LARYNGEAL-PHARYNGEAL REFLUX LPR

11

Laryngealpharyngeal
Reflux
LPR

INFORMATIONAL

LARYNGEAL-PHARYNGEAL REFLUX

The purpose of this informational

handout is to define Laryngealpharyngeal Reflux (LPR) and to help
identify .

What is LPR?
Laryngopharyngeal reflux
is an inflammatory
condition of the larynx. LPR
is a form of
gastroesophageal reflux
disease (GERD). It is when
acid that is made in the
stomach travels up the
esophagus. However, once
this acid reaches your
throat it becomes LPR.
Patients commonly
complain of throat issues,
such as sore throat, chronic
cough, throat clearing, and
hoarseness.

dysfunction that leads to

LPR may be caused by
gastroesophageal reflux
disease (GERD), obesity,
consumption of spicy or
acidic foods, alcohol, and
caffeine.

Signs and
Symptoms

Globus

sensation
Hoarseness
Chronic cough
88% occurs with
vocal fold growths
Sore throat
Throat clearing
Post-nasal drip or
excessive mucous
Dysphagia (aspiration)
Red, swollen, or
irritated laryngeal
area
Loss of high pitch voice
Bitter

taste in back of

Laryngeal-pharyngeal Reflux
By, Lauren Grandal, Audrey McTiernan, Laura Anderson, Mary Salama, and Nicole Ezzo

What causes
LPR?
LPR occurs when the upper
esophageal sphincter
and/or lower esophageal
sphincter are not
functioning properly. When
this occurs, the pharynx,
larynx, or in some cases
the nasal airway are
exposed to gastric acid
(stomach acid) reflux which
causes inflammation and/or
irritation to the mucosal
lining of the structures of
the upper aerodigestive
tract. The place and extent
of inflammation will vary by
case. In many patients, the
upper esophageal
sphincter (UES) and lower
esophageal sphincter (LES)

Symptoms differ from patient to patient,

however may cause silent aspiration if gone
undiagnosed.

throat
Some may
experience difficulty
breathing
Many do not
experience heartburn
throat pain is
uncommon, but can
be a possible
symptom some
patients with LPR
experience
Heartburn is
uncommon to occur
with LPR, and is more
likely to occur with
GERD. GERD and LPR
may co-occur, but
you can experience
LPR or GERD alone.

In Infants and Children,

LPR may cause problems
such as:

Stridor

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will find other

comorbidities such as:
exogenous irritants,
allergies, medications or
vocal cord overuse or
abuse. Some other signs
that the ENT can detect
using the laryngoscopy
are; marked redness,
thickened and dry
epithelium which again
can also be signs that the
patient presents with LPR.

Croup
Asthma
Sleep-disordered

breathing
Difficulty feeding spitting up
Trouble gaining
weight
Cyanosis - turning
blue
Apnea

Who Diagnosis
it?

Diagnosis of LPR will be made

by a gastroenterologist or
preferably an ear, nose, and
throat specialist (ENT). These
specialists will use
assessment tools to
determine true LPR. When a
patient is being evaluated for
LPR, the patients primary
physician will refer to an ENT
physician to evaluate,
diagnose and treat LPR.
During the diagnosing,
evaluating and treating of the
LPR the patients primary
physician will be kept up to
date with all the information
found by the ENT.

Assessment

Laryngoscopy Evaluation:
This will be the first form
of evaluation when
referred to the ENT
physicians. Although the
laryngoscopic evaluation
will not identify reflux it

Oropharyngeal pH
Monitoring: This may also
be called Restech pH
probe. The probe is placed
in the oropharynx and will
detect if liquid and also
vaporized acid reflux
which coincides with LPR.
Patients should not
consider this assessment if
they present with nasal or
sinus issues as well as if
they are currently on
anticoagulant therapy.
Salivary Pepsin Testing:
This test will use two
monoclonal antibodies to
determine if the presence
of pepsin is present in the
patients saliva. If pepsin
is present within the
patients saliva then the
patient will be positive for
reflux. This test is the least
invasive, quick and the
most inexpensive
technique compared to the
other assessments
available.
Swallowing Study: Patient
will swallow a liquid called

barium which will then

cover the esophagus,
stomach and intestine so it
allows the doctor to view
these organs on an x-ray.
Then, the patient will
swallow food and the
doctor will interpret the
patients swallow and
determine if reflux is
present.

FAST FACTS

125 million
About 125 million Americans are
diagnosed with reflux.

24 million
About 24 million of those
Americans are diagnosed with
silent reflux (LPR).

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Prevention
1.
2.
3.
4.
5.

