Laryngopharyngeal Reflux (LPR) Overview Vector

Laryngopharyngeal Reflux: Causes and Treatment (2024)

by | Updated: Feb 7, 2024

Laryngopharyngeal reflux (LPR) is a condition that often goes unnoticed but can significantly impact a person’s quality of life.

Unlike typical acid reflux, LPR primarily affects the throat and voice box, leading to symptoms such as chronic throat clearing, hoarseness, and a persistent cough.

This article explores the causes, symptoms, and potential treatments for laryngopharyngeal reflux, shedding light on this often-overlooked condition.

What is Laryngopharyngeal Reflux?

Laryngopharyngeal reflux (LPR) is a condition where stomach acid flows back into the throat, causing irritation and symptoms like a sore throat, hoarse voice, and cough. Unlike typical acid reflux, LPR doesn’t always cause heartburn but can significantly affect the throat and voice box.

Laryngopharyngeal Reflux Vector Illustration

Causes

Laryngopharyngeal reflux is primarily caused by the dysfunction of the upper esophageal sphincter, allowing stomach acid to flow backward into the throat.

Contributing factors include obesity, diet (spicy, fatty, or acidic foods), alcohol, smoking, stress, and certain medications.

Conditions like hiatal hernia or delayed stomach emptying can also predispose individuals to LPR.

Risk Factors

Risk factors for laryngopharyngeal reflux include obesity, smoking, heavy alcohol consumption, a diet high in fatty or spicy foods, caffeine intake, and certain medications or medical conditions that affect muscle tone and function in the esophagus.

Stress and poor posture, especially while eating, can also exacerbate the condition.

Symptoms

Symptoms of laryngopharyngeal reflux include:

  • Chronic Cough: Persistent cough that doesn’t respond to typical cough treatments.
  • Hoarseness or Voice Changes: The voice may sound raspy, strained, or there may be frequent voice breaks.
  • Throat Clearing: The sensation of something being stuck in the throat leading to frequent throat clearing.
  • Sore or Burning Throat: Persistent soreness or a burning sensation in the throat.
  • Difficulty Swallowing: Sensation of food sticking in the throat or chest, or feeling like food is ‘sticking’ on the way down.
  • Lump in the Throat Sensation (Globus Sensation): Feeling like there is something stuck in the throat.
  • Breathing Difficulties or Choking Episodes: Especially at night or when lying down.
  • Excessive Phlegm or Mucus: Feeling of mucus accumulation in the throat or constant need to clear the throat.

Note: These symptoms can be exacerbated by meals, lying down, or bending over. Unlike typical acid reflux, heartburn isn’t as common in LPR.

Diagnosis

Diagnosing laryngopharyngeal reflux typically involves a combination of clinical evaluation, patient history, and specialized tests:

  • Clinical Evaluation: A healthcare provider will assess symptoms, medical history, and perform a physical examination, focusing on the throat and voice box.
  • Laryngoscopy: A visual examination of the throat, voice box, and vocal cords using a flexible fiber-optic camera (laryngoscope) to look for redness, swelling, and other signs of irritation or damage.
  • 24-Hour pH Monitoring: A test where a probe is placed in the esophagus to measure acid levels over 24 hours. It can detect acid reflux episodes and their correlation with symptoms.
  • Esophagogastroduodenoscopy (EGD): A procedure where a scope is used to view the lining of the esophagus, stomach, and first part of the small intestine. This can detect or rule out other conditions that might mimic LPR.
  • Barium Swallow Study: An X-ray study where the patient swallows a barium solution to show the shape and function of the esophagus and to identify abnormalities.
  • Manometry: A test to measure the functionality of the esophageal muscles and the sphincters.

Note: These tests help in confirming the diagnosis of LPR and ruling out other conditions with similar symptoms. Treatment plans are often based on the results of these diagnostic procedures.

Complications

Laryngopharyngeal reflux, if not properly managed, can lead to several complications:

  • Chronic Throat Irritation and Inflammation: Continuous exposure to stomach acid can cause persistent throat irritation and inflammation, leading to discomfort and pain.
  • Vocal Cord Damage: Acid reflux can cause irritation and damage to the vocal cords, resulting in hoarseness, voice changes, or even loss of voice.
  • Ulcers and Strictures: The acid can cause ulcers in the throat and larynx, and over time, this can lead to the formation of strictures (narrowing of the esophagus), making swallowing difficult.
  • Barrett’s Esophagus: In some cases, ongoing reflux can lead to changes in the cells lining the esophagus (Barrett’s esophagus), a condition that can increase the risk of esophageal cancer.
  • Breathing Problems: LPR can lead to breathing issues, including episodes of choking or wheezing, and can exacerbate asthma symptoms.
  • Dental Problems: The acid can erode tooth enamel, leading to tooth decay, sensitivity, and other dental issues.

