High BMI a Significant Indicator of PPI Weaning Failure

by Amy E. Hamaker •

How feasible is a 22-day proton pump inhibitor (PPI) weaning protocol in a cohort of patients following successful empiric treatment for suspected laryngopharyngeal reflux disease (LPRD)?

Bottom line
Approximately 66% of patients who were on PPIs for LPRD were successfully weaned. High BMI was significantly predictive of failure to wean.

Background: Many physicians prefer an empiric trial of PPI therapy as the first step in patients with symptoms suggestive of LPRD. However, PPIs are not without side effects, and the role of long-term versus short-term PPI therapy for LPRD is not known. A gradual wean is favored over abrupt discontinuation due to rebound gastric acid hypersecretion upon cessation of treatment.

Study design: Retrospective chart review of 35 patients.

Setting: University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine.

Synopsis: PPI weaning was offered patients after they experienced symptomatic relief from an empiric PPI trial, as reflected by a reduction in the reflux symptom index (RSI) scores. Weaning was not offered to those who experienced ongoing LPR-related symptoms. Before initiation of the wean protocol, the median duration of PPI therapy was 7.5 months for the unsuccessful wean group and 6.0 months for the successful wean group. Median duration of follow-up for the unsuccessful and successful wean groups was 13 months and 18 months, respectively.

The unsuccessful wean group had a significantly higher BMI compared to the successful wean group. BMI was found to be a significant negative predictor of successful PPI wean while adjusting for age, sex, PPI treatment duration, and PPI regime. PPI regime was not a significant predictor of successful PPI wean while controlling for age, sex, PPI treatment duration, and BMI. Limitations included the study’s retrospective design, a large variation in PPI-treatment duration and follow-up duration, and lack of assessment of patient compliance on recommended dietary and lifestyle practices for LPRD.

Citation: Lin RJ, Sridharan S, Smith LJ, Young VN, Rosen CA. Weaning of proton pump inhibitors in patients with suspected laryngopharyngeal reflux disease. Laryngoscope. 2018;128:133–137.