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J Voice. 2017 May;31(3):381.e15-381.e25. doi: 10.1016/j.jvoice.2016.06.024. Epub 2016 Sep 16.

A Mixed-Methods Study of Patient Views on Reflux Symptoms and Medication Routines.

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Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, Massachusetts 02118; Boston University, Sargent College, 635 Commonwealth Ave., Boston, Massachusetts 02215. Electronic address:
Santa Clara Valley Medical Center, 751 South Bascom, San Jose, California 95128.
Fairhaven Healthcare Center, 476 Varnum Ave., Lowell, Massachusetts 01854.
Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, Massachusetts 02118.



Gastroesophageal reflux disease is a chronic disorder often accompanied by laryngopharyngeal reflux. Speech-language pathologists are tasked with treating these patients with voice, dysphagia, and/or reflux therapy. This study investigated patient-reported reasons for reduced compliance with recommended reflux treatment and the top symptoms in patients with reflux, dysphagia, and voice symptoms.


This study used a cross-sectional qualitative and quantitative mixed-methods design to identify and describe patients' reflux symptoms and reflux medication routines.


Fifty-one patients completed a face-to-face, semistructured interview, a questionnaire, and the Reflux Symptom Index (RSI). Interview transcripts were coded by authors for concepts in two cycles.


During the 51 interviews, the top four reported symptoms were heartburn (n = 17), mucous (n = 11), dysphagia, and globus (n = 10). Further, 62.7% (n = 32/51) described an incorrect routine in taking their proton pump inhibitor (PPI): taking it with other pills, taking it with food/drink, and uncertainty about which pill is for reflux. RSI scores were moderately correlated with patient-reported reflux severity (r = 0.62, P < 0.0001, r2 = 0.34). Correct compliance with PPI timing was not enough to significantly lower RSI scores more than those who did not comply (an average RSI of 20.0 vs. 25.9, P = 0.1252).


Literature has not described the most relevant reflux-related symptoms and why PPI compliance is notoriously poor, from the patients' perspective. The results of this study confirm that PPI compliance is poor, and the reasons for poor compliance could have been prevented with patient education. Even when PPI compliance was adequate, symptoms like globus, mucous, voice dysfunction, and dysphagia persisted. Other interventions such as evidence-based diet and behavioral changes should be a part of voice/dysphagia/reflux therapy.


PPI; dysphagia; qualitative; reflux; voice

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