Laryngoesophageal reflux (LPR) is a medical condition that results in the contents of the stomach traveling back up to the esophagus¹. In some cases, this backflow may even reach the throat. This can cause discomfort and become a nuisance in day-to-day life. Although LPR may sound similar to gastroesophageal reflux disease (GERD), they are actually two different conditions with different symptoms, diagnoses, and treatments. Read on to learn more about LPR, its common symptoms, how it is diagnosed, and treatment options. 

What Causes LPR?

LPR results from the failure of the body’s physiological barriers to prevent the backflow of acid from the stomach up the esophagus². The esophagus is the narrow tube which food passes through from the throat to the stomach. The upper and lower esophageal sphincters ensure that food not only passes in one downward direction, but they also usually stay closed to prevent reflux. 

When these barriers fail, it permits the backward flow of acid from the stomach up the esophagus. The acid in the stomach has a pH of 1.5 to 2, whereas the esophagus has a neutral pH of 7. Thus, exposure to highly acidic stomach contents damages the lining of the esophagus and throat, leading to the common symptoms of LPR. 

Symptoms of Laryngopharyngeal Reflux

GERD and LPR share several symptoms, but there are differences too. The most marked difference between the two conditions is that GERD usually manifests with symptoms of heartburn³, while in contrast, symptoms of LPR may not include heartburn and may more closely resemble colds or allergies. 

Here is a table comparing the symptoms of LPR vs. GERD^{4 5 6}: 

This shows us that, while they may seem similar, LPR and GERD are two totally unique conditions. 

In children, as well as these symptoms, LPR may manifest with a barking cough, asthma, noisy breathing, difficulty feeding, and trouble with weight gain⁷. 

Complications of LPR

Clearly, these symptoms can be troubling and disruptive in daily life. What happens when these symptoms persist for a long time? 

Complications of LPR can lead to significantly impaired function⁸. Children may experience contact ulcers, recurrent ear infections, and chronic build-up of middle ear fluid. In adults, the acid refluxing into the throat can scar the tissue and voice box. This can cause changes in tissue integrity that may lead to cancer in the throat, affect the lungs, and exacerbate pre-existing conditions such as asthma, emphysema, and bronchitis.

Diagnosing LPR

LPR has been found to be the precursor of serious laryngeal diseases such as granulomas, laryngeal carcinoma, contact ulcers, and vocal nodules⁹. Because of these and the harmful long-term complications of LPR, it is essential to diagnose it early so that prompt treatment can be initiated. Early diagnosis can also shorten the discomfort and suffering that people with LPR endure. 

Your physician will conduct a thorough history and physical examination. They will ask about the timing, duration, and severity of your symptoms, as well as other factors that may alleviate or worsen the condition. It is important that you relay your symptoms as accurately as you can, as infections, vocal abuse, allergies, smoking, irritant inhalation, and heavy drinking may also complicate diagnosis¹⁰. 

Additionally, your doctor may perform an endoscopy, where a viewing instrument is used to assess the throat and vocal cords¹¹. They may also monitor your throat’s pH, which involves the placement of small probes in the throat and esophagus to detect acid levels in a 24-hour period¹². 

Treatment of LPR

The treatment of LPR involves a combination of medications and lifestyle modifications¹³:

• Losing weight
• Stopping smoking
• Avoiding:
  • Alcohol
  • Coffee
  • Chocolate
  • Fatty foods
  • Tomato sauce
  • Carbonated drinks

Other things you can do to manage the symptoms of LPR include the following¹⁴: 

• Avoid wearing tight or binding clothing
• Manage stress, as this can worsen stomach acidity
• Avoid eating at least 2 hours before bedtime

These simple but effective techniques can greatly reduce the impact of LPR. The prognosis for patients with LPR is overall good, as the symptoms can be controlled with the adoption of a healthy lifestyle. 

Medications commonly used for the treatment of LPR include proton pump inhibitors (PPIs)¹⁵. These work by suppressing acid secretion in the stomach and preventing the exposure of the upper digestive tract to highly acidic stomach contents. This leads to a reduction in the damage from the stomach’s enzymes to the lining of the esophagus. 

Medications should be taken for at least three months, with PPIs taken twice a day¹⁶. If any medication is prescribed to you, your doctor or pharmacist will explain how to take it.

In severe cases, surgery may be warranted¹⁷. Fundoplication is a surgical procedure wherein the upper part of the stomach is wrapped around the lower esophagus to act as a stronger valve to prevent reflux. Consult your doctor on the best management for you. 