Note: Addressing LPR through lifestyle changes, medications, or surgery is crucial to prevent these complications and maintain a good quality of life.

Treatment of Laryngopharyngeal Reflux

Treatment of laryngopharyngeal reflux typically involves a combination of lifestyle modifications, medications, and in some cases, surgery.

The goal is to reduce throat irritation and damage caused by stomach acids. Treatment strategies include:

  • Lifestyle Changes: Modify diet to avoid reflux triggers, eat smaller meals, avoid eating before bedtime, manage weight, and elevate the head while sleeping.
  • Medications: Use Proton Pump Inhibitors (PPIs), H2 Blockers, Antacids, and Prokinetics to reduce, neutralize, or manage stomach acid and improve digestive tract function.
  • Voice Therapy: Engage in speech therapy if LPR affects the voice, to reduce strain and improve voice quality.
  • Surgery: Consider surgical options like fundoplication to increase lower esophageal sphincter pressure and prevent reflux, especially in severe or treatment-resistant cases.

Note: It’s important to work closely with a healthcare professional to develop a treatment plan tailored to the individual’s specific symptoms and health needs. Regular monitoring and adjustments may be necessary to manage LPR effectively.

Home Remedies for Laryngopharyngeal Reflux

Managing laryngopharyngeal reflux at home involves lifestyle and dietary changes to reduce symptoms and prevent acid from irritating the throat.

Here are some effective home remedies and strategies:

  • Dietary Adjustments: Avoid foods and beverages that trigger reflux (e.g., spicy foods, citrus, chocolate, caffeine, and alcohol). Eat smaller, more frequent meals to reduce pressure on the lower esophageal sphincter. Reduce fatty and fried foods which can slow stomach emptying and increase reflux risk.
  • Maintain a Healthy Weight: Excess weight can put pressure on the abdomen, pushing stomach contents into the esophagus.
  • Elevate the Head During Sleep: Use a wedge pillow or raise the head of your bed by 6-8 inches to prevent acid from flowing back into the throat while sleeping.
  • Chewing Gum: Non-mint flavored gum can increase saliva production, which can help neutralize stomach acid.
  • Drink Alkaline Water: Water with a higher pH level than regular drinking water may neutralize stomach acid.
  • Avoid Late Meals and Snacks: Refrain from eating 2-3 hours before bedtime to allow the stomach to empty, reducing the chance of reflux.
  • Wear Loose-Fitting Clothes: Tight clothing can put pressure on the stomach and lower esophageal sphincter, potentially causing or worsening reflux.
  • Mindful Eating Habits: Eat slowly and chew food thoroughly to promote digestion and reduce the workload on the stomach.
  • Limit Alcohol and Quit Smoking: Both can relax the lower esophageal sphincter and aggravate symptoms.
  • Stress Management: Techniques such as yoga, meditation, or controlled breathing can reduce stress, which may help alleviate LPR symptoms.

Note: While these home remedies can be beneficial, it’s essential to consult with a healthcare professional for proper diagnosis and treatment, especially if symptoms persist or worsen.

Laryngopharyngeal Reflux vs. Gastroesophageal Reflux Disease

Laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD) are both conditions resulting from the backward flow of stomach contents, but they affect different parts of the body and have distinct symptoms and management strategies:

Laryngopharyngeal Reflux (LPR)

  • Affected Area: Primarily affects the throat, larynx (voice box), and nasal passages.
  • Symptoms: LPR symptoms are more related to the respiratory system and throat, including chronic cough, hoarseness, throat clearing, a sensation of a lump in the throat, difficulty swallowing, and postnasal drip. Heartburn is less common in LPR.
  • Diagnosis: Diagnosed through symptoms, laryngoscopy (to view throat and voice box inflammation), and pH monitoring in the throat.
  • Management: Involves dietary and lifestyle changes, such as avoiding trigger foods, eating smaller and more frequent meals, not eating close to bedtime, and elevating the head while sleeping. Medications may include proton pump inhibitors and H2 blockers. Voice therapy may be recommended if vocal cords are affected.

