What is LPR?

Laryngo-pharyngeal reflux (LPR) is a condition where stomach contents including acid flow back and up into the throat.  Women, men, infants, and children can all have gastro-esophageal reflux disease (GERD) or LPR.

Many patients with LPR do not experience the symptom of heartburn associated with GERD. While GERD and LPR may occur together, patients can also have GERD alone (without LPR) or LPR alone (without GERD).

What are the symptoms of LPR?

Common signs and symptoms of LPR include:

• Persistent cough
• Feeling of something stuck in the throat (globus sensation)
• Persistent clearing of the throat
• Hoarseness of voice or voice fatigue
• Sensation of drainage from the back of the nose (post nasal drip)

Many patients with LPR do not experience the symptom of heartburn associated with gastroesophageal reflux disease (GERD).

Perform a self-test of LPR symptoms?

The reflux score index is a self-administered questionnaire that provides insight into the diagnosis of LPR.

What are the causes of LPR?

LPR may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach. Lifestyle factors include diet (chocolate, citrus, fatty foods, spices), destructive habits (overeating, alcohol and tobacco abuse) and even pregnancy. Young children experience GERD and LPR due to the developmental immaturity of both the upper and lower esophageal sphincters. It should also be noted that some patients are just more susceptible to injury from reflux than others.

How is LPR diagnoses?

Diagnosis starts with a careful history by the ENT doctor. This is followed by an endoscopy (a long tube with a camera) to examine the throat and voice box.

What are the treatment options?

The treatment options include:

• Lifestyle and behaviour modifications
  • Weight loss
  • Diet changes
    • Many small meals instead of large lunches or dinner
    • Eating dinner 3 hours before you go to sleep
    • Avoiding exercising right before you go to sleep
    • Limit problem foods
      • Caffeine (tea, coffee or cola drinks)
      • Chocolate
      • Pepper mint
      • Spicy foods
      • Citrus fruits
      • Fatty and fried foods
    • Eliminate alcohol and smoking
  • Sleep with the head of the bed elevated at 30 degrees
  • Medication
    • Proton pump inhibitors
    • H2 receptor blockers as add on
    • Antacids if needed
  • Surgery
    • Tailored for each patient and very carefully considered

Disclaimer

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

References

1. Martinucci, Irene, et al. “Optimal treatment of laryngopharyngeal reflux disease.” Therapeutic advances in chronic disease6 (2013): 287-301.
2. Philip O. Katz , et al. “Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease” Am J Gastroenterol 2013; 108:308–328; doi:10.1038/ajg.2012.444