HSC Section 6 Nov2016 Green Book

Original Investigation Research

Age and Proton Pump Inhibitor Treatment

Table 1. Initial Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and LPR–Health-Related Quality of Life (LPR-HRQOL) According to Age Group

Score, Mean (SD)

18-39 y (n = 35)

40-59 y (n = 83)

60-79 y (n = 111)

P Value

Test RSI RFS

13.88 (7.68) 6.78 (4.86)

12.20 (8.90) 7.18 (4.55)

18.45 (10.43)

<.001

7.75 (3.84)

.44

LPR-HRQOL Voice

14.48 (18.65)

18.63 (21.36)

29.55 (21.17) 14.10 (12.40) 12.78 (11.50) 11.31 (9.30) 34.81 (23.26)

<.001 <.001 <.001 <.001 <.001

Cough

6.42 (7.36) 6.97 (7.99) 6.05 (7.25)

8.96 (7.36) 6.15 (7.22) 6.40 (6.38)

Throat clearing

Swallowing

Overall impact of acid reflux

21.28 (18.46)

21.45 (14.72)

Table 2. Improvement in Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and LPR–Health-Related Quality of Life (LPR-HRQOL) After Proton Pump Inhibitor Therapy According to Age

P Value

Score, Mean (SD)

Test

Baseline

1 Month

3 Months

Within Group Among Groups

RSI

18-39 y 40-59 y 60-79 y 18-39 y 40-59 y 60-79 y

13.88 (7.68) 12.20 (8.90) 18.45 (10.43)

8.77 (6.80) 7.57 (7.31) 12.89 (9.15) 3.89 (3.10) 4.34 (3.36) 5.76 (3.39) 14.28 (8.38) 17.41 (12.40) 24.27 (17.57)

4.62 (5.35) 5.32 (6.28) 10.81 (9.86) 2.92 (2.59) 2.98 (2.66) 4.40 (2.67) 11.93 (4.13) 14.02 (8.03) 23.08 (19.15)

<.001 <.001 <.001 <.001 <.001 <.001 <.001 <.001 <.001

.59

RFS

6.21 (4.87) 6.46 (4.70) 7.74 (3.92)

.50

LPR-HRQOL 18-39 y

21.50 (19.29) 20.81 (14.50) 35.20 (23.29)

40-59 y 60-79 y

.09

Statistical Analysis For statistical analysis, SPSS, version 18.0 (SPSS), was used, and all of the data are presented as mean (SD). A t test and analy- sis of variance (ANOVA) were used to compare age differ- ences in RSI, RFS, and LPR-HRQOL data. A repeated measure of ANOVA was used to determine which age group showed a greater response to PPI therapy. An ANOVA model in re- peatedmeasures at 3 timepointswas usedwithBonferroni cor- rection for multiple comparisons. Comparison of the propor- tion of responders according to age was made using a χ 2 analysis. A difference was considered statistically significant when the P value was less than .05.

Difference of RSI, RFS, and LPR-HQOL According to Age

The oldest patient group (60-79 years) with LPR had signifi- cantly higher mean (SD) baseline RSI scores than the 18- to 39- year-old and 40- to 59-year-old patient groups (18.45 [10.43] vs 13.88 [7.68] and 12.20 [8.90], respectively; P < .001). How- ever, the RFS score showed no significant difference among age groups. The oldest patient group showed significantly worse results on all domains of the LPR-HRQOL (all P < .001) ( Table 1 ).

Improvement of RSI, RFS, and LPR-HRQOL After PPI Therapy

Within each age group, scores on all 3 tests improved signifi- cantly during the period of PPI therapy; however, there was no significant difference among groups in the amount of im- provement (RSI, P = .59; RFS, P = .50; LPR-HRQOL, P = .09) ( Table 2 ).

Results Study Populations

Of 264 consecutive patients considered for the study, 35 were excluded because of loss of follow-up at 3 months. A total of 229 patients with LPRwere enrolled and completed the study without loss to follow-up. Therewere 135men (59.0%) and 94 women (41.0%). Themean (SD; range) age of the patients was 55.7 (14.0; 18-79) years. Patientswere divided into 3 age groups of 18 to 39, 40 to 59, and 60 to 79 years. The number of pa- tients in each groupwas 35 (15.3%), 83 (36.2%), and 111 (48.5%), respectively.

Difference in Proportion of Responders on RSI According to Age

Among the age groups, the proportion of responders, as evalu- ated by RSI score, showed no significant difference at 1month; however, responders were significantly more plentiful in the 2 younger groups than the oldest group at 3months ( P = .002) ( Table 3 ).

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