{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:08:31Z","timestamp":1790287711937,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"S6","license":[{"start":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T00:00:00Z","timestamp":1503705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Empiric proton pump inhibitor (PPI) trials for laryngopharyngeal reflux (LPR) are common. A majority of the patients respond to acid suppression. This work intends to evaluate once\u2010daily, 40 mg omeprazole and once\u2010nightly, 300 mg ranitidine (QD\/QHS) dosing as an alternative regimen, and use this study's cohort to evaluate empiric regimens prescribed for LPR as compared to up\u2010front testing with pH impedance multichannel intraluminal impedance (MII) with dual pH probes and high\u2010resolution manometry (HRM) for potential cost minimization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort review and cost minimization study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A chart review identified patients diagnosed with LPR. All subjects were treated sequentially and outcomes recorded. Initial QD\/QHS dosing increased after 3 months to BID if no improvement and ultimately prescribed MII and HRM if they failed BID dosing. Decision tree diagrams were constructed to determine costs of two empiric regimens and up\u2010front MII and HRM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010seven subjects met the criteria. Responders and nonresponders to empiric therapy were identified. Seventy\u2010two subjects (74%) responded. Forty\u2010eight (67% of responders and 49% of all) improved with QD\/QHS dosing. Forty\u2010nine (51%) subjects escalated to BID dosing. Twenty\u2010four subjects (33% of responders and 25% of all) improved on BID therapy. Twenty\u2010five subjects (26%) did not respond to acid suppression. Average weighted cost was $1,897.00 per patient for up\u2010front testing, $3,033.00 for initial BID, and $3,366.00 for initial QD\/QHS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An alternate QD\/QHS regimen improved the majority who presented with presumed LPR. Cost estimates demonstrate that the QD\/QHS regimen was more expensive than the initial BID high\u2010dose PPI for 6 months. Overall per\u2010patient cost appears less with up\u2010front MII and HRM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4. <jats:italic>Laryngoscope<\/jats:italic>, 127:S1\u2013S13, 2017<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26806","type":"journal-article","created":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T10:36:44Z","timestamp":1503743804000},"source":"Crossref","is-referenced-by-count":53,"title":["Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up\u2010front, pH\u2010impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5666-2482","authenticated-orcid":false,"given":"Thomas L.","family":"Carroll","sequence":"first","affiliation":[{"name":"Department of Surgery Division of Otolaryngology, Brigham and Women's Hospital 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