What Is Laryngopharyngeal Reflux?

Overview

Laryngopharyngeal reflux (LPR), also known as silent reflux or gastropharyngeal reflux disease, is a disorder where acid from the stomach flows back up into the throat (pharynx) and voice box (larynx). This may result in irritation and swelling within these regions, resulting in symptoms like hoarseness, repeated coughing, and a sense of a mass in the vocal cords. This can result in a wide range of unpleasant problems if not addressed.¹ 

Acid reflux is a condition that occurs when the lower oesophageal sphincter, a muscular valve that divides the stomach and oesophagus, does not shut correctly. The inability of the lower oesophageal sphincter to shut properly allows stomach acid and additional digestive secretions to flow upwards. Acid reflux tends to cause symptoms lower down in the chest, such as heartburn and indigestion. LPR, on the other hand, is a form of acid reflux that causes irritation to the vocal cords and the upper respiratory tract. This may lead to multiple symptoms, such as throat pain, voice changes, throat burning, coughing episodes, and trouble swallowing. 

In certain situations, LPR can bring about more serious complications. Such complications include laryngitis, oesophageal irritation, and potentially Barrett's oesophagus. Therapy for LPR usually includes habit adjustments, such as staying away from food and drinks that could induce reflux. Moreover, drugs are given to diminish the production of stomach acid. Occasionally, surgery might be essential to resolve the underlying cause of the LPR.²

Causes of laryngopharyngeal reflux

Many factors might contribute to the emergence of laryngopharyngeal reflux (LPR). These include: 

Physical abnormalities, such as a hiatus hernia or a weakened lower oesophageal sphincter:

• Hernias in the hiatus happen when the upper section of the stomach extends through the barrier between the chest and abdomen. This enables gastric acid to flow into the oesophagus and lead to discomfort
• A weakened lower oesophageal sphincter, which is responsible for keeping stomach acid from flowing back into the oesophagus, can also cause symptoms of LPR

Personal decisions including:

• Smoking: Tobacco use can cause irritation in the throat and oesophagus, and increase stomach acid production
• Acidic food and drinks: Consuming and ingesting sour foods and drinks, like oranges, tomatoes, and coffee, could also result in discomfort and swelling inside the oesophagus. Staying away from these triggers may assist in relieving LPR symptoms
• Certain medications: Finally, specific drugs, like aspirin and ibuprofen, can lead to the emergence of LPR by irritating the throat and oesophagus. Moreover, these drugs may raise stomach acid secretion

LPR can result from a blend of these aspects. It is crucial to recognise and tackle the fundamental reasons to properly handle the disease.³ 

Signs and symptoms of laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is an ailment that may lead to various uncomfortable and occasionally painful symptoms that can influence the oropharynx, voice box, and auditory pathways. Typical symptoms associated with LPR consist of:⁴

• A continual or long-lasting cough 
• Sore throat, raspiness
• Regular throat clearing 
• The sensation of an obstruction in the pharynx 

Additional signs that could be linked to LPR include: 

• Subglottic constriction
• Trouble with swallowing
• Ear complications, necessitating hearing aid intervention

Management and treatment for laryngopharyngeal reflux

Managing laryngopharyngeal reflux (LPR) involves multiple aspects like modifying your lifestyle, prescribed medications, and, in certain situations, an operation.⁶ 

To decrease LPR symptoms, changes in lifestyle like steering clear of foods that trigger symptoms, keeping a healthy body weight, and raising the head during sleep are encouraged. Moreover, stopping smoking can decrease symptom severity. Medications, like proton pump inhibitors (PPIs), help lower the production of stomach acid and bring relief. In highly severe instances, surgery might be required to fix any irregularities or damaged tissues. Surgical intervention is typically the final option since it involves inherent dangers and potentially unwanted consequences. Nevertheless, in certain situations, it is the only approach to properly handle the disorder. It is crucial to consult a physician to establish the best plan for addressing LPR.⁵ 

Diagnosis

Laryngopharyngeal reflux (LPR) may be challenging to identify because its symptoms are similar to other ailments. Nevertheless, through a comprehensive assessment and health assessments, a precise diagnosis can be concluded. 

To effectively diagnose LPR, medical experts might employ various approaches. This includes endoscopy, acid monitoring, and analysing bronchoscopic findings. Besides the tests previously mentioned, a physician might also prescribe a barium meal examination or an oesophageal function test. A barium swallow involves the use of an X-ray to detect abnormal structures within the throat or oesophagus. An oesophageal manometry test assesses the stress and displacement of the oesophagus. This can detect any irregularities within the muscles of your oesophagus that potentially lead to LPR-related symptoms. 

It is equally important to mention that reflux disease arises from diverse factors. Those factors involve acid reflux, sensitivities, tobacco use, and particular medications. Thus, it is crucial to talk about any changes in lifestyle or drugs that are possibly contributing to this state with a physician. 

FAQs

How can I prevent laryngopharyngeal reflux?

Although it might sometimes not be feasible to avoid LPR, specific changes in lifestyle can lower the probability of suffering from symptoms: 

• Consuming a well-balanced and healthy diet
• Steering clear of food triggers and beverages
• Consuming smaller portions at regular intervals 
• Sustaining a balanced weight
• Handling stress levels and getting enough rest
• Frequent physical activity
• Quitting tobacco and alcohol 

Making these lifestyle changes can help reduce the risk of experiencing LPR symptoms and improve overall health and well-being. Nevertheless, it is crucially important to seek advice from a healthcare practitioner for a precise diagnosis and therapy. 

How common is laryngopharyngeal reflux?

LPR is more prevalent than previously thought, affecting a significant number of individuals globally. However, due to the varied nature of symptoms and potential misdiagnosis, it is often underdiagnosed or mistaken for other conditions.

Who is at risk of laryngopharyngeal reflux?

Certain factors increase the risk of developing LPR. These can include obesity, pregnancy, smoking, consuming a high-fat diet, and having a family history of acid reflux or gastro-oesophageal reflux disease (GORD). Understanding these risk factors can help individuals take proactive steps to mitigate their chances of developing LPR.

What can I expect if I have laryngopharyngeal reflux?

If you are diagnosed with LPR, understanding the condition can help you navigate your treatment journey effectively. Your healthcare provider will work with you to develop a tailored management plan based on the severity of your symptoms and underlying causes. With proper management and treatment, most individuals experience improvements in their symptoms and overall quality of life.

When should I see a doctor?

If you experience persistent or worsening symptoms such as chronic cough, sore throat, or hoarseness, it is essential to consult with a healthcare professional. They can evaluate your symptoms, perform necessary tests, and provide an accurate diagnosis. Early intervention and treatment can help prevent further complications.

Summary

Laryngopharyngeal reflux (LPR) is a condition characterised by the backflow of stomach acid into the throat and voice box. It can result in a range of uncomfortable symptoms, such as a chronic cough, sore throat, and hoarseness. Lifestyle modifications, medications, and, in severe cases, surgery are often used to manage and treat LPR. Understanding the causes, symptoms, prevention methods, and treatment options is vital for individuals seeking relief from LPR-related symptoms. If you suspect you may have LPR, consult with a healthcare professional for an accurate diagnosis and personalised treatment plan.