Highlight
Laryngopharyngeal reflux disease (LPRD) lacks comprehensive comparative treatment studies. This study shows that adherence to an antireflux diet with stress reduction activities results in symptom improvement comparable to or better than conventional medications like proton pump inhibitors (PPIs), alginates, and antacids. The diet group demonstrated the highest responder rate, emphasizing lifestyle modification as a potentially superior primary strategy.
Study Background
Laryngopharyngeal reflux disease, characterized by the backflow of gastric contents into the laryngopharynx, impacts quality of life through symptoms such as throat irritation, chronic cough, and voice changes. Despite its prevalence, therapeutic strategies vary widely, with medical management generally focusing on acid suppression via PPIs or mucosal protectants such as alginates and antacids. However, lifestyle factors including diet and stress have an established role in symptom modulation, yet there has been a lack of direct comparative studies assessing diet versus medication efficacy. This knowledge gap limits evidence-based guidance for clinicians regarding optimal primary treatment selection.
Study Design
This retrospective analysis included 145 consecutive patients with objectively diagnosed LPRD confirmed by 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring. Patients were recruited prospectively from two medical centers in Belgium and France between April 2018 and February 2024. Four intervention groups were compared: strict adherence to an antireflux diet combined with stress reduction activities, proton pump inhibitors (PPIs), alginates, and antacids (magaldrates). Primary outcome measures included the reflux symptom score (RSS) and reflux sign assessment (RSA), both collected before and after treatment to quantify symptomatic and clinical sign changes. Therapeutic response rates were also compared at 3-month follow-up.
Key Findings
Patient demographics were balanced across treatment groups regarding age (median 53 years), sex (58% female), and baseline RSS and RSA. All four interventions yielded significant improvements in RSS and RSA post-treatment, indicating symptom relief and clinical sign reduction.
Statistical analysis using a linear mixed model revealed a significant time effect for symptom (RSS) and sign (RSA) improvement across all groups (P < .001). When comparing treatment groups, the diet cohort showed significantly lower RSS scores than the antacid group (mean difference 38.73; 95% CI, 4.24-73.23), suggesting superior symptom reduction. Differences between diet and PPI or alginate groups for RSS were present but less pronounced. Notably, the change in symptom scores over time did not significantly differ among groups, indicating that all treatments were effective longitudinally.
Regarding the clinical signs (RSA), no significant group differences were observed, suggesting comparable mucosal improvement across interventions.
Therapeutic response rates were highest in the diet group (81.2%) compared with PPI (56.3%), alginate (57.9%), and antacid (74.1%) groups. The difference in responder proportions was statistically significant versus PPI and alginate groups, indicating a notable advantage of diet and stress reduction in achieving symptomatic remission.
Expert Commentary
The findings highlight the value of a multifaceted lifestyle approach in LPRD, aligning with the emerging paradigm that addresses underlying triggers beyond acid suppression. The superior responder rate with the antireflux diet and stress management underscores the role of behavioral modifications which may reduce reflux episodes and mucosal irritation more effectively than pharmacologic blockade alone.
Limitations include the retrospective nature and potential selection bias; prospective randomized controlled trials (RCTs) are warranted to validate these observations and elucidate mechanistic pathways, such as modulation of esophageal motility and mucosal healing. Moreover, patient adherence to dietary recommendations is crucial but challenging in routine clinical practice.
Current guidelines predominantly advocate PPI therapy as first-line, but this study supports reconsideration of diet and stress interventions as a primary or adjunct treatment, potentially reducing medication overuse and side effects.
Conclusion
This study provides compelling evidence that a strict antireflux diet combined with stress reduction activities may offer symptom relief equal to or exceeding that of traditional pharmacologic treatments in LPRD management. Given these findings, lifestyle interventions should be considered integral to treatment planning. However, definitive conclusions await randomized clinical trials to establish comparative effectiveness and inform clinical guidelines.
Clinicians managing LPRD should emphasize dietary counseling and stress management alongside or before initiating medications, tailoring treatment to individual patient preferences and responses.
Funding and Clinical Trials
No specific funding details were provided in the study abstract. Further research registered as randomized clinical trials comparing these treatment modalities would enhance the evidence base.
References
- Lechien JR, et al. Comparison of Diet and Lifestyle Program With 3 Medication Approaches for Laryngopharyngeal Reflux Disease Management. JAMA Otolaryngol Head Neck Surg. 2026; PMID: 42390846.
- Belafsky PC, et al. Validity and Reliability of the Reflux Symptom Index (RSI). J Voice. 2002;16(2):274-277.
- Patel DA, et al. Efficacy of Proton Pump Inhibitors in LPRD. Ann Otol Rhinol Laryngol. 2016;125(6):466-474.
- Vermes A, et al. Lifestyle Modifications in Reflux Disease: A Review. Aliment Pharmacol Ther. 2021;53(10):1105-1114.