Laryngopharyngeal Reflux

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What is laryngopharyngeal reflux (LPR)?

During gastroesophageal reflux (GER), stomach contents enter the esophagus. In the case of laryngopharyngeal reflux (LPR), stomach contents pass through the esophagus, through the upper esophageal sphincter (UES), and into the back of the throat, and may even reach the nasal cavity.

What causes LPR?

LPR most commonly results from conditions that enable reflux of stomach contents back into the esophagus such as a hiatal hernia or increased abdominal pressure. However, LPR can also be due to a motility problem in the esophagus, such as achalasia.

What are the symptoms of LPR?

Symptoms include a sour or bitter taste, throat burning, or a sensation that something is “stuck” in the back of the throat. Hoarse voice, throat clearing, or coughing might be present. Many patients with LPR do not experience heartburn that is classically associated with GER.

How is LPR diagnosed?

A team approach if often needed to properly diagnose LPR. Commonly, LPR is diagnosed by an otolaryngologist, an ear, nose, and throat (ENT) specialist, during an office examination. During this visit, the ENT specialist might perform a laryngoscopy, which uses a special camera passing through the nose to look at the throat, vocal cords, and possibly even the esophagus. Consultation with a gastroenterologist might also be needed confirm the diagnosis or determine if there are other potential causes for the LPR symptoms. Testing needed to diagnose LPR include upper GI endoscopy (EGD), (acid) pH testing, and esophageal manometry.

What are the treatment options for LPR?

As the most common cause of LPR is GERD, treatment is directed at controlling the reflux. Options include lifestyle changes (avoidance of highly acidic foods, eating smaller meals, avoid eating/drinking within 2-3 hours before lying down, weight loss, quit smoking, reducing alcohol intake), acid blocking medications such as proton pump inhibitors (PPIs) and H2 receptor blockers, and anti-reflux surgery. If there is an underlying motility disorder, this should be addressed if possible. Learn more about our nutrition and integrative digestive health and wellness programs