**Author details**

Comparing the patients' perception of treatment efficacy, reduction in RSI values for each single symptom before and after a 4 week-treatment with Marial® alone or with PPI in addon in EMERGE and RELIEF patients are reported in **Figures 5** and **6**. Marial® alone treatment induced a statistically significant higher reduction in each single symptom in RELIEF patients than in EMERGE patients, with the exception of heartburn, chest pain, indigestion, or stomach acid coming up (**Figure 5**). Similar results were obtained evaluating the reduction in RSI values in patients treated with PPI in add-on that was able to determine a higher statistically significant decrease in RELIEF than in EMERGE patients in each single symptom, with the

exception of heartburn, chest pain, indigestion, or stomach acid coming up (**Figure 6**).

gists in clinical practice.

60 Esophageal Cancer and Beyond

EMERGE and in RELIEF patients.

In conclusion, these two surveys provided some interesting outcomes: (i) diagnostic questionnaires (RSI, RFS, and GIS) are reliable and useful both during the visit and to orient the treatment decision; (ii) GERD and LPR present different clinical features; (iii) as consequence the treatments (both previous and actual) are different; (iv) the introduction of Marial® significantly affected the otolaryngologist approach and partially the gastroenterologist orientation; (v) Marial® was effective both in LPR and GERD patients; (vi) Marial® showed more effectiveness than conventional therapy (PPI plus add-on); and (vii) LPR patients were more responsive to medical treatments than GERD patients. Therefore, these outcomes may give a pragmatic usefulness to both otolaryngologists and gastroenterolo-

**Figure 6.** Reduction in RSI values for each single symptom before and after a 4 week-treatment with PPI + add-on in

Aragona Salvatore Emanuele1 , Mereghetti Giada1 and Giorgio Ciprandi2 \*

\*Address all correspondence to: gio.cip@libero.it

