Clinical Trial: Assessing the Impacts of a UESAD on Laryngeal Symptoms and Salivary Pepsin

Study Status: Enrolling by invitation
Recruit Status: Enrolling by invitation
Study Type: Interventional

Official Title: Assessing the Impacts of an Upper Esophageal Sphincter Assist Device on Laryngeal Symptoms and Salivary Pepsin: A Pilot Study

Brief Summary: It is postulated that the incompetence of the upper esophageal sphincter (UES) to restrict passage of esophageal refluxate is fundamental to the development of LPR. The UES Assist Device (UESAD) is a novel device that applies relatively modest external cricoid pressure, which results in a 20 to 30 mmHg intraluminal UES pressure increase. Pepsin, a proteolytic enzyme produced in the stomach, has been detected in the laryngeal epithelium of patients with reflux associated laryngeal symptoms and implicated in the pathogenesis of laryngopharyngeal reflux. This study will asses the effectiveness of a UESAD worn for 2 weeks on LPR symptoms and salivary pepsin levels.

Detailed Summary: A cost-effective and care appropriate algorithm to streamline the diagnosis and management of patients with laryngopharyngeal reflux (LPR) has not been described. It is postulated that the incompetence of the upper esophageal sphincter (UES) to restrict passage of esophageal refluxate is fundamental to the development of LPR. The UES Assist Device (UESAD) is a novel device that applies relatively modest external cricoid pressure, which results in a 20 to 30 mmHg intraluminal UES pressure increase. Pepsin, a proteolytic enzyme produced in the stomach, has been detected in the laryngeal epithelium of patients with reflux associated laryngeal symptoms and implicated in the pathogenesis of laryngopharyngeal reflux. A study examining salivary pepsin levels for patients pre- and post-fundoplication for LPR found that all patients with positive preoperative pepsin levels and postoperative elimination had symptom improvement, suggesting that changes in pepsin level may be reflective of surgical responsiveness. This study seeks to explore the therapeutic role of the UESAD in patients with LPR symptoms, and measure its effectiveness by objective criteria (salivary pepsin) and symptomatic improvement. In this study, 25 patients seen in GI clinic with laryngeal complaints will complete validated symptom questionnaires - the RSI, GerdQ and N-GSSIQ scores. Those with an RSI > 13 and GerdQ > 8 will be included. They will submit 3 baseline sputum samples for pepsin analysis, taken upon awaking. They will then be advised to use the UESAD nightly for 2 weeks. 3 follow-up sputum samples for pepsin analysis will be taken and symptom scores reevaluated after the 2 week period.
Sponsor: Northwestern University

Current Primary Outcome: Change in Salivary Pepsin Concentration [ Time Frame: 2 weeks ]

change in average salivary pepsin concentration before and after UESAD treatment


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Change in RSI score [ Time Frame: 2 weeks ]
    change in respiratory symptom index score
  • Change in GerdQ score [ Time Frame: 2 weeks ]
    change in GerdQ reflux questionnaire score
  • Change in NGSSIQ score [ Time Frame: 2 weeks ]
    change in NGSSI questionnaire score


Original Secondary Outcome: Same as current

Information By: Northwestern University

Dates:
Date Received: September 16, 2015
Date Started: September 2015
Date Completion: August 2018
Last Updated: October 3, 2016
Last Verified: October 2016