Laryngopharyngeal reflux (LPR) is a condition in which the gastric content in the stomach rises up the esophagus and affects the throat, especially the laryngopharynx. The assessment and management of LPR vary among Otolaryngologists and Gastroenterologists. In the review article of Chin-Lung Kuo, published in the Archives of Otorhinolaryngology-Head & Neck Surgery Journal, various approaches of diagnosis and treatment of LPR and the latest findings on LPR research have been discussed. The article also presents an algorithm intended to facilitate the assessment and management of LPR.
Reflux diseases which lead to complications like throat clearing, heat burning, cough, hoarseness, and globus pharyngeus are divided into two categories, namely, LPR and gastroesophageal reflux disease (GERD). In spite of their similarities, these two are two different disease entities. In LPR, the reflux of gastric content affects the larynx and pharynx, whereas, in GERD, it is limited to the esophagus. Acidity and heat burn occur in GERD patients, but it is rarely found in LPR patients.
A number of methods are used to provide diagnostic information on LPR, which include reflux symptom index, upper gastrointestinal endoscopy to find mucosal damage, laryngoscopic examinations for symptoms of laryngeal irritation, multichannel impedance and pH probe monitoring study, esophageal manometry, spectrophotometric measurement of bile reflux, radiography, and mucosal biopsy.
Even though the researchers have identified a correlation between LPR and GERD, it is often difficult to exactly differentiate between LPR and GERD, mainly due to the overlap of the symptoms, which results in underestimating the disease. Also, controversy exists regarding the right course of diagnostic procedure in producing a conclusively reliable result. In such situations, it is advised to refer the patient to an expert.
An accurate diagnosis and effective treatment of LPR are very important. A failure to do so may lead to complications like arytenoids granulation, chronic cough, and ulcers on vocal folds, as well as the manifestation of bronchitis, laryngitis, sinusitis, asthma, chronic rhinitis, and otitis media.
Generally, in most cases, the symptoms of LPR can be eliminated by applying changes in lifestyle related to eating, drinking, and other habits. It is recommended to follow healthy dietary habits and avoid sweets and fried foods, and refrain from alcohol consumption and smoking. It is necessary to reduce weight, as obesity can aggravate reflux symptoms. It is advised to do at least half an hour exercise daily and involve in some physical activity to avoid the risk of developing reflux problems.
In this article, the author reviews the manifestations, diagnosis, and treatments of LPR and suggests adopting a multidisciplinary approach for a reliable and conclusive diagnosis of LPR. Based on the previous research and latest findings, an algorithm is put forth to streamline the assessment and management of reflux disorders. Highlighting the significance of correct diagnosis and effective treatment of LPR, the author suggests that in case the diagnosis is doubtful, and the therapeutic response is unsatisfactory, the patient should be referred to a specialist.
Chin-Lung Kuo. Laryngopharyngeal Reflux: An Update. Archives of Otorhinolaryngology-Head & Neck Surgery 2019;3(1):1. [View Article]