A lesser-known type of acid reflux, in which the stomach acid flows back into the throat, is called laryngopharyngeal reflux (LPR). Sometimes, this condition is the underlying cause of hoarseness, laryngitis, chronic (long-term) throat clearing, and other symptoms. Moreover, people who develop LPR may not have typical acid reflux symptoms, such as indigestion or heartburn.
Generally, acid reflux happens when the stomach juices flow back into the esophagus. However, in people with LPR, the stomach acids flow up into the larynx (voice box) and pharynx (throat). In some cases, this condition is called extraesophageal reflux because the acids go beyond the esophagus (the tube that carries food and drinks from the mouth to the stomach). Some people may develop LPR without any symptoms. In this case, the condition is called silent reflux.
LPR is a common condition that negatively affects about 10% of people who visit a throat specialist. Furthermore, some studies suggest that about 50% of people who suffer from chronic hoarseness have LPR.
What Are The Symptoms of Laryngopharyngeal Reflux?
The primary symptom of this condition is hoarseness. It may also cause other symptoms. Check some examples below:
- Excessive mucus or phlegm
- Chronic (long-term) sore throat
- Laryngitis (inflammation of the vocal cords)
- Wheezing
- Postnasal drip
- Throat clearing
- A feeling like you have a lump in the throat
- Cough
- New or worsening asthma
- Frequent upper respiratory infections
If any of the previous symptoms occur, do not hesitate to visit a doctor for a diagnosis and treatment.
Causes and Risk Factors
The primary cause of LPR is stomach acids that travel from the stomach through the esophagus into the larynx and pharynx. Normally, the stomach acids should not flow into the throat because the esophagus has upper and lower esophageal sphincters (muscular valves that seal off the esophagus at the top and bottom). These valves separate the esophagus and stomach (the upper sphincter), and the esophagus and throat (the lower sphincter). In most cases, the acids from the stomach pass through these valves when at least one of them is weakened. People often develop LPR due to weakening of the upper esophageal sphincter.
However, there are some specific causes that may also lead to LPR. While some of them negatively affect the upper esophageal sphincter, which weakens it over time, others may cause problems with this valve temporarily. Usually, people develop LPR due to multiple factors. Check some examples below:
Lower Esophageal Sphincter
This valve is the first guard against acid reflux into the esophagus. While prolonged acid reflux will cause GERD (gastroesophageal reflux disease) symptoms, in mild cases, people do not know they have stomach acids in their esophagus. Moreover, the esophagus has several protective layers, but the throat does not. Check some common factors that can weaken your upper esophageal sphincter (LES) below:
- Medicines – For example, benzodiazepines (a type of sedative), calcium channel blockers (used to treat hypertension), tricyclic antidepressants (used to reduce pain and treat depression), theophylline (a medicine used to treat asthma), hormone therapy medicines (used to relieve the symptoms of menopause), and NSAIDs (nonsteroidal anti-inflammatory drugs).
- Foods and drinks – These include onions, garlic, alcohol, caffeine, chocolate, mint, and others.
- Lifestyle habits – The following things often weaken your LES for a short period. Examples include lying down or reclining too soon after eating, eating larger meals, wearing tight clothes or belts around the abdomen, sleeping on your back, and others.
Furthermore, there are some additional factors that may also weaken your LES and cause LPR. These include:
- Hiatal hernia – This is a health condition in which the stomach bulges through a hole in the diaphragm. As a result, the LES moves above the diaphragm and loses some of its muscle support system.
- Pregnancy – Generally, a lot of people get acid reflux during pregnancy. It occurs when the abdominal pressure pushes against the diaphragm and LES.
- Obesity – Excessive body weight is a common cause of constant abdominal pressure that may also weaken your LES over time.
- Smoking – Tobacco products have a relaxing effect on the LES. Most of the time, it is associated with coughing that puts chronic pressure on the LES. Additionally, a long-term cough is also a common cause of a hiatal hernia.
Upper Esophageal Sphincter
When the stomach juices enter the esophagus, they flow up to the upper esophageal sphincter (UES), which normally should stop them from entering the throat. A small amount of reflux in the esophagus usually is not enough to cause irritation to the throat tissues. Check some common factors that weaken the UES below:
- Lying down – In some cases, people develop LPR during the night because the esophageal sphincter relaxes when a person lies down.
