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In this crossover observational study, a low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet was investigated as a single treatment for laryngopharyngeal reflux (LPR). Authors recruited 50 participants with demonstrated LPR on hypopharyngeal-oesophageal multichannel intraluminal impedance-pH-monitoring (HEMII-pH), off acid suppressive medication, to take part in the study. The Reflux Symptom Score (RSS), a patient reported outcome questionnaire, was measured at three stages to assess symptoms and response to intervention. This was done before and after HEMII-pH prior to any intervention as a control measure. It was then assessed six weeks after the diet had started. Scores were compared between the control baseline period assessments and the post-diet assessment. After six weeks of starting the diet, patients were reviewed and RSS was evaluated. A significant statistical improvement in the mean RSS was demonstrated following six weeks of diet when compared to baseline results (P = 0.001). Individual analysis showed 18 patients with limited or no response to the diet who, at this stage, opted to start a combination of PPI, alginate and magaldrate, however 32 continued with the diet due to substantial symptom relief. Patients were then reviewed at 12 weeks and, among the 32 with symptom relief, five reported recurrent or worsening therefore received medication. This meant that 27 (54%) of the patients reported satisfactory symptom improvement 12 weeks after starting the diet. The authors conclude that diet alone could be a cost-effective therapeutic approach for half of LPR patients. They highlight the growing body of evidence that diet has a key role in the occurrence of oesophageal dysmotility, sphincter insufficiency, and related pharyngeal reflux events. The authors add that future controlled randomised studies are needed to better identify patients with whom diet could be sufficient for the treatment.

Is Diet Sufficient as Laryngopharyngeal Reflux Treatment? A Cross-Over Observational Study.
Lechien JR, Crevier-Buchman L, Distinguin L, et al.
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Zach Shellman

Nottingham University Hospitals NHS Trust, Nottingham, England, UK.

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