Laryngopharyngeal Reflux: Causes, Symptoms, and Treatment
It is estimated that over 100 million visits to medical facilities each year in the U.S. can be attributed to some form of digestive problem. Yet there are likely far more symptoms experienced that are either ignored or too mild to warrant a visit to a doctor. One of the most common of these digestive problems is acid reflux and its chronic counterpart, gastroesophageal reflux disease (GERD). A related but less common condition is laryngopharyngeal reflux disease.
What Is Laryngopharyngeal Reflux?
Laryngopharyngeal reflux (LPR) is a condition where contents of the stomach flow up through the esophagus and into the larynx, pharynx, and the upper aerodigestive tract. Under normal circumstances, the lower esophageal sphincter and upper esophageal sphincter open and close automatically to allow swallowed food to continue along the digestive tract. In a patient with LPR, however, dysfunction in one or both of these sphincters causes them to not close properly or remain open. The inconsistent presentation of symptoms makes the prevalence of LPR hard to determine, but research suggests it affects around 10% of the population.
How Is Laryngopharyngeal Reflux Different from GERD?
LPR and GERD are often compared because of how similar they are; just as in LPR, the main mechanism of GERD is dysfunction in the lower esophageal sphincter (LES). The LES is a small ring of muscle that sits at the junction of the stomach and esophagus, and it is responsible for allowing food to enter the stomach while keeping the stomach contents from reentering the esophagus. When the LES doesn’t close properly, the normal churning activity of peristalsis can cause bits of food and stomach acid to move back up the esophagus.
The main difference between LPR and GERD is how far up the esophagus the stomach contents travel. In GERD, the reflux typically extends part of the way up the esophagus and in rare cases even all the way to the back of the throat (pharynx). In LPR, the gastric acid and undigested food can travel all the way up the esophagus past the pharynx and into the larynx; the larynx (also known as the voice box) contains the vocal cords and is involved in breathing, producing the sounds of speech, and keeping solids and liquids out of the airway that leads to the lungs.
Symptoms of Laryngopharyngeal Reflux
The symptoms of LPR can be difficult to identify because of how closely related to GERD the condition is; in fact, it’s possible to have just GERD, just LPR, or both GERD and LPR. You might have symptoms associated with both or no symptoms at all; this is part of why LPR is also sometimes referred to as silent reflux. It can also be a different set of symptoms for infants and children, who generally have breathing, eating, or sleeping problems. For adults the most common symptoms are listed below:
- regurgitation of stomach contents
- chronic cough or sore throat
- frequent throat clearing
- difficulty swallowing
- burning sensation in the back of the throat
- bitter taste in the mouth
- excess mucus or post-nasal drip
- a feeling that something is stuck in the throat
- choking sensation
- hoarseness in the voice
- difficulty breathing
Causes of Laryngopharyngeal Reflux
As noted above, the cause of both LPR and GERD is dysfunction in the upper or lower esophageal sphincters; each time these sphincters fail to close properly, stomach contents can back up into the esophagus and cause the associated symptoms. Yet the underlying cause that leads to the esophageal sphincter dysfunction is less clear; however, ongoing research has identified several factors that seem to play a role in weakening or abnormally relaxing the two sphincters at either end of the esophagus:
- Obesity: Being obese or overweight is associated with a host of negative health outcomes, but in the case of LPR it’s the actual weight itself that can cause a problem. Carrying extra body weight around the midsection puts pressure on the whole abdominal cavity and the lower esophageal sphincter particularly. This added pressure can cause the LES to gradually weaken and begin to allow more and more reflux of stomach contents.
- Medication: Some medications are known to cause the LES to relax temporarily and even cause a long-term problem. Examples include tricyclic antidepressants, asthma medication, proton pump inhibitors (PPIs), and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Alcohol: Alcohol is a commonly known trigger for GERD, and it can also cause the kind of relaxation of esophageal sphincters involved in LPR.
- Smoking: Smoking is detrimental to many aspects of health, but it can also specifically cause damage to the gastrointestinal tract. One of the ways it does this is by causing inflammation in the esophageal lining, but the nicotine in tobacco smoke also relaxes the LES. There is also evidence that smoking increases the acidity of stomach acid, thereby potentially causing more damage during reflux.
- Certain foods: There are a variety of foods that are linked to heartburn, but high fat foods are suspected to have a relaxing effect on the LES. Spicy foods, citrus fruits, and some types of dairy can also cause excess stomach acid and reflux symptoms.
- Hiatal hernia: A somewhat rarer influence on the development of LPR and GERD is a hiatal hernia. The esophagus connects to the stomach at an opening in the diaphragm, the sheet of muscle that is involved in breathing and keeping the abdominal organs in place; in a hiatal hernia, part of the stomach pushes through this opening in the diaphragm and in the process can damage the lower esophageal sphincter.
Treatment for Laryngopharyngeal Reflux
The treatment of LPR is somewhat dependent on the symptoms that are presenting. For most people with LPR, though, the treatment primarily involves lifestyle changes that can help the patient avoid having symptoms. One of the most common approaches is to make changes to the diet; this can involve eating smaller meals more frequently and avoiding spicy foods or foods that are high in fat. Weight loss, stopping smoking, and reducing alcohol consumption are also important steps to take for LPR and overall health. For mild heartburn, antacids are another way to ease the symptoms.
In rare cases—usually when GERD symptoms are severe and chronic—surgery may be required in order to help the patient improve their quality of life. Surgery typically only becomes an option when lifestyle changes, medication, and other treatment options have not worked. After confirming the need for surgery via a laryngoscopy (essentially an endoscopy for the larynx), a procedure called a fundoplication may be performed; in this surgery, a portion of the stomach is wrapped around the lower end of the esophagus in order to reinforce the ability of the LES to close properly.
Contact Cary Gastro
More often than not, management of laryngopharyngeal reflux is a relatively minor concern that can be dealt with through mild lifestyle changes. If your symptoms seem to be ongoing, or if they are presenting in a way similar to GERD, you may benefit from speaking with a qualified gastroenterologist. At Cary Gastro, we are passionate about providing excellent gastrointestinal health care so that you can maintain a high quality of life. If you would like to speak to someone about your symptoms, please contact us today to request an appointment.