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Laryngopharyngeal Reflux

Laryngopharyngeal Reflux (LPR) is a condition characterized by the regurgitation of the acidic contents from the esophagus, which have back flowed from the stomach, into your throat (pharynx) and voice box (larynx).

Causes

The esophagus has two sphincters, the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES). The former prevents the regurgitation of the acidic contents of the stomach from entering your esophagus and the later prevents the back flow of the contents of the esophagus into your throat. A dysfunction of these sphincters results in reflux. A dysfunctioning of the LES causes gastroesophageal reflux disease (GERD) characterized by the reflux of acidic contents of the stomach into your esophagus. While a UES dysfunction causes laryngopharyngeal reflux (LPR) which is the reflux of the acidic contents of the esophagus into your throat and voice box.

Symptoms

LPR may or may not be associated with heartburn. Heartburn may not occur if the acidic contents of the stomach do not stay in the esophagus long enough to irritate it.

Some of the common symptoms of laryngopharyngeal reflux include:

  • Hoarseness of voice
  • Weak voice
  • Cracking voice
  • Constant sensation of something in the throat
  • Frequent throat clearing
  • Irritation in the throat
  • Persistent cough
  • Post-nasal drainage
  • A blockage in the respiratory passages
  • Involuntary muscle spasms in the larynx (voice box)
  • Trouble swallowing
  • Trouble breathing
  • Wheezing

Diagnosis

To diagnose LPR your doctor may conduct one of the following tests:

  • Laryngoscopy: This procedure employs a laryngoscope to visualize the changes in the throat and voice box.
  • 24-hour pH testing: This test is performed to determine the quantity of acid moving up from the stomach into the esophagus and throat. During the procedure, two pH sensors are used; one placed at the top end of the esophagus and other at the bottom. This allows the doctor to determine if acid moves to the top of the esophagus.
  • Upper GI Endoscopy: This procedure is commonly used in patients with complaints of difficulty while swallowing.  The procedure allows the doctor to identify any scars or abnormal growths in the esophagus and to take a biopsy of the abnormality as well (tissue samples are collected). Any inflammation of the esophagus can be visualized by this technique.

Treatment

Treatment of LRP is like that of GERD. The treatment options include:

  • Lifestyle modifications: Lifestyle changes may help reduce or prevent the incidence of acid reflux.
  • Diet modifications: Foods causing heartburn should be avoided.
    Medications:  Medications such as proton pump inhibitors and H2 receptor antagonists may be prescribed to reduce the production of acid in the stomach.
  • Surgery: Surgery may be considered in patients not responding to medications. Nissen’s fundoplication is one of the commonly performed surgeries in which the upper part of the stomach is wrapped and sutured around the lower end of your esophagus and esophageal sphincter. This surgery strengthens the sphincter and reduces acid reflux.

General measures you can take to reduce or prevent reflux include:

  • Avoid going to bed immediately after eating
  • Eat smaller and more frequent meals
  • Lose weight if you are overweight
  • Elevate the head end of the bed
  • Eliminate foods that increase the reflux
  • Avoid smoking and alcohol consumption

Check with your doctor about the side effects of any prescribed medications