Do not eat food 2 hours prior bedtime

Avoid clearing of throat
Keep head propped up while sleeping
Follow a bland diet (low in fat, not spicy)
Avoid or reduce intake of: chocolate, peppermint, tomato, citrus fruits, carbonated
beverages, and fatty/fried foods.
6. Eat smaller meals more often.
7. Avoid frequent use of alcohol, tobacco and caffeine
8. Elevate the head of your bed by 4-6 inches - particularly if your reflux is worse in the
morning.
9. Maintain a healthy weight and lose weight if necessary.
10.Wear loose clothing.
11.Practice good vocal hygiene: drink plenty of fluids and reduce abusive behaviors such as
shouting, whispering, excessive talking, and constant throat clearing.
If the patient is not treated for LPR it can lead to a sore throat, chronic cough, ulcers (open sores)
on the vocal folds, and also swelling of the vocal folds. There can also be granulomas, or masses,
throughout the throat. In severe cases, untreated LPR can lead to cancer of the voice box.

Treatment
o

Proton Pump Inhibitor: Patients will be given a medication called Proton Pump Inhibitor
Therapy and if the symptoms continue to persist they will be referred to see a
gastroenterologist. The Proton Pump reduces the production of acid by blocking the enzyme in
the wall of stomach. Some common side effects of the Proton Pump Inhibitor are: nausea,
headache, constipation, diarrhea, and abdominal pain. Proton Pump Inhibitors should generally
be taken 30 minutes to 1 hour before meals, twice a day. It can take 2 - 6 months of taking
prescribed medication to see significant improvement. Common PPIs are: Nexium, Protonix,
Prevacid, Aciphex, or Prilosec (omeprazole)

H2 Blockers: these medications can help reduce gastric acid.

Prokinetic agents: aids movement of the GI tract and increases the pressure of the esophageal
sphincter. These medications are not as common and have side effects such as diarrhea and
effects on heart rhythm.

Antacids: to help neutralize acid but these medications are more for patients who present with
heartburn.
FOR MORE INFORMATION

Surgical Treatment: recommended surgery is Laparoscopic

Nissen Fundoplication. This surgery is performed by a general

Contact your doctor for any

concerns or questions. Do not
diagnose or treat any symptoms
of LPR.

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surgeon who makes small incisions, small surgical equipment, and a laparoscope to wrap the
upper part of the stomach around the lower part of the esophagus to make a stronger valve
between them. Prior performing the surgery, the doctor will perform a probe study to determine
if reflux is present. Also, the esophagus will be examined to determine if there are any premalignant changes.
Treatment is dependent on the severity of the condition. Your physician will prescribe the proper dosage that
should be taken. Treatment duration will also be determined based on the severity but you should continue
routine follow ups with your physician. However, most patients with LPR do not require life-long medical
treatment

Can LPR be Cured

If treatment is discontinued, signs and symptoms will come back. LPR can be managed with proper
treatment and requires continuous maintenance, e.g., diet restrictions. If LPR goes undiagnosed it
can cause other medical issues, (i.e., throat cancer and other symptoms mentioned above), and as
a result may lead to a longer healing period. However, with a healthy lifestyle and treatment the
prognosis of LPR is typically very good, but there is no absolute cure.

References
(n.d.). Retrieved November 1, 2015, from https://my.clevelandclinic.org/services/headneck/diseases-conditions/hic-laryngopharyngeal-reflux-lpr
Acid Reflux (LPR & GERD) | The Voice Institute of New York | Dr. Jamie Koufman. (n.d.).
Retrieved from, http://www.voiceinstituteofnewyork.com/category/acid-reflux-lprgerrd/
Ford CN. Evaluation and Management of Laryngopharyngeal Reflux. JAMA.
2005;294(12):1534-1540. doi:10.1001/jama.294.12.1534.
GERD and LPR. (2014, April 22). Retrieved November 1, 2015, from
http://www.entnet.org/content/gerd-and-lpr
Laryngopharyngeal Reflux Disease (LPR). (n.d.). Retrieved from
http://uthscsa.edu/oto/lpr.asp
Laryngeal Pharyngeal Reflux (LPR). (n.d.). Retrieved November 1, 2015, from
http://www.aboutgerd.org/site/symptoms/lpr
Martinucci, I., Bortoli, N., Savarino, E., Nacci, A., Romeo, S., Bellini, M., Marchi, S. (2013).
Optimal treatment of laryngopharyngeal reflux disease. Therapeutic Advances in
Chronic Disease, 287-301.
Murry, T., & Carrau, R. (2011). Clinical management of swallowing disorders (3rd ed.). San
Diego: Plural Pub.

Vaezi, M. (n.d.). New Tests for the Evaluation of Laryngopharyngeal Reflux. Retrieved December
1, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754770/

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LARYNGEAL-PHARYNGEAL REFLUX