Multicomponent treatment for laryngopharyngeal reflux disease in patients over 65: age-related differences in patient-reported and endoscopic outcomes compared with younger adults

BACKGROUND: Laryngopharyngeal reflux disease (LPRD) in older adults may present with greater endoscopic severity, impaired symptom perception, and increased comorbidity burden, making clinical assessment and treatment selection particularly challenging in this population. Although proton pump inhibitors (PPIs) are commonly used, prolonged treatment in elderly patients raises safety concerns. Multicomponent medical devices, including alginate-based formulations, may offer a PPI-sparing alternative. Patients were assessed with the Revised Reflux Symptom Index (R-RSI), Voice Handicap Index-10 (VHI-10), and Reflux Sign Assessment (RSA) at baseline and after 2 months of treatment; the over-65 group underwent an additional assessment at 3 months. Mixed-effects linear regression models were used for longitudinal analysis. RESULTS: Both groups improved significantly across all outcomes. At 2 months, younger patients showed a greater reduction in R-RSI than older patients (Δ -13.3 vs. -7.3; P=0.016), whereas improvements in VHI-10 and RSA were similar. In patients aged ≥65 years, extending treatment to 3 months produced further clinically meaningful gains, with large effect sizes for R-RSI, VHI-10, and RSA, reaching values broadly comparable to those observed in younger adults at 2 months. CONCLUSIONS: was effective in older patients with clinically confirmed LPRD. Symptom improvement was more gradual in patients aged ≥65 years, but extending treatment to 3 months yields outcomes comparable to those observed in younger adults after 2 months. These findings may support the PPI-sparing strategy in elderly patients and suggest that treatment duration may need to be individualized based on age-related clinical characteristics.