Influence of age on treatment with proton pump inhibitors in patients with laryngopharyngeal reflux disease: a prospective multicenter study

Abstract

Importance: Several trials on the predictors of response to proton pump inhibitor (PPI) treatment of laryngopharyngeal reflux (LPR) have shown conflicting results. Furthermore, the influence of age in disease severity and response to PPI therapy is unclear.

Objective: To assess the difference in disease severity and response to PPI therapy according to age in patients with LPR.

Design, setting, and participants: Prospective multicenter study at 3 tertiary medical centers of 264 consecutive patients with LPR who were referred to the otolaryngology clinic from November 2010 to February 2012.

Interventions: Participants were prescribed 15 mg of lansoprazole (PPI) twice daily for 3 months.

Main outcomes and measures: Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and laryngopharyngeal reflux-health-related quality of life (LPR-HRQOL) were collected at baseline and at 1 and 3 months postbaseline.

Results: After 3 months, 35 patients were lost to follow-up and excluded; the remaining 229 patients included 135 men and 94 women. The oldest group (60-79 years; n = 111) showed higher baseline RSI (P < .001) and LPR-HRQOL (P < .001) scores than the 18- to 39-year-old (n = 35) and 40- to 59-year-old (n = 83) groups. However, baseline RFS scores showed no significant difference among age groups (P = .44). Within each age group, the RSI, RFS, and LPR-HRQOL improved significantly with PPI therapy (all P < .001); however, no significant difference in improvement of RSI (P = .59), RFS (P = .50), or LPR-HRQOL (P = .09) was seen among the groups. At 3-month follow-up, significantly more responders, defined as those whose RSI score improved by more than 50%, were found in the 18- to 39-year-old and 40- to 59-year-old groups (86% and 75%, respectively) than in the oldest group (57%) (P = .002), but there was no significant difference in proportion of responders among age groups at 1-month follow-up (P = .69).

Conclusions and relevance: In patients with LPR, age seems to affect the subjective symptoms and resulting impact on quality of life but not the laryngeal findings. Furthermore, older patients are more likely not to respond to PPI therapy than younger patients.