Clinical and therapeutic outcomes
Symptoms were evaluated with reflux symptom score-12
(RSS-12),7 which is a validated 12-item patient
reported-outcome questionnaire including otolaryngological, digestive
and respiratory symptoms of reflux pre- to post-treatment and at the end
of the lockdown period. Reflux sign assessment (RSA) was used to rate
oral, pharyngeal and laryngeal findings associated with LPR throughout
treatment period.6 The stress level of patient at the
end of the lockdown period was evaluated with Perceived Stress Scale
(PSS), which is a 10-item validated patient-reported outcome
questionnaire.8
According to the HEMII-pH findings of reflux, patients benefited from a
3-month personalized treatment combining antireflux diet, proton pump
inhibitors (PPIs; pantoprazole 20mg once daily), alginate (Gaviscon®
3/d, Reckitt Benckiser, Slough, UK) or magaldrate (Riopan® 3/d, Takeda,
Zaventem, Belgium).6 Patients with acid reflux
benefited from pantoprazole and post-meal alginate, while those with
nonacid reflux were treated with post-meal magaldrate or alginate.
Individuals with weakly acid reflux received a combination of
pantoprazole and post-meal alginate or magaldrate. Patients with
nighttime reflux at the HEMII-pH tracing benefited from an additional
alginate or magaldrate (alkaline LPR) at bedtime.6
The antireflux diet consisted of the consumption of high-protein,
low-fat, alkaline, plant-based foods and beverages.6,9The drug titration was performed regarding the pre- to posttreatment
reflux symptom score (RSS-12) reduction, considering the following
response definitions: mild (RSS-12 reduction from 20 to 40%), moderate
(41 to 60%), high (61 to 80%) and complete (>80%)
responses.
At the first consultation, patients were invited to specify
‘refluxogenic’ foods and beverages that they commonly consumed through a
predefined list.9 At posttreatment time (the end of
the lockdown), they had to specify which foods and beverages that they
succeeded to decrease or stop. At this time, they were invited to
evaluate the influence of the lockdown on both the diet adherence and
stress level through a short patient-reported outcome questionnaire
(Appendix 1).