The role of oral formulation of hyaluronic acid and chondroitin sulphate for the treatment of the patients with laryngopharyngeal reflux

Introduction: Proton pump inhibitors (PPI) are an important breakthrough in the treatment of gastroesphageal reflux disease (GERD). However, in patients with laryngopharyngeal reflux (LPR), one of the extraoesophageal syndromes of this disease, the effectiveness of PPI therapy is partial or limited, and additional treatment is required to alleviate the symptoms. Currently, the important role of hyaluronic acid (HA) and chondroitin sulfate (CS) and their important role in the healing of mucosal damage, primarily the larynx, is emphasized. The aim of the study was to evaluate the results of treatment of patients with LPR by the oral combination preparation of hyaluronic acid and chondroitin sulfate (HA + CS) on a bioadhesive carrier. Material and methods: The study included 51 patients (18 men and 33 women) aged 25-75 years reporting symptoms of LPR, confirmed in the laryngovideoscope study. Patients were qualified for the study on the basis of reflux symptom index (RSI) above 13 points and the scale of reflux morphological symptoms of LPR in laryngofiberoscopic examination (reflux finding score; RFS) above 7 points. They were recommended to use the HA + CS combination for 14 days with subsequent evaluation. Results: Symptoms indicating a serious or severe problem (4 or 5 points on the RSI scale) before treatment are: grunting (48 patients; 90.19%), hoarseness (29 people; 56.86%) and coughing after eating/lying down (37 people; 72.50%). After treatment, the patients indicated that the above conditions limit their daily functioning to a moderate extent (p < 0.001). Symptoms such as the presence of mucus in the throat, a nagging cough, a feeling of obstruction in the throat, defined initially as moderate (3 points), after the supportive treatment decreased to a low level (1 point) (p < 0.001). The total RSI value after treatment was assessed as borderline for LPR diagnosis (median 13, range 12-15). The patient was not free of GERD symptoms, however, a significant reduction of discomfort was achieved in the whole study group. Morphological changes of the larynx before treatment most often included: redness/hyperemia, swelling of the vocal folds and hypertrophy of the posterior commissure. They were found in all patients. After treatment, the total RFS value below the LPR diagnosis limit (median 6, range 5-7) was observed, which compared to RFS (median 9, range 8-10) before treatment indicated a significant reduction of larynx changes in almost the entire study group (N = 50; 98.04%) (p < 0.001). Conclusions: A combined preparation of hyaluronic acid and chondroitin sulfate on a bioadhesive carrier, acting locally,significantly reduces the symptoms of laryngopharyngeal reflux, mainly in patients with: chronic cough, grunting and hoarseness. In addition, by covering the laryngeal mucosa with a protective layer, it allows better hydration and accelerates the healing process and regeneration of the mucosa, which in turn causes a reduction or withdrawal of morphological changes in the larynx.