Laryngopharyngeal Reflux

GERD, or gastroesophageal reflux disease, is characterized by stomach acid that flows back into the esophagus. The symptoms of GERD include frequent heartburn that occurs more than twice a week. In some cases, stomach contents will actually flow past the esophagus up to the larynx or pharynx, which are located at the back of the throat. This is referred to as laryngopharyngeal reflux or pharingotracheal reflux.

Laryngopharyngeal reflux (LPR) and GERD are two related, yet different, diseases. They each have different risk factors, symptoms, and treatments. People who suffer from one type of reflux disease are not necessarily diagnosed with other types of reflux diseases.

LPR Symptoms vs. GERD Symptoms

The most common symptoms of gastroesphageal reflux disease include:

  • Frequent heartburn
  • Pressure or nausea in the stomach
  • Regurgitation
  • Reflux symptoms when laying down

People who suffer from laryngopharyngeal reflux or pharingotracheal reflux do not usually complain of frequent heartburn. Instead, their symptoms are more likely to include:

  • Hoarseness
  • Globus sensation (feeling a lump in your throat)
  • Throat-clearing
  • Sensation of postnasal drip
  • Difficulty swallowing
  • Chronic cough
  • Laryngospasm (vocal chord spasm that makes it difficult to speak or breathe)
  • Reflux symptoms when sitting up

GERD can cause damage to the esophageal lining. LPR, on the other hand, involves damage to the laryngeal mucosa. Because the laryngeal mucosa is more susceptible to injury from acid reflux, it usually requires a longer treatment time for the symptoms of laryngopharyngeal reflux and pharingotracheal reflux to subside.

Diagnosing Pharingotracheal or Laryngopharyngeal Reflux

Pharingotracheal reflux (or, Laryngopharyngeal reflux) involves stomach acid backflowing past the esophagus to the larynx or pharynx, which lies at the top of the the larynx before the split between the esophagus and trachea. This type of reflux is usually characterized by hoarseness, sore throat, or upper respiratory problems rather than frequent heartburn.

Often times, LPR can be diagnosed by a simple examination in a doctor’s office. A mirror and light is used to view the throat and vocal box. In people suffering from LPR, the tissue in the throat may appear to be red, irritated, or swollen.

Further diagnostic testing may include barium esophagography, radionucleotide scanning, the Bernstein acid perfusion test, esophagoscopy with biopsy, impedance testing, and pH probe to determine the extent of damage caused by pharingotracheal or laryngopharyngeal reflux.

Treating Pharingotracheal or Laryngopharyngeal Reflux

While it often takes as little as two weeks of treatment to reduce symptoms of GERD, it may take several months of treatment for LPR symptoms to resolve. Treatment for LPR may include:

  • Histamine blockers: Medicines such as Pepcid, Tagamet, or Zantac that reduce acid production
  • Proton pump inhibitors: Medicines such as Prilosec, Nexium, or Prevacid that prevent stomach acid from forming
  • Lifestyle changes: Eating smaller meals, avoiding late-night snacks, and quitting smoking
  • Dietary changes: Avoiding alcohol, caffeine, carbonated beverages, citrus fruits and juices, fatty foods, and spicy foods

If antireflux therapy does not reduce the symptoms of LPR, further testing may be needed to rule out another underlying laryngeal disorder.