About Laryngopharyngeal Reflux

Laryngopharyngeal Reflux (LPR) refers to the backflow of stomach acid into the larynx (the voice box) or the pharynx (the throat). LPR can occur day or night, but is most common at night when lying down. Because the tissues of the voice box and throat are very sensitive to injury and irritation from stomach acid, problems can occur if even small amounts of refluxed material reach into the throat.

Many people with LPR don’t have heartburn… Why is that?

Not everyone with reflux has a lot of heartburn or indigestion. In fact, many people with LPR never have heartburn. This is because the material that refluxes does not stay in the esophagus for long enough to irritate the esophagus and cause heartburn. Consequently, this is why LPR is called Silent Reflux. Because LPR is silent, it can be difficult for patients to know this that they are having reflux.

Diagnosis and Treatment

Chronic hoarseness, throat clearing, and cough, as well as a feeling of a lump in the throat or difficulty swallowing, may be signs that you have LPR. Some people have hoarseness that comes and goes, and others have a problem with too much nose and throat drainage, that is, too much mucus or phlegm. If you have any of these symptoms, and especially if you smoke, you should talk with us about LPR.

Laryngopharyngeal reflux can usually be diagnosed by taking a good history and doing a fiberoptic laryngoscopy. A fiberoptic laryngoscopy is a painless exam that is done in the office. It allows us to get a close up view of the larynx or voice box. LPR causes certain changes in the throat that can be seen on fiberoptic laryngoscopy.

How is LPR treated?
  • Medications to reduce stomach acid
  • Diet modifications
  • Weight reduction
  • Surgery to prevent reflux (rarely needed)
Tips for reducing reflux and LPR
  • Do not smoke. Smoking will cause reflux.
  • Avoid tight fitting clothes around the waist.
  • Avoid eating three hours prior to bedtime and avoid eating a large meal at night.
  • Weight loss; shedding a few pounds is often all that is required to prevent reflux.
  • Avoid caffeine, carbonated beverages, citrus beverages, alcoholic beverages, cheese, fried foods, eggs and chocolate.
  • For patients with more severe symptoms, it is helpful to sleep with the head of the bed elevated six inches.
Will I need LPR treatment forever?

With medication, most patients will begin to notice some relief in their symptoms in about 6 weeks. However, it is generally recommended that the medication be continued for several months. If the symptoms completely resolve, the medication can then begin to be tapered. Some people will be symptom free without the medication while other people may have relapses which require treatment again.

Surgery to prevent reflux is rarely needed. Diet modifications and current medications have allowed LPR to be treated without surgery most of the time. If surgery is needed it involves tightening the muscle at the top of the stomach to prevent the reflux from happening. This is done by a general surgeon in consultation with a gastroenterologist.