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Devoted to Your Care
Laryngopharyngeal Reflux (LPR)
Who suffers from reflux?
Most of us have a clear picture of the typical patient with "reflux". This includes a slightly overweight, sedentary person with a history of burping, heartburn, and gastric pain, usually associated with meals. Is it possible that your otherwise healthy, active patient may suffer from reflux? New evidence demonstrates that that may, in fact, be the case. Interestingly, patientren with reflux do not have typical symptoms that you might expect. When people hear the word "reflux" they usually think of gastroesophageal reflux (GER) referring to stomach acid refluxing into the esophagus (swallowing tube). Reflux that causes damage to the esophagus or symptoms such as heartburn is known as gastroesophageal reflux disease (GERD).
How does GERD compare to LPR?
Although patients may have GERD, we now believe many patients suffer with laryngopharyngeal reflux (LPR). LPR causes symptoms you may not ordinarily associate with reflux. The vast majority of patients will LPR do not have esophagitis or heartburn. They usually do not complain of stomachache or have pain associated with meals which is typical for GERD. Patients that have LPR are predominantly daytime refluxers although they can have symptoms at night. The length of exposure of acid in LPR is also shorter than GERD. In addition, the primary defect in GERD is thought to be failure of the lower esophageal sphincter keeping stomach acid from entering the swallowing tube whereas in LPR the primary defect is thought to be the upper esophageal sphincter allowing acidic fluid to backflow into the back of the throat and back of the nose.
What are the symptoms of LPR?
Symptoms of LPR can be very nonspecific and in many times puzzling. Symptoms include:
- Hoarseness
- Chronic throat-clearing, excessive mucous
- Chronic cough
- Stridor (noisy breathing)
- Difficulty swallowing
- "Lump in the throat" (globus)
- Reactive airway disease (wheezing)
- Chronic bronchitis
- Chronic airway obstruction
- Wheezing
- Apnea
- Aspiration pneumonia
- Nasal obstruction
- Ear pain
- Chronic nasal congestion
- Sore throat
- Gagging
These symptoms are also related to many conditions thought to be aggravated or caused by LPR. These conditons include:
- Otitis media (ear infections)
- Sinusitis
- Chronic nasal congestion
- Vocal cord nodules
- Chronic laryngitis
- Laryngomalacia
- Apnea
- Subglottic stenosis
- Arytenoid fixation
- Laryngospasm
- Recurrent pharyngitis
- Chronic cough
- Exacerbation of asthma or reactive airway disease
What is the initial treatment for LPR?
A patient with LPR may be treated with antibiotics for other conditions including ear infections (otitis media), sinus infections (sinusitis), and sore throats (pharyngitis). The first hint that a patient may have LPR may be the failure of standard antimicrobial therapy or allergic therapy. However, because otitis media, sinusitis and allergic rhinitis are very common in children, it is important to rule out these conditions when the patient is a child prior to moving to rule out a diagnosis of LPR.
How is LPR diagnosed?
The diagnosis of LPR is made by demonstrating that there is acid reflux into the back of the throat. Examination with a flexible laryngoscope by an ENT will often demonstrate signs of LPR if present. Sometimes barium studies (X-ray test) and esophagoscopy (scope looking at swallowing tube) can be used to evaluate the swallowing tube for related conditions.
What are the treatments for LPR?
Once LPR is diagnosed, principal therapy remains the administration of proton pump inhibitors (PPIs). These drugs stop the production of acid in the stomach, therefore reducing the amount of acid that is refluxed into the throat. Within two to three months of treatment, most patients will report reduction in their symptoms due to LPR. However, many patients will show symptomatic improvement within three to four weeks. The length of treatment currently is somewhat controversial although it is clear that at least six months of therapy is necessary to see resolution of laryngeal damage caused by LPR. Therefore, a minimum treatment of six months is recommended in patients with LPR. After six months, PPI therapy can be weaned off. If the patient has return of symptoms off medication, therapy should be continued indefinitely.
The most important aspect of GERD and LPR is to consider them when a patient has recurrent upper respiratory illnesses.
I have hoarseness and I smoke.What should I do?
This symptom should not be ignored. Hoarseness is a caused by a problem with the voice box or vocal cords. Inflammation or laryngitis is a common cause. Growths or nodules on the vocal cords can also produce hoarseness. Of course, cancer is a possibility. Smokers are five times more likely to develop throat cancer than non-smokers. Fortunately, this cancer can be cured if the diagnosis and treatment are started early.
Laryngoscopy is a simple office procedure done by an otolaryngologist (ENT) doctor. I recommend this for any patient who has been hoarse for over one month.
For more information
contact our office
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