Laryngopharyngeal RefluxThe backwards flow of stomach contents into the pharynx and larynx.
What is laryngopharyngeal reflux?
The term is made up of several parts: laryngo- means larynx (voice box), pharyngeal means pharynx (throat) and reflux means regurgitation or backwards flow. Laryngopharyngeal reflux (LPR) is therefore the backwards flow of stomach contents into the pharynx and larynx.
Normally, when you swallow, food goes from the mouth, through the esophagus, into the stomach. There in a one-way valve between the esophagus and the stomach, called the lower esophageal sphincter. In LPR, it is thought that this sphincter is malfunctioning, allowing stomach contents to travel (or reflux) back up in to the esophagus.
Is it the same as gastroesophageal reflux disease (GERD)?
GERD and LPR occur by the same mechanism, the backwards flow of stomach contents into the esophagus (swallowing passageway). In GERD, the stomach contents do not rise all the way to the larynx. They stay in the esophagus and produce symptoms like heartburn. In LPR, the stomach contents rise all the way back up to the larynx, producing symptoms of LPR.
What does LPR look like?
There are many signs of LPR. These include swelling of the vocal folds, redness and swelling in the back of the larynx, mucous on the vocal folds, and swelling below the vocal folds.
Swelling occurs in the back of the larynx because the swallowing passageway (esophagus) is located at the back of the throat. Refluxed stomach contents come back up at the back of the throat and coat the back of the larynx more than the front. This results in more severe swelling in the back of the larynx.
What are the symptoms?
- Chronic cough
- Throat clearing
- Sensation of an object in your throat (globus sensation)
- Post-nasal drip
What is the treatment?
“Lifestyle modifications” are ways that you can change your diet, your sleeping habits, and your daily life to help minimize the creation and reflux of acid. For example, elevating the head of your bed, reducing LPR triggers (i.e., chocolate, alcohol, high-fat or acidic foods), and changing the timing of your meals can improve your symptoms.
Medications called proton pump inhibitors are adjuncts that may be required if lifestyle modifications alone do not control symptoms. These medications prevent acid from being formed in your stomach. Although stomach contents will still regurgitate back up to the larynx, they will not be acidic. This will result in less damage and allow the larynx to heal.
The only definitive way to treat LPR is surgical, fixing the valve between the esophagus and the stomach.