Introduction¹

Laryngopharyngeal reflux (LPR) is a type of acid reflux, which happens when the stomach acid rises from the stomach to your esophagus, the swallowing tube. In the case of LPR, the reflux goes beyond the lower esophagus and also affects the larynx, the voice box and the pharynx, your throat. 

Difference between LPR and gastroesophageal reflux disease (GERD)

GERD is also known as chronic acid reflux, so this means the stomach acid routinely rises into your esophagus, affecting your lower esophagus. LPR, however, affects the throat more. 

Importance of early diagnosis and treatment in children

It is important to make sure your child has an early diagnosis, as untreated LPR can lead to many complications, such as bronchial inflammation, chronic voice and throat irritation, excessive mucus and frequent infections. 

Causes⁶

LPR is very common in the first few weeks /months of life, because of the sphincter at the base of the oesophagus, which has not yet matured. Many children with reflux will see improvement as they grow, mainly when they start to eat more solid foods and eat in an upright position. 

In some children, however, this reflux continues. This could be caused by a combination of several different factors, such as having a wider opening in the diaphragm and the oesophagus and a weaker sphincter. 

Symptoms of LPR in children^1,2,3

It is hard for your child to describe and to understand what they are feeling, so it is important to look out for symptoms such as:

• Chronic cough
• Hoarseness of voice
• Noisy breathing
• Asthma
• Croup
• Spit up
• Difficulty in feeding
• Turning blue
• Aspiration
• Pauses in breathing
• Growth deficiency
• Recurrent respiratory infections

Diagnosis^1,3,4

To this day, there is no standard test to identify LPR, but if you, as a parent, start to notice any symptoms of LPR in your child, you should ask your paediatrician to have a referral to see an otolaryngologist for an evaluation. The otolaryngologist would first ask general questions, such as about the symptoms and the onset of the symptoms. To help diagnose, they may use different tools and techniques, such as:

• Laryngoscopy - a 2mm tube is inserted via the nose to look directly at the voice box. This would be done after a numbing substance is given to your child
• 24-hour pH monitoring - also known as multichannel intraluminal impedance (MII-pH), which measures and monitors the acid reflux into the swallowing tube and the back and front of the throat for 24 hours

Differential diagnosis

It is easy to mistake other conditions, because of how similar the symptoms are to other conditions, including:

• Asthma
• Allergies
• Laryngitis
• Respiratory infections
• GERD

Treatment options^1,4,5,6,7

Lifestyle and dietary modifications

Changing some lifestyle steps can help in reducing LPR, including:

• Making sure they eat in an upright position
• Have your child eat smaller, more frequent meals
• Avoid any trigger foods
• Make sure they have some sort of exercise, like walking
• Dressing them in looser clothing can also help 
• Changing sleeping posture

Medical treatment

Medication is usually still very limited for treating LPR, but your doctor may provide proton pump inhibitors (PPIs), which aim to reduce acid reflux in combination with changing lifestyle. PPIs help to neutralise the acid by coating and protecting the tissues in your throat while they heal.

If symptoms still continue, then an acid-blocking medication like histamine-2 (H2) blockers can help by reducing the acid content in your reflux. Any medication given to your child should be discussed with your paediatrician or physician. 

There are other medications that you may give to your child that may also cause higher stomach acid, which include:

• Alpha blockers or calcium channel blockers (Dibenzyline, Procardia, Calan)
• Aspirin
• Anticholinergics (Bentyl, Donnatal)
• Beta blockers (Inderal, Corgard)
• Vitamin C supplements
• Progesterone (Provera, Ortho)
• Theophyllin (Theodur)

Surgical interventions

Surgery is usually not typical for LPR, unless it is affecting the esophageal muscles. To treat this, a minor procedure such as Nissen fundoplication treats the hiatal hernia and reinforces the esophageal muscles. 

In some children, any symptoms associated with stomach acid reflux can disappear with or without treatment, commonly by the age of two. However, in other children, LPR can be a long-term condition that can have a serious effect on both the child and the family’s quality of life. 

These days, there is more treatment available, with new medicine and surgical options that are being researched alongside a better understanding of the reason why LPR happens in children. 

Most children will see improvements in the symptoms experienced, particularly after surgical intervention, though there are some long-term effects in the long run. In this case, your child would be regularly reviewed by the healthcare professionals. 

Conclusion

LPR causes symptoms that affect your throat, vocal chords and sinuses. Most people may not think of acid reflux as a possible cause of the symptoms, but they are usually unaware of it. It only takes a small amount of acid to cause changes in your throat and voice, and an even smaller amount to cause inflammation to your lungs. Fortunately, LPR is easily managed with a change in lifestyle, and in most cases, treatment is successful, and it is only required for a short amount of time.