Lechien Jérôme R
Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251347602. doi: 10.1177/19160216251347602. Epub 2025 Jul 31.
ImportanceProton pump inhibitors (PPIs) do not demonstrate superiority over placebo in laryngopharyngeal reflux disease (LPRD). While poorly used, many alternative medical treatments exist for controlling the gastroduodenal and gastro-pharyngeal reflux processes.ObjectiveTo investigate the clinical findings of controlled studies comparing therapeutic regimens for treating LPRD.DesignPubMED, Scopus, and Cochrane Library systematic review without meta-analysis using the PRISMA statements.SettingReview of prospective or retrospective cohort studies comparing 2 medical regimens in patients with suspected or confirmed LPRD.ParticipantsPatients with suspected or confirmed LPRD.InterventionComparison of PPI therapy to other therapeutic regimens for LPRD.OutcomesSymptom, sign changes, and therapeutic responses were considered from pre- to posttreatment. Bias analysis was conducted with Methodological Index for Non-Randomized Studies (MINORS). Implications for practice were summarized with a focus on the pharmacological and biological findings of all drug classes in the LPRD pathophysiology.ResultsFourteen studies met the inclusion criteria, including 1269 patients. There were 675 females (59.6%) and 458 males (40.4%). The mean age of patients was 49.1 years. Substantial variability was observed among studies regarding both pharmacological interventions and participant selection criteria. Two of the four comparative studies demonstrated superior therapeutic efficacy with prokinetic-PPI combination therapy compared with PPI monotherapy. The alginate-PPI combination yielded enhanced symptom amelioration compared with PPI alone.The mean MINORS score of 9.1 ± 1.2 indicated an important heterogeneity between randomized and non-randomized controlled studies for inclusion and exclusion criteria, LPRD diagnosis, therapeutic regimens, and outcomes. Recommendations are provided for future randomized controlled studies.ConclusionTo date, only a few studies investigated the effectiveness of alternative medications to PPIs in the treatment for LPRD, which represents an important gap with the gastroesophageal reflux disease literature. Although the limited number of studies and their heterogeneity preclude definitive conclusions, the preliminary findings from this review support the need for future randomized controlled trials examining the therapeutic potential of alginates and prokinetics in patients with primary or refractory LPRD.
重要性
质子泵抑制剂（PPI）在喉咽反流病（LPRD）中并未显示出优于安慰剂的效果。尽管使用不当，但存在许多替代医学疗法来控制胃十二指肠和胃咽反流过程。
目的
调查比较治疗LPRD的治疗方案的对照研究的临床结果。
设计
使用PRISMA声明，在不进行荟萃分析的情况下对PubMED、Scopus和Cochrane图书馆进行系统评价。
设置
回顾比较疑似或确诊LPRD患者的两种医学方案的前瞻性或回顾性队列研究。
参与者
疑似或确诊LPRD的患者。
干预
将PPI治疗与其他LPRD治疗方案进行比较。
结果
从治疗前到治疗后，考虑症状、体征变化和治疗反应。使用非随机研究方法学指数（MINORS）进行偏倚分析。重点总结了LPRD病理生理学中所有药物类别的药理学和生物学发现对实践的影响。
结果
14项研究符合纳入标准，包括1269例患者。其中女性675例（59.6%），男性458例（40.4%）。患者的平均年龄为49.1岁。在药理学干预和参与者选择标准方面，各研究之间存在很大差异。四项比较研究中的两项表明，促动力药-PPI联合治疗比PPI单药治疗具有更好的治疗效果。与单独使用PPI相比，藻酸盐-PPI联合治疗能更好地改善症状。
平均MINORS评分为9.1±1.2，表明在纳入和排除标准、LPRD诊断、治疗方案和结果方面，随机对照研究和非随机对照研究之间存在重要的异质性。为未来的随机对照研究提供了建议。
结论
迄今为止，只有少数研究调查了PPI替代药物治疗LPRD的有效性，这与胃食管反流病文献相比存在重要差距。尽管研究数量有限且存在异质性，无法得出明确结论，但本综述的初步结果支持未来需要进行随机对照试验，以研究藻酸盐和促动力药对原发性或难治性LPRD患者的治疗潜力。
