CERT

The Comparative Efficacy of Reflux Treatments: an interim report

An unpublished 2014 survey of 100 refluxers recruited via social media groups, identified the most reported symptoms of acid reflux apart from heartburn.1

70% reported experiencing Hoarseness, 64% constant throat clearing, 58% post nasal drip, 58% chronic cough, 53% sinusitis, 53% bad taste in mouth, 50% Globus (lump in throat), 42% Asthma-like symptoms (shortness of breath), 41% tooth decay or sharp edges to teeth, 35% Catarrhal symptoms (blocked nose), 35% Loss of voice, 35% dry or gritty eyes, 30% nocturnal ear waxing. 

In other responses, the following indicators were highly indicated: Bad breath, Tinnitus, Hyposmia (poor sense of smell), Sore throat. 

These findings were used to inform further linked surveys in 2017 to ascertain the efficacy of PPI medication vs fundoplication surgery in the management of the extra-oesophageal symptoms.2

The 2017 surveys had responses from 50 acid refluxers who didn’t used acid suppressants but only antacids as required. This provided a “control” group by which treatment regimens could be judged.

There were 100 responses from regular users of acid suppressant medicine, specifically PPIs, and 50 from refluxers who had undergone surgery, specifically Laparoscopic Nissen Fundoplication (LNF).

It was that survey that demonstrated that, although PPIs may be great in reducing acid production, they do not have any noticeable effect on reflux. Reflux is a mechanical action of material flowing back through a Lower Oesophageal Sphincter that is not working properly.

1.   The study is reported in this personal blog, LPR  (2014 survey)

2.   Published in Academia “Prevalence of Extra-Oesophageal Reflux symptoms ...”

These charts compare reported symptoms from PPI users and LNF recipients with the control group.

It must be assumed those taking regular PPI acid reduction medicine may have had more pronounced symptoms initially compared with the control group. The reported symptoms from those using PPIs are largely only within a few percentage points of those reported by the control group but notably, when looking at reported chest symptoms, i.e. chronic cough, are a massive 70% greater, highlighting continuation of aspirated reflux, thus leading to the conclusion that PPIs are ineffective at controlling reflux.

To compare efficacy, a simple score was allocated to each by simply adding the percentage points for each of the symptom categories. For a group who have zero symptoms in a category, the score would be zero, whereas if all the members exhibited the symptoms, the score would be 100.
With 8 identified categories, the efficacy scores could theoretically range from zero (a perfect score) to 800 which would mean no effect whatsoever.

Results:

For the control group (no reflux control treatments), score is 295

For those taking PPIs, the score is 371. Higher than control but probably greater previously. There is no suggestion that PPIs actually made reflux worse.

For those who had LNF, the score is 167 which is significantly less.

Newer treatments

With other anti-reflux treatments available, in 2025, it was considered this survey tool may be used to assess the efficacy of those.

Two treatments were selected. LINX which had been heavily promoted and RefluxStop which had gained an almost religious following from a number of refluxers who considered this must be their salvation.

Surveys identical to those used for LNF were used. With the approval of their moderators, responses were sought from members of Facebook groups for LINX recipients and for RS recipients. It was hoped that we would be able to recruit 50 members for each group with a minimum of 20 decided to provide sufficient data. Unfortunately, the moderators of the RS group, decided to rescind their decision regarding recruitment for the surveys on their site as a member questioned whether the data was truly anonymous (which, of course, it was). At that point we had received 19 responses from RS recipients and 20 responses from LINX recipients.

It was decided to terminate those surveys and utilise the reduced data we had.

This chart shows results from the LINX surveys:

Using the efficacy scoring, LINX scored 200.

This chart shows the results from the RS surveys:

Although the necessity to keep clearing the throat shows a dramatic improvement, the overall score was disappointingly only 328. Although this is better than PPIs, it is not really much different to the score of the control group.

This chart compares all the treatments:

This compares the CERT scores:

If it is possible to recruit recipients of other anti-reflux treatments, e.g. TIF or Stretta, this study could be expanded further.

8 July 2026