Conclusion

Although LPR and GERD initially seem like similar conditions, they actually differ in their presentation, diagnosis, and management. LPR is a laryngeal condition wherein the stomach’s acidic contents reflux up into the esophagus. It usually manifests with symptoms similar to allergies or asthma and often includes a hoarse voice, whereas GERD involves heartburn and doesn’t involve voice hoarseness. 

Taking simple but effective lifestyle modifications, like avoiding spicy, caffeinated, and fatty food as well as alcohol, and ceasing smoking, can significantly reduce the symptoms of LPR. Medications such as PPIs are most effective in the management of LPR. In severe cases, surgery may be warranted to improve the sphincter function of the lower esophagus.

If conservative management of your symptoms at home is insufficient, consult your doctor. They will not only ensure that prompt treatment is initiated but also prevent further damage. This will greatly reduce the discomfort and suffering experienced by people with LPR.

1. Stuart, A. (2022). Laryngopharyngeal Reflux (Silent Reflux). WebMD. Retrieved on January 2, 2022 from http://webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux[↩]
2. Priston, J., Thoen, R., Medeiros, T., Assunção, A., & Campagnolo, A. (2013). Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. International Archives of Otorhinolaryngology, 18(2), 184–191. https://doi.org/10.1055/s-0033-1352504[↩]
3. Behring, S. (2021). How to Tell Between Laryngopharyngeal Reflux (LPR) and GERD. Healthline. Retrieved on January 2, 2022 from https://www.healthline.com/health/digestive-health/lpr-vs-gerd[↩]
4. Behring, S. (2021). How to Tell Between Laryngopharyngeal Reflux (LPR) and GERD. Healthline. Retrieved on January 2, 2022 from https://www.healthline.com/health/digestive-health/lpr-vs-gerd[↩]
5. Madanick R. D. (2013). Management of GERD-Related Chronic Cough. Gastroenterology & hepatology, 9(5), 311–313. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740808/[↩]
6. Brown, J., Shermetaro, C. (2022), Laryngopharyngeal Reflux. StatPearls (Internet). https://www.ncbi.nlm.nih.gov/books/NBK519548/[↩]
7. Stuart, A. (2022). Laryngopharyngeal Reflux (Silent Reflux). WebMD Retrieved on January 2, 2022 from http://webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux[↩]
8. Stuart, A. (2022). Laryngopharyngeal Reflux (Silent Reflux). WebMD. Retrieved on January 2, 2022 from http://webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux[↩]
9. Priston, J., Thoen, R., Medeiros, T., Assunção, A., & Campagnolo, A. (2013). Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. International Archives of Otorhinolaryngology, 18(2), 184–191. https://doi.org/10.1055/s-0033-1352504[↩]
10. Priston, J., Thoen, R., Medeiros, T., Assunção, A., & Campagnolo, A. (2013). Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. International Archives of Otorhinolaryngology, 18(2), 184–191. https://doi.org/10.1055/s-0033-1352504[↩]
11. Stuart, A. (2022). Laryngopharyngeal Reflux (Silent Reflux). WebMD. Retrieved on January 2, 2022 from http://webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux[↩]
12. Stuart, A. (2022). Laryngopharyngeal Reflux (Silent Reflux). WebMD. Retrieved on January 2, 2022 from http://webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux[↩]
13. Priston, J., et al.(2013). Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. International Archives of Otorhinolaryngology, 18(2), 184–191. https://doi.org/10.1055/s-0033-1352504[↩]
14. Cleveland Clinic. (2018). Laryngopharyngeal Reflux. Retrieved on January 2, 2022 from https://my.clevelandclinic.org/health/diseases/15024-laryngopharyngeal-reflux-lpr[↩]
15. Priston, J., et al.(2013). Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. International Archives of Otorhinolaryngology, 18(2), 184–191. https://doi.org/10.1055/s-0033-1352504[↩]
16. Cleveland Clinic. (2018). Laryngopharyngeal Reflux. Retrieved on January 2, 2022 from https://my.clevelandclinic.org/health/diseases/15024-laryngopharyngeal-reflux-lpr[↩]
17. Stuart, A. (2022). Laryngopharyngeal Reflux (Silent Reflux). WebMD. Retrieved on January 2, 2022 from http://webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux[↩]

Mikaela Millan

Mikaela is a dentistry clinician at the University of the Philippines.