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Thursday, October 5, 2017

PPIs Not Superior to Dietary Intervention for Reflux

A primarily plant-based, Mediterranean-style diet with alkaline water showed significantly greater improvement for laryngopharyngeal reflux (LPR) symptoms than treatment with proton-pump inhibitors (PPIs), according to a retrospective study published September 7 in JAMA Otolaryngology–Head & Neck Surgery. 

"This study indicates that, by supplementing with alkaline water and a Mediterranean-style diet, effective control of symptoms as defined by the RSI [Reflux Symptom Index] may be obtained without PPI use," write Craig H. Zalvan, MD, from New York Medical College in Valhalla, and colleagues. "Other benefits of this diet-based approach include decreased risk for and improved control of cardiovascular disease, diabetes, stroke, and cancer, and avoiding the risks of drug interaction or complication."

The researchers retrospectively analyzed the medical records of two cohorts from different timeframes who received different treatments for LPR. One cohort of 85 patients, from 2010 to 2012 with a median age of 60 years, took esomeprazole twice daily or dexlansoprazole daily. They also followed standard reflux dietary precautions, including avoiding coffee; tea; chocolate; soda; alcohol; and greasy, fried, fatty, and spicy foods.

The other cohort, 99 patients from 2013 to 2015 with a median age of 57 years, received alkaline water and a 90% plant-based Mediterranean-style diet in addition to standard reflux precautions. (The water had a pH above 8.0.) Patients with potentially confounding comorbidities, such as a cough, a history of neuropathic pain, or dysphonia, were excluded.

The researchers compared the change in RSI scores between the two groups after 6 weeks of treatment. Among those taking PPIs, 54.1% of the patients had at least a 6-point reduction in their RSI, the minimum improvement deemed clinically meaningful. The average reduction in RSI across the group was 27.2%.

Meanwhile, 62.6% of those receiving the alkaline water and diet had a meaningful improvement in their RSI (difference between the groups, 8.05; 95% confidence interval [CI], –5.74 to 22.76). This group had a 39.8% average reduction in RSI (difference between groups, 12.1; 95% CI, 1.53 - 22.68).

http://www.medscape.com/viewarticle/885356

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