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Laryngopharyngeal reflux (LPR) is a condition that develops in individuals who are diagnosed with gastro-oesophageal reflux disease (GORD). What happens is that stomach acid flows back up the oesophagus and when it reaches the throat, causing symptoms and pathology, then this is LPR.

Symptoms

Half of the patients with LPR don't exhibit any signs or symptoms of an upset stomach or heartburn. Those who are diagnosed with LPR show signs and symptoms which relate to sensations in the throat and they include:

  • A constant need to clear the throat.
  • Chronic cough.
  • Mild hoarseness.
  • Difficulty swallowing.
  • Sore throat.
  • Post-nasal drip.
  • The feeling of a lump in the throat.
  • Feels like mucous is clinging to the throat.
  • Red and swollen or irritated pharynx.

Risk factors

Unfortunately, anyone can get LPR but there are those who are prone to this condition, and include the following factors:

  • Advanced age.
  • Certain dietary habits.
  • People who consistently wear tight fitting clothing.
  • People who are overweight.
  • Increased physical and/or emotional stressors.

Diagnosis

The diagnosis of LPR is made on clinical examination. A patient who is known with GORD will have swelling or irritation in the throat, more specifically in the posterior part of the pharynx (voice box). Therefore, no further investigations are needed most of the time to confirm the diagnosis.

If the diagnosis isn't clear, then further investigations can be performed, and they include looking direct at the stomach and esophagus by doing a gastroscopy, a barium swallow study to view the movement of food and a pH test to determine the level of acidity in the throat.

Complications

If LPR is not treated optimally, or is left untreated, then this can result in the following issues:

  • Swelling of the vocal cords.
  • Chronic cough.
  • Sore throat.
  • Open ulcers/sores on the vocal folds.
  • The formation of granulomas (masses that form due to chronic irritation) in the throat.
  • Worsening of asthma, bronchitis or emphysema in those who are diagnosed with these conditions.
  • Possible development of pharyngeal cancer.

Management

The following are prevention and treatment methods used to manage LPR.

  • Eat a bland diet that consists of low acid levels, is low in fat and not spicy.
  • Eat small meals more frequently instead of a couple of large ones.
  • Don't eat food less than 2 hours before going to bed.
  • Lose weight as this will help reduce your intra-abdominal pressure and therefore reduce the chances of reflux.
  • If possible, try avoid clearing the throat too many times.
  • Avoid the use of caffeine, tobacco products and alcohol as they stimulate acid production in the stomach.
  • Try raising the head of the bed or place a strong, solid object under the top portion of the mattress. This will help elevate your head slightly so that the stomach acid doesn't easily flow back up the oesophagus and thus irritate the throat.
  • Try using over-the-counter medications such as antacids or stomach acid reducers (ranitidine), as well as proton pump inhibitors (PPIs - Omeprazole, esomeprazole and pantoprazole). The PPIs need to be prescribed so you would have to consult with your primary care doctor regarding the use of this medication.
  • Surgical intervention may be needed if the case is severe.

 

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