PPI medication. Among them, 18 patients (48.6%) showed abnormal findings that were classified as Peristaltic dysfunction (38.9%), Diffuse esophageal spasm (11.1%), Relaxation impairment of LES (11.1%), Achalasia (5.6%), Hypotensive LES (11.1%), Relaxation impairment of UES (11.1%), Nutcracker esophagus (5.6%), Decreased resting pressure (5.6%). Other 62 patients (62.6%) show improvement of LPRD symptoms, 23 patients (37.1%) showed abnormal findings. Most common finding was Peristaltic dysfunction (43.4%) More prevalent abnormal findings of HRM were found in patients who revealed no response to PPI medication (48.6% vs. 37.1%), but it does not reach the statistical significance. Conclusion : Although statistical significances is not showed, the difference observed in the frequency of HRM abnormal finding between response and no response for PPI medication. It has been estimated that HRM may be used to determine differential diagnosis in patients with LPRD. Further studies in lager population containing normal controls will be needed to prove clinical usefulness.

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