J Neurogastroenterol Motil  https://doi.org/10.5056/jnm23118
The Impact of a Twice-daily vs Once-daily Proton Pump Inhibitor Dosing Regimen on Laryngopharyngeal Reflux Symptoms: A Prospective Randomized Controlled Trial
Jeong-Yeon Ji,1,2 Gene Huh,2,3 Eunjeong Ji,4, Jin Yi Lee,1 Seung Heon Kang,1,2 Wonjae Cha,1,2 Woo-Jin Jeong,1,2,5* and Young Ho Jung6*
1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea; 2Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea; 3Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 4Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea; 5Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea ; and 6Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence to: *Woo-Jin Jeong and Young Ho Jung are equally responsible to this work.

Woo-Jin Jeong, MD
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
Tel: +82-31-787-7407, E-mail: safar@snubh.org

Young Ho Jung, MD
Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Tel: , E-mail: entist@naver.com

Jeong-Yeon Ji and Gene Huh contributed equally to this work.
Received: July 31, 2023; Revised: October 26, 2023; Accepted: February 27, 2024; Published online: August 14, 2024
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Proton pump inhibitors (PPIs) play a crucial role in managing laryngopharyngeal reflux (LPR), but the optimal dosing regimen remains unclear. We aim to compare the effectiveness of the same total PPI dose administered twice daily versus once daily in LPR patients.
Methods
We conducted a prospective randomized controlled trial at a tertiary referral hospital, enrolling a total of 132 patients aged 19-79 with LPR. These patients were randomly assigned to receive either a 10 mg twice daily (BID) or a 20 mg once daily (QD) dose of ilaprazole for 12 weeks. The Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) were assessed at 8 weeks and 16 weeks. The primary endpoint was the RSI response, defined as a reduction of 50% or more in the total RSI score from the baseline. We also analyzed the efficacy of the dosing regimens and the impact of dosing and duration on treatment outcomes.
Results
The BID group did not display a higher response rate for RSI than the QD group. The changes in total RSI scores at the 8-week and 16-week visits showed no significant differences between the 2 groups. Total RFS alterations were also comparable between both groups. Each dosing regimen demonstrated significant decreases in RSI and RFS.
Conclusions
Both BID and QD PPI dosing regimens improved subjective symptom scores and objective laryngoscopic findings. There was no significant difference in RSI improvement between the 2 dosing regimens, indicating that either dosing regimen could be considered a viable treatment option.
Keywords: Ilaprazole; Laryngopharyngeal reflux; Proton pump inhibitors; Reflux Finding Score; Reflux Symptom Index

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