From the Guidelines
For excessive burping after laryngeal cancer treatment while taking Prilosec 20 mg twice daily, I recommend increasing the Prilosec dose to 40 mg twice daily or adding an H2 blocker like famotidine 20 mg twice daily, as well as implementing dietary modifications and other interventions to reduce symptoms. The patient's current medication regimen and symptoms should be reassessed to determine the best course of action. Dietary modifications are essential: eat smaller, more frequent meals; avoid carbonated beverages, alcohol, and foods that trigger symptoms (spicy, fatty, acidic); and don't lie down for 2-3 hours after eating. Chew food thoroughly and eat slowly to reduce air swallowing. Try over-the-counter simethicone (Gas-X) 125 mg after meals to reduce gas. Smoking cessation is crucial if still smoking. These interventions target both acid reflux and aerophagia (air swallowing), which commonly occur after laryngeal cancer treatment due to anatomical changes and swallowing difficulties.
Some key considerations for managing symptoms in patients with cancer include addressing reversible causes of anorexia, such as oropharyngeal candidiasis and depression, as outlined in the palliative care guidelines 1. Additionally, the use of appetite stimulants, such as megestrol acetate, may be considered for patients with months-to-weeks or weeks-to-days life expectancy, if increased appetite is an important aspect of quality of life 1. However, the current evidence does not directly support the use of these interventions for excessive burping after laryngeal cancer treatment.
If symptoms persist despite these measures, consult your oncologist or gastroenterologist, as an endoscopy might be needed to rule out recurrence or other complications like strictures. The NCCN guidelines for antiemesis may also be relevant in managing symptoms, although the current evidence does not directly support the use of antiemetic agents for excessive burping after laryngeal cancer treatment 1.
From the Research
Excessive Burping after Laryngeal Cancer Treatment
- Excessive burping can be a symptom of laryngopharyngeal reflux (LPR), which is often comorbid with chronic rhinosinusitis (CRS) 2.
- Treatment with proton-pump inhibitors (PPIs) such as omeprazole 20 mg once daily for 8 weeks has been shown to significantly reduce signs and symptoms of LPR and CRS 2.
- However, the provided study used omeprazole 20 mg once daily, whereas the patient is taking prilosec 20 mg twice daily, which may have different effects.
Laryngeal Cancer Treatment
- Definitive radiotherapy is a viable alternative to surgical treatment for locally advanced laryngeal cancer, with comparable outcomes in terms of overall survival, disease-free survival, and local recurrence-free survival 3.
- Adjuvant therapies such as docetaxel, cisplatin, and fluorouracil, as well as cetuximab, are used in the treatment of laryngeal cancer, especially in cases where laryngeal preservation is a goal 4.
- Multidisciplinary management of laryngeal cancer is crucial, as it affects vital functions such as voice and swallowing 4.
Diagnostic Imaging and Treatment Planning
- Diagnostic imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are used to assess the extent of laryngeal cancer and plan treatment 5.
- The choice of examination method depends on the patient's physical resilience, with CT being the tool of choice due to its short acquisition time and ability to perform functional maneuvers 5.
Systemic Therapy in Laryngeal Cancer
- Systemic therapy considerations for rare tumor types of the larynx, such as verrucous carcinoma, HPV-related SCC, and basaloid SCC, are important for patients with advanced disease or those who are not surgical candidates 6.
- However, there is a lack of guidelines regarding the best therapeutic approaches to these tumors, and treatment is often modeled after their recommended management at non-laryngeal sites 6.