Continuous versus on-demand proton pump inhibitor treatment for laryngopharyngeal reflux: A randomized clinical trial

Objective: This study aimed to compare continuous and pro re nata (PRN) proton pump inhibitor (PPI) treatments for laryngopharyngeal reflux (LPR). Methods: This randomized clinical trial included 52 LPR patients with lingual tonsil hypertrophy (LTH). Those patients who showed LPR improvement with an initial PPI trial were randomly divided into continuous and PRN PPI treatment groups. The Reflux Symptom Index (RSI) score, Reflux Finding Score (RFS), and LTH grade were used to assess the treatment results. Results: The PPI treatment (30 mg of lansoprazole twice daily) for 6 mo resulted in a significantly decreasing RSI score (p<0.001). The PPI treatments for the first 8 w and the second 8 w also showed significant LPR improvement. However, there was no significant improvement after the third 8 w (p>0.05). After 6 mo, the PPI treatment also resulted in a continuous decrease in the RFS (p<0.001). There were no significant differences in the mean RSI scores (p=0.518) and mean RFSs (p=0.393) between the continuous and PRN PPI groups. In the grade II LTH cases, there was a significant improvement after 6 mo of PPI treatment (p<0.001), although there was no improvement after the first 2 mo in the treatment group. For the grade III LTH cases, there was no significant improvement after the first 2 mo and 6 mo of the PPI treatment. Conclusion: Six months of PPI treatment improved the RSI score, RFS, and LTH grade, although there was no difference between the continuous and PRN PPI treatment groups.