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JAMA Otolaryngology-Head & Neck Surgery
Among patients with laryngopharyngeal reflux, there was no significant difference in the reduction of reflux symptoms between patients treated with alkaline water and a plant-based, Mediterranean-style diet and those treated with proton pump inhibitors, according to a study published by JAMA Otolaryngology-Head & Neck Surgery.
Laryngopharyngeal reflux (LPR) is a common disorder that is the reflux (backing up) of stomach acid into the throat (pharynx) or voice box (larynx). Treatment of this disease has remained controversial, with few studies demonstrating that the current predominant regimen of proton pump inhibition (PPI) has a statistical advantage over other treatment methods. The treatment of LPR using this approach has significant economic ramifications, with PPI therapy alone costing more than 13 billion dollars in the United States in 2009.
Craig Zalvan, M.D., of New York Medical College, Valhalla, N.Y., and colleagues examined whether treatment with a diet-based approach alone can improve symptoms of LPR compared with treatment with PPI. The study included two treatment groups: 85 patients with LPR that were treated with PPI and standard reflux precautions (PS); and 99 patients treated with alkaline water, 90 percent plant-based, Mediterranean-style diet, and standard reflux precautions (AMS). The outcome was based on change in the Reflux Symptom Index (RSI).
The researchers found that the percentage of patients achieving a clinically meaningful reduction in RSI was 54.1 percent in PS-treated patients and 62.6 percent in AMS-treated patients. The average reduction in RSI was 27.2 percent for the PS group and 39.8 percent in the AMS group.
“Because the relationship between percent change and response to treatment has not been studied, the clinical significance of this difference requires further study. Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR. This approach may effectively improve symptoms and could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet,” the authors write.
The study notes some limitations, including the inherent biases of retrospective chart reviews, such as selection, information, and exclusion group biases. As rigorous as exclusion criteria were, patients with dual diagnoses may have been enrolled in the study, thus confounding results.
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