Therapeutic success of proton pump inhibitors in the therapy of contact granulomas

According to the current S2k guideline "Gastroesophageal Reflux Disease (GERD)" of 05/2014, an empirical proton pump inhibitor (PPI) therapy in double standard dose (e. g. Pantoprazole 40 mg 2 x/day) is recommended for the extraesophageal GERD manifestation (e. g. with formation of a contact granuloma, CG) for 8 weeks. However, valid study data don't exist. In a prospective study from 05.2015 to 12.2019 39 patients consecutively randomized with endoscopically proven KG received PPIs in single (1 x PPI, n = 22) or double standard dose (2 x PPI, n = 17) for 8 weeks. A possible gastrolaryngeal reflux as well as throat sensations, a tendency to clear the throat or a hoarseness were recorded at first presentation and at control after 4 months.This was archieved by videolaryngostroboscopy to detect hoarseness and to assess the development of the granuloma (progression, constant, remission <50%, >50% or complete). The two groups were compared. The granuloma disappeared or regressed in 40% of the cases with 1 x PPIs and in 77 % of the cases with 2 x PPIs (p<0.05) after therapy. At the control appointment 23 % of the patients with 1 x PPIs were completely symptom-free and 77% of the patients with 2 x PPIs. Throat sensation was the most frequent symptom at first presentation with 64%. In the control group after PPI therapy in single or double standard dose, throat sensations were only detectable in 33 % and 15 % in case of granuloma remission. However, if the granuloma was persistent, the symptoms could hardly be influenced. The therapy of a KG with PPIs in double standard dose is more effective than in single standard dose. These results must be confirmed on a larger collective.