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).