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With laryngopharyngeal reflux (LPR) being such a common presenting complaint to ENT clinics, who would not want to have more, effective treatment options for patients suffering with this annoying condition? In their small randomised, controlled trial, Chae et al put mucolytics (200mg Acebrophylline bd) in combination with a proton pump inhibitor (10mg Rabeprazole bd) compared to a proton pump inhibitor alone (10mg Rabeprazole bd) to the test. The combination therapy used is hypothesised to improve LPR resolution, in particular the sensation of ‘sputum-plugging’, by synergistically harnessing Acebrophylline’s mucus clearing and anti-inflammatory characteristics. A total of 116 patients were enrolled, randomised into the two treatment arms with the option of a crossover after one month, treated and followed for three months. Treatment effects were assessed at one and three months using the reflux symptom index (RSI) and reflux finding score. So far, so good. However, this study’s biggest issue is the attrition rate of enrolled patients observed during the study period: at one month, only 56% of the patients originally enlisted remain in the study, and at three months this figure further drops to 29%. Thus, the findings that combination therapy does not improve ‘throat clearing’ or ‘globus pharyngeus’ symptoms, or impact the overall RSI scores at one or three months of treatment compared to PPI therapy alone, may be disappointing, but should not deter further much needed research into this area. So, for now, the quest for more effective LPR treatment options continues.

Clinical Trial of Combination Therapy with Proton Pump Inhibitors and Mucolytics in Patients with Laryngopharyngeal Reflux.
Chae M, Jang DH, Kim HC, Kwon M.
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Lucy Dalton

University Hospitals Birmingham, UK.

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