- Burping – This is one reflex that can trigger both the LES and UES to open. Therefore, these gas bubbles can carry small amounts of stomach acids into the throat.
- Singing, bending over, or exercising – The previous activities can put pressure on the UES, which weakens it over time.
- Smoking and alcohol use – Both substances also have a relaxing effect on the esophageal sphincters.
What Are The Possible Complications of Laryngopharyngeal Reflux?
People who develop LPR may also experience some complications, especially if they leave it untreated. Check some complications below:
- Frequent infections and excessive mucus – The stomach juices often interfere with body processes that clear mucus, and infections from the throat and sinuses. Normally, the mucus helps trap infections and helps to clear them.
- Chronic voice and throat irritation – This complication may negatively affect the ability to speak and swallow. As a result, people with LPR may experience vocal cord lesions and chronic inflammation (laryngitis), which is a significant risk factor for laryngeal cancer.
- Respiratory complications – In some cases, the stomach acid may pass through the trachea into the bronchial tubes and lungs. Hence, it may lead to bronchial inflammation and respiratory infections.
Sometimes, the previous complications can be serious and require immediate treatment. In any case, your physician may recommend some options that will help to reduce the risk or even prevent the previous complications.
Diagnosis
Commonly, doctors begin the diagnosis of LPR with a physical examination in which they examine the mouth and throat for irregularities linked to the disease. They may also ask some questions about your medical history and symptoms to get more clues about your health condition. While the primary test used to diagnose this condition is a flexible laryngoscopy, doctors may also perform additional tests for this disorder. These include:
- Upper endoscopy – This is another form of endoscopic examination that is used to examine the upper gastrointestinal tract further. During this procedure, the endoscope passes from the mouth through the throat, esophagus, and stomach. Usually, it helps show both esophageal sphincters.
- Esophageal pH test – This test involves one or multiple sensors that are placed in the throat or esophagus to monitor acid levels. These sensors stay there for about 24 hours to collect the data.
- Esophageal manometry – This is a specific test used to determine how well the muscles in the esophagus are working.
Treatment
Usually, doctors recommend options to treat the underlying cause. When this condition happens without an obvious cause, physicians recommend dietary and lifestyle changes to reduce all contributing causes. If a person needs treatment, physicians may recommend medicines and surgery.
Medicines
Most of the time, physicians prescribe proton pump inhibitors that help reduce stomach acid production along with lifestyle changes. These medicines neutralize stomach acid and help protect tissues in the throat from further damage. If these medications do not work, doctors may prescribe other medicines, including H2 blockers. Commonly, these medicines should be taken for a few months to notice improvements. Additionally, your doctor may also recommend some medicines called alginates to protect against other irritants in the reflux (such as enzymes).
Surgery
This treatment is rarely recommended for people with LPR. It can be used if you develop LPR due to a hiatal hernia. Mostly, physicians recommend a procedure called a Nissen fundoplication that helps repair a hiatal hernia and reinforce the LES. Rarely, some people may need multiple procedures to get rid of LPR.
Frequently Asked Questions
Can you treat LPR naturally?
In some cases, LPR disappears on its own without treatment. According to some research, LPR is more likely to improve without medications than GERD. While it does not work for everyone, a proton pump inhibitor medicine can help with the healing process.
What is the difference between GERD and LPR?
The medical term GERD, which stands for gastroesophageal reflux disease, happens when stomach juices flow back into the esophagus and cause irritation. However, people who develop LPR, the stomach acid flows up to the larynx and pharynx.
What dietary and lifestyle changes help with LPR?
The following tips may help get rid of a mild form of LPR and help with recovery even in people with moderate to severe LPR. Check some examples below:
- Eat smaller meals
- Limit or avoid acidic, spicy, and rich foods
- Avoid excessive burping
- Reduce alcohol or visit a doctor if you think you have alcohol use disorder
- Sleep on your left side
- Eat dinner earlier (do not lie down for about 3 hours after eating)
- Decrease abdominal pressure
If you have additional questions, ask your healthcare provider.
