A meta-analysis for the role of proton pump inhibitor therapy in patients with laryngopharyngeal reflux

We aimed to systematically review the randomized controlled trials (RCTs) regarding the therapeutic efficiency of proton pump inhibitor (PPI) therapy for laryngopharyngeal reflux (LPR). Randomized and placebo-controlled trials regarding the therapeutic efficacy of PPIs on LPR patients were systematically searched from MEDLINE, Cochrane Library, and EMBASE. Data were extracted from eligible studies meeting the inclusion criteria. Heterogeneity among these eligible studies was evaluated by the Q-statistic and I (2) test, based on which a fixed- or random-effects model was performed to pooled relative risks (RRs) for the response rate and standardized mean differences (SMDs) for reflux symptom index (RSI) and the reflux finding score (RFS). Potential publication bias was evaluated by trim and fill method. Totally, 13 RCTs including 831 LPR patients were eligible for this meta-analysis. Pooled results demonstrated that the total RSI significantly improved for patients who received PPI therapy by comparing with those receiving placebo (SMD = 3.65; 95 % CI 1.56-5.75), though no significant difference was found in response rate (RR = 0.04, 95 % CI -0.06 to 0.14) and RFS (SMD = 0.91; 95 % CI -0.53 to 2.35) between these two groups of patients. No publication bias was found among eligible studies. PPI treatment could significantly improve reflux symptoms in LPR patients and, therefore, should be taken into consideration for LPR management with other strategies, such as lifestyle modification.