Reflux Band in Laryngopharyngeal Reflux

Study Overview
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Brief Summary
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This 12 week biomarker targeted double blind randomized controlled trial (RCT) will enroll subjects with salivary pepsin positive laryngopharyngeal reflux (LPR) to assess efficacy of the external upper esophageal sphincter (UES) compression device, also known as the Reflux Band. Subjects will be randomized to one of two arms: control or experimental. Following the 8 week intervention period subjects in both arms will continue in a 4 week unblinded period. The primary hypothesis is that a significantly higher proportion of subjects in the experimental arm will meet the primary endpoint for symptom response, compared to subjects in the control arm.

Detailed Description
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This study seeks to understand if the Reflux Band is an effective treatment for laryngopharyngeal reflux (LPR) in comparison to a sham device. LPR is a syndrome in which acid that is made in the stomach travels up the esophagus and into the throat, causing chronic symptoms including throat clearing, voice hoarseness, sore throat, etc. Participation in the study may or may not benefit you directly, and may result in new knowledge that may help others. Participation in this study involves: 3 - 4 in person visits (2 of which are part of standard of care) ranging from 30 - 45 minutes each and 2 virtual visits, either by phone or video, each 15 minutes. Participants are assigned with a 50/50 chance (similar to a coin flip) via a computer generator to receive the Reflux Band or sham device (a device that will not provide you medical therapy) which they will wear around their neck nightly while sleeping (6+ hours) over a duration of 8 weeks. The Reflux Band, which has been cleared for use by the FDA, applies pressure to the outside of the neck at the cricoid cartilage, at the middle of the neck, and increases the internal pressure of the muscle separating the throat from the esophagus (upper esophageal sphincter). Participants will only wear the band while sleeping at night and remove in the morning upon waking. The in person visits will occur at one of these UCSD La Jolla locations: the Perlman Medical Office Gastroenterology clinic, the Center for Voice and Swallowing, Altman Clinical and Translational Research Institute (ACTRI) Clinic. There is an optional 4 week extension at the end of this study in which the Reflux Band will be refit (if sham) to provide the manufacturer's specified pressure. This portion contains 1 virtual follow up during week 10 and an in person follow up during week 12, at which time study participation will conclude. The most commonly expected risks of the study are skin reaction, discomfort, and difficulty sleeping. These were generally mild and short in duration. No serious risks were observed when the Reflux Band was worn around the neck in previous studies.

Official Title
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Randomized Sham-Controlled Trial of the Reflux Band in Laryngopharyngeal Reflux (LPR)

Conditions
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Laryngopharyngeal Reflux

Intervention / Treatment
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* Device: External Upper Esophageal Sphincter (UES) Compression Device
* Device: Sham Device


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults between 18-99, English or Spanish speaking ≥8 weeks of laryngeal symptoms (dysphonia, throat clearing, cough, globus, and/or sore throat) Current use of double daily dose acid suppression therapy (ex. omeprazole 40mg, omeprazole 20mg and famotidine 20mg) Laryngoscopic exam prior to screening with current symptoms At least 1 of the following: Elevated reflux testing Findings on upper endoscopy that are consistent with pathologic GERD Fasting pepsin analysis result of ≥25 ng/mL within 4 months of enrollment (12 months if treatment plan has not changed) *testing allowed at enrollment if not previously obtained Exclusion Criteria: Prior use of Reflux Band (UES Compression Device) Sino-pulmonary conditions (such as asthma, COPD, post-nasal drip, heavy voice use) as primary etiology of laryngeal symptoms as deemed by treating gastroenterologist and / or laryngologist Laryngeal mass or lesion on laryngoscopy Pregnant or breastfeeding Unable to consent in English or Spanish Imprisoned Patients with a prior foregut surgery Patients with a known achalasia diagnosis Inability to fast for 4 hours Active tobacco use Supplemental oxygen use Contraindication to UES Compression Device manufacturer guidelines: Patients with implants or implant parts that reside in the area where Reflux Band is applied: implanted pacemarker, implanted cardioverter defibrillator (ICD), vagus nerve stimulator (VNS), or other such devices implanted in the neck Patients diagnosed with glaucoma. Patients who had a malignancy of the neck, including neck surgery. Patients that may have an altered mental status including due to the use of sedative drugs or narcotics. Patients with carotid artery disease, uncontrolled thyroid disease, a history of cerebrovascular disease, or connective tissue disorder of Marfan's Syndrome or Ehlers-Danlos Syndrome Patients who use nocturnal NIV machines such as CPAP or BiPAP.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Subjects will be randomized to one of two arms: control or experimental. Randomization will be 1:1 to control (sham, known not to provide intervention) and experimental (fit to manufacturer guidelines).
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Control<br>Participants allocated to the control arm will be fit with the UES Compression Device at a pressure known not to provide intervention. | Device: Sham Device<br>* External Upper Esophageal Sphincter (UES) Compression Device fit to pressure known not to provide treatment.<br>|
| Experimental: Experimental<br>Participants allocated to the experimental arm will be fit with the UES Compression Device according to manufacturer guidelines. | Device: External Upper Esophageal Sphincter (UES) Compression Device<br>* External Upper Esophageal Sphincter (UES) Compression Device fit to manufacturer guidelines.<br>* Other names: Reza Band;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measure response to the UES Compression Device in pepsin positive LPR. | Change in reflux symptom index score (primary outcome) between intervention versus sham arm will determine device efficacy. | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measure pepsin response to the UES Compression Device in pepsin positive LPR. | Change in salivary pepsin concentration between pre and post treatment. | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Proton Pump Inhibitor (PPI), Upper Esophageal Sphincter (UES) Compression Device