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PPIs have been tested against placebo for silent reflux (LPR) in randomized trials. A meta-analysis of 8 placebo-controlled trials (344 patients) found PPIs did not reduce throat symptoms significantly more than placebo. A later review of the RCTs reached the same conclusion. PPIs lower stomach acid. LPR symptoms in the throat involve more than acid, including pepsin and a barrier that is not holding pressure. That may be why acid suppression alone so often falls short. If you take a prescribed
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