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Old 05-16-2008, 11:20 AM   #1
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studies showing PPIs do not help LPR

I haven't seen this mentioned here, that there are at least two medical studies that have shown that PPIs are not effective in treating LPR (please note, GERD and LPR are not the same things, so these studies should not be applied to GERD). (PPIs, for those not familiar with all the terms, are proton pump inhibitors, which include Nexium, Prilosec, Prevacid, Protonix, etc.)

The first study was done by the University of Louisville School of Medicine. This found that placebos (in other words, sugar or "empty" pills) were actually more effective than PPIs in relieving LPR symptoms. The second study, done in the UK, concluded that there was no difference between placebos and PPIs in treating LPR.

I'm not a doctor. I'm recently diagnosed with LPR, but have had the symptoms for about 15 years. I've been doing research to learn more. In the meantime, I am on a PPI, Protonix, and have been for many months. My guess as to why PPI might not work for LPR in the way in would for GERD has to do with the difference between acid in the lower esophagus (which is what happens with GERD) and the throat (what happens in LPR). The throat, from what I understand, is less equipped to deal with even small amounts of acid than the lower esophagus. So even if the PPI lowers acid, there is still acid that escapes into the throat and the difference between amounts of acid don't change symptoms that much.

I know some people on the board with LPR swear by their PPI. And there might be other studies showing high levels of effectiveness. I just thought those with LPR who assume PPI should instantly work would be interested.

The first study was reported in the article "Double-Blind, Placebo-Controlled Trial with Single-Dose Pantoprazole for Laryngopharyngeal Reflux CME" in
The American Journal of Gastroenterology 101 (9) , 1972–1978. There is a link to an abstract here:
[url]http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2006.00693.x[/url]

The second study I found is in "Empiric Treatment of Laryngopharyngeal Reflux with Proton Pump Inhibitors: A Systematic Review" in Laryngoscope. 116(1):144-148, January 2006.
The link to the abstract is here:
[url]http://www.laryngoscope.com/pt/re/laryngoscope/abstract.00005537-200601000-00029.htm;jsessionid=LtHLq9b7Jygrd9cLT8y 4qv4ylZ0GyrnSp5DlyJPsqWKNVhDM8bYt!-2123996546!181195629!8091!-1[/url]

 
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Old 05-16-2008, 12:41 PM   #2
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Re: studies showing PPIs do not help LPR

Did they give any suggestions for what does work?

 
Old 05-16-2008, 01:37 PM   #3
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Re: studies showing PPIs do not help LPR

My impression is this: first, that medications, including PPIs, are engineered primarily for GERD and heartburn, not LPR and throat problems, and if they work for some LPR sufferers it's incidental or accidental to their purpose. Even if the PPI worked to its maximum degree for LPR, it still is treating the symptom, not the cause, which is a loose connection between stomach and esophagus (that's true of GERD and LPR). Remember, there are many more GERD sufferers than LPR sufferers, so I don't know if the drug companies have incentive to design drugs specifically for LPR (if such distinct treatment is theoretically possible).

I have found another study (actually more than one, but this is the abstract for one of them: [url]http://www.ncbi.nlm.nih.gov/pubmed/11768700[/url]) that concludes that gum chewing, particularly chewing gum with sodium bicarbonate in it (two pieces of gum for at least an hour after eating) helps balance the PH levels in LPR patients. I've been doing just that for about a month and a half and it has helped immensely. I encourage anyone with LPR to try the gum! The two gums I know that have sodium bicarbonate (=baking soda) are ORbit White (not Orbit regular) and Arm and Hammer Baking Soda gum (if you can find it! I haven't yet, but am having a family member ship it to me who did find it). There are also some lozenges that have baking soda, I haven't tried those yet.

The other things I have found to help are to get a "wedge pillow" to sleep on so you're not lying flat at night; and, similarly, make sure you're not lying down during the day anytime with three hours after eating (not just at night).

Like others with LPR on this board (as opposed to those with GERD) I find what you eat has little to do with LPR symptoms. My guess is what I said below, that with LPR it doesn't matter how much acid it is, the throat can't deal with any of it well. I could be wrong on that. But I think when and how much you eat, and when you lie down, has much more to do with it.

 
Old 05-21-2008, 12:30 PM   #4
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Re: studies showing PPIs do not help LPR

Are you still taking the Protonix? Did your Dr. prescribe it 2x a day or just once a day? I seem to get better results on Protonix 2x a day, but am having problems with my insurance covering it. But, in all reality it doesn't seem like all the symptoms ever go away even on 2x daily dosing, but they do seem to get better. I am going to try the gum that you suggested, because I am sick of this LPR and I really want it gone.

 
Old 05-22-2008, 07:08 AM   #5
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Re: studies showing PPIs do not help LPR

I noticed long ago that PPI's didn't help LPR one bit. The only thing that did help a little was Pepcid Complete, I take that when the LPR gets really bad, it seems to help a little. I get LPR mostly when I sleep, only thing to help me was sleeping on a rediculous slant, problem is you slide off bed and wife said no way. May end up buying myself another bed so I can raise the top way up. Oh the things we do to stop acid reflux. There must be a way to stop it completely. I was sure stress was the cause of mine but it came back like a bat out of hell and I wasn't stressed at all. Now it seems to be settling down a little, why? I have no idea.

