What is Laryngopharyngeal Reflux?

Laryngopharyngeal reflux (LPR) is a disorder in which the contents of the stomach, including stomach acid, back up into the throat. Unlike the more common form of reflux, gastroesophageal reflux disease (GERD), LPR does not always cause heartburn, and its symptoms may not always be as clear-cut. Diagnosis generally requires special testing, which can include looking inside the throat with a special scope or testing the pH of the throat over time. Treatment of laryngopharyngeal reflux may include lifestyle changes, medications, and surgery.

Normally, the contents of the stomach, such as partially digested foods and stomach acid, are kept from flowing backward by special muscles in the esophagus, the tube that carries food from the throat to the stomach. With laryngopharyngeal reflux, these muscles don’t work properly, which allows the contents of the stomach to rise back up through the esophagus and into the throat. Acid from the stomach can irritate the lining of the throat, the vocal cords, and in some cases, even parts of the sinuses.

The symptoms associated with laryngopharyngeal reflux are generally related to the irritation being caused in the upper throat. They may include, for example, frequent coughing or throat clearing, hoarse voice, and a feeling of excess mucus or a lump in the throat. Unlike GERD, where the stomach contents back up only into the esophagus, heartburn is not always present in people with LPR.

Due to the fact that the symptoms of laryngopharyngeal reflux are not disease specific and can be caused by other health conditions, special testing is usually required for a firm diagnosis. One test that can be used involves inserting a scope into the back of the throat, which allows a health care provider to view the tissues of the throat and the vocal cords. In people with LPR, these are generally red and swollen and may show signs of acid damage. Another test that can be used to diagnose LPR involves inserting a special device through the nose and into the throat to test for changes in pH levels of the throat, which can be affected by the presence of stomach acid over about a 24-hour period.

Health care providers may recommend lifestyle changes, medication, or surgery to help treat laryngopharyngeal reflux. Lifestyle changes can include losing weight; raising the head of the bed a few inches; and limiting caffeine, alcohol, and spicy foods. Medications that may be used to treat LPR can include those to reduce the formation of stomach acid, such as proton pump inhibitors, and those to block the effects of acid, such as antacids. Surgery to make it harder for stomach contents to flow backward may be recommended in severe cases of LPR or if other treatments don’t work.