Gastroesophageal Reflux Disease (GERD)

  • Affected Area: Primarily affects the esophagus.
  • Symptoms: GERD symptoms are more related to the digestive system, including heartburn, regurgitation of food or sour liquid, chest pain, and difficulty swallowing. While it can also cause a chronic cough and throat irritation, the primary symptom is usually heartburn.
  • Diagnosis: Diagnosed through symptoms, endoscopy (to view esophagus damage), and pH monitoring in the esophagus.
  • Management: Focuses on dietary and lifestyle changes similar to LPR, medications like proton pump inhibitors and H2 blockers, and in severe cases, surgery (e.g., Nissen fundoplication) to tighten the lower esophageal sphincter.

While both conditions involve acid reflux, the primary distinction lies in the area affected and the predominant symptoms.

GERD primarily affects the esophagus with predominant heartburn symptoms, whereas LPR affects the throat and voice box, with symptoms more related to throat irritation and respiratory issues.

Treatment for both conditions often involves a combination of lifestyle changes, dietary adjustments, and medication. In some cases, surgery may be required.

Note: It’s important to consult with a healthcare professional for an accurate diagnosis and tailored treatment plan.

FAQs About Laryngopharyngeal Reflux

How Do You Get Rid of Laryngopharyngeal Reflux?

To alleviate laryngopharyngeal reflux, it’s crucial to combine lifestyle modifications with medical treatment.

Lifestyle changes may include altering your diet to avoid trigger foods, eating smaller, more frequent meals, not lying down immediately after eating and elevating the head of the bed.

Medications such as proton pump inhibitors (PPIs) or H2 blockers may be prescribed to reduce stomach acid production. In severe cases, surgical options like fundoplication might be considered.

What Medicine is Best for Laryngopharyngeal Reflux?

The best medicine for managing laryngopharyngeal reflux often includes proton pump inhibitors (PPIs) like omeprazole, esomeprazole, or lansoprazole.

These medications reduce the production of stomach acid, helping to alleviate throat irritation and other symptoms associated with LPR.

H2 blockers, such as ranitidine or famotidine, can also be effective in reducing stomach acid. It’s important to consult a healthcare professional for a proper diagnosis and personalized treatment plan.

Can Laryngopharyngeal Reflux Go Away?

Laryngopharyngeal reflux can improve with appropriate treatment and lifestyle adjustments. While it may not completely “go away” for everyone, symptoms can be significantly reduced or managed effectively.

This often involves a combination of medication, dietary modifications, and changes in eating habits and lifestyle. For some, symptoms may resolve completely, but others may need ongoing management to keep symptoms at bay.

Regular follow-ups with a healthcare provider are important to monitor the condition and adjust treatment as needed.

What Provides Immediate Relief for Laryngopharyngeal Reflux?

Immediate relief for laryngopharyngeal reflux often involves actions and remedies that reduce throat irritation and neutralize stomach acid.

Elevating the head of the bed can prevent acid from reaching the throat during sleep. Chewing gum can increase saliva production, helping to neutralize acid.

Over-the-counter antacids may provide quick relief by neutralizing stomach acid, but they don’t address the underlying cause. It’s also beneficial to avoid foods and drinks known to trigger reflux, such as spicy foods, caffeine, and alcohol.

Note: While these measures can offer temporary relief, they are not a substitute for a comprehensive treatment plan.

Is Laryngopharyngeal Reflux Serious?

Laryngopharyngeal reflux can be serious if not appropriately managed. Chronic exposure to stomach acid can lead to severe throat irritation, voice changes due to vocal cord damage, and the formation of ulcers in the throat.

In some cases, it can cause narrowing of the esophagus due to scar tissue or even lead to Barrett’s Esophagus, a condition that can increase the risk of esophageal cancer.

The persistent symptoms can significantly affect quality of life, making it crucial to address LPR with proper medical guidance and a tailored treatment approach.

Final Thoughts

Laryngopharyngeal reflux (LPR) is a challenging condition that can cause discomfort and disrupt daily life for those affected.

By understanding its causes and recognizing its symptoms, individuals can seek appropriate medical guidance and treatment options.

Managing LPR can improve one’s overall well-being and ensure that this condition no longer remains in the shadows of silent discomfort.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Brown J, Shermetaro C. Laryngopharyngeal Reflux. [Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

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