 
Old 05-22-2008, 08:47 AM   #6
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Re: studies showing PPIs do not help LPR

Neddy: I'm surprised to hear your LPR is worse at night, as one of the supposed traits of LPR is that, unlike GERD, it doesn't show up at night. But as I say in another post on this board ([url]http://www.healthboards.com/boards/showthread.php?t=600089[/url]) that difference, or the reason for it, isn't clear to me at all.

Zach: yes, I'm on Protonix 2x a day, and before that was on Nexium and before that Prilosec. It's important to note that the standard dosage for PPIs for LPR is ALWAYS two times a day. Which is not to address whether or not it helps. I honestly can't say whether or not it makes a difference for me, sometimes I think yes, sometimes no. Part of the problem I find with LPR (and maybe this is the same with GERD) is it's so difficult to tell what is helping, hurting, or doing nothing, and that goes for food, drink, sleeping positions and medication. Especially when you factor in abstract things like stress.

Re: gum: I did find out about another type of gum that has baking soda and natural ingredients (rather than the chemicls in Orbit White and almost all gums): ] ... supposedly you can find it at natural food stores and possibly Whole Foods, maybe in the dental aisle. I haven't looked for it quite yet.

Last edited by moderator2; 05-22-2008 at 12:48 PM. Reason: posted commercial website

 
Old 05-26-2008, 12:59 PM   #7
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Re: studies showing PPIs do not help LPR

Hi newbie7500 thats interesting about the ppis not working. I too believe I got Lpr i noticed when I had the 48 hr ph probe the numbers stayed around 6,or 7 when i was lying down. ( normal ph) but when i started to move around the numbers went lower sometimes below 4 and i saw a 1.2 at one time. So if ppis dont work what does? surgery? ( i hear surgery odds are not the greatest)) I am going to see my doctor this friday about my ph test and I fear the worst. thanks for your post.

15 years is a long time can i ask what your symptoms are?

my symptoms are just a sore throat and sometimes light pain below my left ribs. My pcp and ent all ready gave me nexium and i got very sick on it

Last edited by jasonv11; 05-26-2008 at 01:03 PM.

 
Old 05-26-2008, 02:04 PM   #8
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Re: studies showing PPIs do not help LPR

Hi Jason, I really only have one pronounced symptom, but very consistently disruptive, which is the need to clear my throat all the time (from the acid being in the throat). LPR symptoms are all a bit different for each person. Secondarily, I sometimes have the feeling of post nasal drip or asthma which also comes from LPR (again, for some people). I'm not a doctor, but from my research I think it's important for everyone here with LPR (or who thinks they might have LPR) to remember that LPR is a very "new" condition. What I mean by this is that LPR didn't begin to be diagnosed until around 2000 (obviously research and analysis of it in the medical community came before it). So compared to GERD, (a) there are far fewer people with LPR to spur specialized drugs to treat it, and (b) there has been only a few years in which such drugs or other treatment could have been developed. I'm afraid those of us with LPR are often given courses of treatment built for GERD that may work, may work partially, or may not work at all, but all more or less by accident. GERD and LPR, as I say repeatedly, manifest themselves very differently, even if the reflux is the same source.

Also, the very, ahem, stringent posting policy here (you can't link to a "commercial" website) censored the gum website I posted. I won't post it again, of course, but the gum is called Eco-Dent Between. It's the only natural gum I know about with baking soda in it, which studies do show alleviate some LPR symptoms (obviously without curing anything!).

The fact is, even if Nexium or the other PPIs worked beautifully, which for some people they do, reducing your stomach acid over a long period of time strikes me (and many others) as a strange jolt to your body. As for surgery, I know very little about it, but there are several threads on this board that you can search for -- it seems like sometimes it helps but sometimes it doesn't.

Last edited by moderator2; 05-26-2008 at 06:03 PM. Reason: posted commercial website

 
Old 05-26-2008, 05:02 PM   #9
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Re: studies showing PPIs do not help LPR

Bethanechol chloride (Urocarb) might assist.... it tightens the oesophogal sphincter, and speeds gastric emptying.

Meteclopramide has the same effect via a different mechanism.

No reason why either of these couldnt be taken along with a PPI

Last edited by aussiejono; 05-26-2008 at 05:03 PM.

 
Old 05-26-2008, 06:31 PM   #10
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Re: studies showing PPIs do not help LPR

Thanks you guys ....You all are a big help. I have been pounding the compter keys trying to find something anything that might help.

 
Old 06-09-2008, 04:53 PM   #11
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Re: studies showing PPIs do not help LPR

Newbie ~ I am also from the Boston area and think I have LPR. I need to make an appointment with a gastroenterologist. Do you have any recommendations? One of your posts sounded as if you were fairly pleased with your doctor. So many don't seem to know about LPR.

Thank you!

 
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