2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Calvo-Henriquez C, Ruano-Ravina A, Vaamonde P, et al. Is pepsin a reliable marker of laryngopharyngeal reflux? A systematic review. Otolaryngol Head Neck Surg . 2017; 157(3):385-391. EBM level 2..................................................................................188-194 Summary : This study reviews the recent publications addressing the diagnosis of laryngopharyngeal reflux using various pepsin assays. Results support the utility of pepsin, though the best method of detection has yet to be elucidated. It also highlights the potential problems with sensitivity and specificity that prevent its espousal as a “gold- standard” tool. Francis DO, Patel DA, Sharda R, et al. Patient-reported outcome measures related to laryngopharyngeal reflux: a systematic review of instrument development and validation. Otolaryngol Head Neck Surg . 2016; 155(6):923-935. EBM level 4......................195-207 Summary : In the absence of readily available diagnostic tests, many clinicians rely upon patient-reported outcome (PRO) measures to diagnose laryngopharyngeal reflux and to gauge treatment success. This study critically and systematically examined those outcome measures and found all measures to be deficient to variable degrees. It highlights the need to understand each PRO before applying it in research or clinical decision-making. This study employs investigational methods that do not often appear in otolaryngologic literature. Gomm W, von Holt K, Thomé F, et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims data analysis. JAMA Neurol . 2016; 73(4):410-416. EBM level 2....................................................................................208-214 Summary : This article has made a big splash in the lay press. It is a prospective cohort study of 73,679 subjects who take proton pump inhibitors (PPIs) regularly and an internal control group of individuals who do not take PPIs. The authors found an increased risk if dementia in individuals taking PPIs. The hazard ratio was 1.44 (95% CI, 1.36 to 1.52; p < 0.001). Xie Y, Bowe B, Li T, et al. Risk of death among users of proton pump inhibitors: a longitudinal observational cohort study of United States veterans. BMJ Open . 2017; 7(6):e015735. EBM level 3.....................................................................................215-225 Summary : This a large 5-year longitudinal cohort study using an Veterans Administration (VA) database following patients prescribed proton pump inhibitors (PPIs) and H2 blockers. Their primary outcome measure was death. The authors use several statistical techniques to try to control for the numerous variables to determine if PPIs were an independent risk factor. While there are some mythological questions that remain, the authors determined that they believe that PPI use is associated with an increased risk of death in the VA population.