Introducing: Ask a Doctor
At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.
That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.
Today, let’s discuss laryngopharyngeal reflux, or LPR.
Prepared by: Akash Patel
Reviewed by: Dr. Sandra Stinnett
What is laryngopharyngeal reflux (LPR)?
LPR is a condition where stomach contents are regurgitated back up the esophagus and into a portion of the throat called the laryngopharynx. This is the lowest part of the throat and it is involved in directing air and food into their correct locations in the body. The laryngopharynx is also home to the vocal cords, making it an important structure to protect.
In LPR, the regurgitated stomach contents can irritate the throat and lead to damage, causing many of the symptoms associated with the condition.
What causes LPR?
LPR is caused by refluxed stomach contents that make their way back into the throat. This happens when one or more of the normal functions of the esophagus is damaged, allowing refluxed material to pass through the upper end of the esophagus, known as the upper esophageal sphincter.
Some of the impaired barriers include damage to the upper esophageal sphincter or damage to the lower esophageal sphincter (such as a hiatal hernia).
Who gets LPR?
It is mostly unclear how common LPR is. This is because LPR can look different in different people. It also has a lot of overlap with other illnesses, making it hard to diagnose.
Currently, it is believed anyone can get LPR, but those with typical risk factors for reflux may also be at higher risk of developing LPR. These risk factors include obesity, smoking, consuming fatty foods and carbonated beverages, and moderate to high caffeine consumption.
What are its symptoms?
LPR displays a wide range of symptoms. Because it is a condition involving the throat, symptoms tend appear in that area.
The most common of these include:
- Feeling like something is stuck in your throat (known as globus sensation)
- Pain with swallowing
- Excessive throat clearing
- Sore throat
Though these are common symptoms, having any or all of these does not mean that you have LPR.
How is this different from other reflux disorders?
LPR is often confused with the more commonly diagnosed Gastroesophageal Reflux Disease (GERD), as there is a lot of overlap. However, there are important differences between the two, making them separate diagnoses.
First, LPR patients may not experience one of the hallmark symptoms of GERD: heartburn. Because of this, LPR is sometimes called a “silent reflux” disease. Second, GERD patients tend to experience their symptoms when they lie down, especially after eating, whereas LPR patients can actually reflux while they are sitting or standing upright.
When should I see my doctor?
LPR is considered a chronic condition. This means that you may have symptoms for a long period of time, but as long as they are tolerable there is no reason to be concerned.
If you are concerned, it is always safer to get your voice box checked out to ensure there are no other underlying causes to your symptoms, especially if any of your symptoms worsen or effect your day-to-day.
How will my doctor know if I have LPR?
In some cases, LPR is diagnosed based solely on your symptoms and signs of irritation in your throat. In other cases, further testing might be required. This may include laryngoscopy or endoscopy.
Laryngoscopy is a non-surgical procedure where an ENT specialist passes a tube into your nose to examine your voice box. Most of the time this procedure is done while you are awake, and typically your physician will give you medicines to numb your throat area. This procedure is a good way to rule out other more serious causes of your symptoms.
Endoscopy is a non-surgical procedure where a doctor passes a long tube with a camera attached to the end of it into a patient’s mouth to view their throat, esophagus, and stomach. This is a very safe procedure typically performed by a GI specialist that is helpful in confirming the severity of reflux.
What are the treatments?
LPR can be treated with lifestyle changes or in combination with medication. Typically, if your symptoms are milder, your physician will start with recommending lifestyle changes first.
Some lifestyle changes your doctor may ask you to make include:
- Weight loss
- Quitting smoking
- Drinking less alcohol and carbonated or caffeinated beverages
- Avoiding fatty or acidic foods
- Not exercising within 2 hours of eating
- Not lying down within 3 hours of eating
If these do not work or if you have more severe symptoms, then your doctor may prescribe some medicines that will decrease the amount of harsh acid your stomach makes.
- Proton pump inhibitors (PPIs), like omeprazole
- H2 blockers, like Zantac
- Over the counter antacids, like Tums
PPIs are usually started on their own before adding the other drugs; many patients see their symptoms improve by 6 to 8 weeks. We recommend discussing these medications with your doctor before starting them on your own.