Comparison of Diet and Lifestyle Program With 3 Medication Approaches for Laryngopharyngeal Reflux Disease Management.

Abstract

There are no studies comparing the primary therapeutic options for laryngopharyngeal reflux disease (LPRD). To compare the effectiveness of antireflux diet and 3 medication classes in patients with LPRD. This is a retrospective analysis of consecutive patients with LPRD who were prospectively recruited from April 2018 to February 2024 from 2 medical hospitals in Belgium and France. Data were analyzed in November 2025. Strict antireflux diet and stress reduction activities, alginates, magaldrates, or proton pump inhibitors. Age, sex, pretreatment to posttreatment reflux symptom score (RSS), and reflux sign assessment (RSA) were prospectively collected in patients with an objective LPRD diagnosis at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing. The pretreatment to posttreatment clinical features (RSS, RSA, and therapeutic response rates) were compared across patient groups regarding treatment regimens. Of 145 included patients, 84 (57.9%) were female, and the median (IQR) age was 53 (37.0-63.3) years. Patients treated with proton pump inhibitors (n = 32), antacids (n = 27), alginates (n = 38), and strict diet (n = 48) were comparable for median age, sex proportions, and baseline RSS and RSA. RSS and RSA demonstrated significant reduction in all groups. Linear mixed model analysis revealed a significant main effect of time on both RSS (F1,274 = 19.82; P < .001) and RSA (F1,219 = 26.47; P < .001), confirming symptom and sign improvement across all groups. For RSS, treatment group was significantly associated with RSS scores (F3,274 = 3.53; P = .02). The diet group had significantly lower estimated marginal mean RSS scores than the antacid group (mean difference, 38.73; 95% CI, 4.24-73.23). The change in RSS scores over time did not differ between groups. For RSA, neither the group effect nor the interaction reached significance. The diet group had the highest proportion of responders (diet, 39 of 48 [81.2%]; proton pump inhibitor, 18 of 32 [56.3%]; alginates, 22 of 38 [57.9%]; antacids, 20 of 27 [74.1%]), with proportion differences of 24.9 percentage points (95% CI, 4.6-45.4) compared with proton pump inhibitors, 23.4 percentage points (95% CI, 4.2-42.5) compared with alginates, and 7.2 percentage points (95% CI, -12.7 to 27.1) compared with antacids. In this cohort study, adherence to an antireflux diet and stress-reduction activities may be associated with comparable or greater symptom relief at 3 months posttreatment compared with conventional medical therapies. Randomized clinical trials comparing the 4 regimens are needed.