Tuesday, 18 January, 2022
HomeOtolaryngologyMediterranean diet plus water at least as good as PPIs for reflux

Mediterranean diet plus water at least as good as PPIs for reflux

Among patients with laryngo-pharyngeal 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 (PPIs), according to a study.

Laryngo-pharyngeal 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 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 $13bn in the US in 2009.

Dr Craig Zalvan, of New York Medical College, Valhalla, 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% 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% in PS-treated patients and 62.6% in AMS-treated patients. The average reduction in RSI was 27.2% for the PS group and 39.8% 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.

Abstract
Importance: Laryngopharyngeal reflux (LPR) is a common disorder with protean manifestations in the head and neck. In this retrospective study, we report the efficacy of a wholly dietary approach using alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions compared with that of the traditional treatment approach of proton pump inhibition (PPI) and standard reflux precautions.
Objective: To determine whether treatment with a diet-based approach with standard reflux precautions alone can improve symptoms of LPR compared with treatment with PPI and standard reflux precautions.
Design, Setting, and Participants :This was a retrospective medical chart review of 2 treatment cohorts. From 2010 to 2012, 85 patients with LPR that were treated with PPI and standard reflux precautions (PS) were identified. From 2013 to 2015, 99 patients treated with alkaline water (pH >8.0), 90% plant-based, Mediterranean-style diet, and standard reflux precautions (AMS) were identified. The outcome was based on change in Reflux Symptom Index (RSI).
Main Outcomes and Measures :Recorded change in the RSI after 6 weeks of treatment.
Results: Of the 184 patients identified in the PS and AMS cohorts, the median age of participants in each cohort was 60 years (95% CI, 18-82) and 57 years (95% CI, 18-93), respectively (47 [56.3%] and 61 [61.7%] were women, respectively). The percentage of patients achieving a clinically meaningful (≥6 points) reduction in RSI was 54.1% in PS-treated patients and 62.6% in AMS-treated patients (difference between the groups, 8.05; 95% CI, −5.74 to 22.76). The mean reduction in RSI was 27.2% for the PS group and 39.8% in the AMS group (difference, 12.10; 95% CI, 1.53 to 22.68).
Conclusions and Relevance :Our data suggest that the effect of PPI on the RSI based on proportion reaching a 6-point reduction in RSI is not significantly better than that of alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions, although the difference in the 2 treatments could be clinically meaningful in favor of the dietary approach. The percent reduction in RSI was significantly greater with the dietary approach. 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.

Authors
Craig H Zalyan, Shirley Hu, Barbara Greenberg, Jan Geliebter

[link url="https://media.jamanetwork.com/news-item/dietary-approach-found-effective-medications-treating-type-reflux-disease/"]JAMA material[/link]
[link url="http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2652893"]JAMA Otolaryngology-Head and Neck Surgery abstract[/link]
[link url="http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2652892"]JAMA Otolaryngology invited commentary[/link]

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