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Laryngopharyngeal reflux

Author
Ramon A Franco, Jr, MD
Section Editor
Daniel G Deschler, MD, FACS
Deputy Editor
H Nancy Sokol, MD

INTRODUCTION

Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents (acid and enzymes such as pepsin) into the laryngopharynx leading to symptoms referable to the larynx/hypopharynx [1,2]. Typical LPR symptoms include dysphonia/hoarseness, globus pharyngeus, mild dysphagia, chronic cough and nonproductive throat clearing [3].

Most patients are relatively unaware of LPR with only 35 percent reporting heartburn. There are no unequivocal criteria that reliably demonstrate a causal link between acid reflux and laryngeal symptoms; results of esophageal pH testing, and response to proton pump inhibition therapy in controlled trials, are variable. (See 'Diagnosis' below.)

In fact, the validity of reflux as a cause of symptoms attributed to LPR, in the absence of esophageal symptoms associated with GERD, has been called into question. Guidelines issued by specialty societies in laryngology [1] and gastroenterology [4] present differing perspectives. Both groups acknowledge that interpretation of existing studies is confounded by uncertain diagnostic criteria for LPR, differing measures of treatment response, and a significant placebo treatment effect.

Thus, it is likely that some patients are mistakenly diagnosed with LPR, and investigation of other causes of laryngeal symptoms (allergy, sinus, or pulmonary disease) should be considered for patients who fail to respond to LPR measures.

The clinical manifestations, diagnosis, and treatment of LPR are discussed here. Gastroesophageal reflux disease is discussed separately. (See "Clinical manifestations and diagnosis of gastroesophageal reflux in adults" and "Medical management of gastroesophageal reflux disease in adults" and "Surgical management of gastroesophageal reflux in adults".)

                         

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 13 00:00:00 GMT 2015.
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