Laryngopharyngeal reflux (LPR)

Laryngopharyngeal reflux (LPR), also known as silent reflux, is a condition where the contents of the stomach, including acid and enzymes, flow back up into the throat, voice box (larynx), and nasal passages. Unlike gastroesophageal reflux disease (GERD), which primarily affects the oesophagus and is associated with heartburn, LPR often does not present with heartburn symptoms, making it more challenging to diagnose. Instead, LPR affects the upper airway and voice box, leading to a range of symptoms that can significantly impact quality of life and vocal health.

Causes and Risk Factors

The primary cause of LPR is the malfunction of the lower oesophagal sphincter (LES) and the upper oesophagal sphincter (UES), which normally act as barriers to prevent stomach contents from flowing back up. Factors that can contribute to LPR include:

• Dietary Habits: Consuming large meals, and eating late at night, as well as intake of fatty foods, caffeine, alcohol, chocolate, and spicy foods.
• Lifestyle Factors: Obesity, smoking, and high levels of stress.
• Medications: Certain medications can relax the LES, including antihistamines, calcium channel blockers, and antidepressants.
• Medical Conditions: Hiatal hernia, pregnancy, and conditions that increase abdominal pressure can contribute to LPR.

Symptoms

LPR symptoms can be subtle or mimic other conditions, making diagnosis challenging. Common symptoms include:

• Hoarseness or Voice Changes: Particularly in the morning or after eating.
• Chronic Cough: A persistent cough that doesn’t respond to traditional cough treatments.
• Throat Clearing: Frequent need to clear the throat of mucus or the sensation of a lump in the throat (globus sensation).
• Difficulty Swallowing: Sensation of food sticking in the throat.
• Sore Throat: Persistent soreness without infection.
• Breathing Difficulties: Including episodes of asthma-like symptoms such as wheezing.

Diagnosis

Diagnosis of LPR involves a comprehensive evaluation, including:

• Medical History: Discussion of symptoms, dietary habits, and lifestyle factors.
• Laryngoscopy: A visual examination of the throat and larynx using a flexible scope to identify signs of irritation or inflammation.
• pH Monitoring: Measurement of acid levels in the throat over a 24-hour period to confirm the presence of reflux.
• Barium Swallow Test: An X-ray examination of the oesophagus and stomach during swallowing to identify abnormalities.

Treatment

Treatment for LPR focuses on lifestyle modifications, dietary changes, and medication, aiming to reduce reflux episodes and protect the throat and larynx from damage:

• Dietary Changes: Avoiding foods that trigger reflux, eating smaller meals, and not eating 2-3 hours before bedtime.
• Lifestyle Modifications: Losing weight if overweight, quitting smoking, and managing stress effectively.
• Medications: Proton pump inhibitors (PPIs) or H2 blockers may be prescribed to reduce stomach acid production.
• Elevation: Elevating the head of the bed to prevent nighttime reflux.

Management and Prevention

Long-term management of LPR involves ongoing attention to diet and lifestyle to prevent recurrence:

• Voice Care: Avoiding shouting or prolonged talking, and staying hydrated to protect the voice.
• Monitoring Symptoms: Keeping a diary of symptoms and potential trigger foods or activities can help identify patterns and prevent flare-ups.
• Regular Follow-ups: Periodic check-ups with a healthcare provider to monitor the condition and adjust treatment as necessary.

Conclusion

Laryngopharyngeal reflux is a condition that can significantly affect the throat, voice, and overall quality of life, often without the typical symptoms of acid reflux. Understanding the risk factors, recognising the symptoms, and implementing effective treatment and management strategies are crucial for controlling LPR and preventing potential complications. If you suspect you may have LPR, it’s important to consult with an ENT specialist for an accurate diagnosis and personalised treatment plan. With the right approach, many individuals with LPR can achieve significant relief from their symptoms and protect their vocal and throat health.