Laryngopharyngeal Reflux (LPR)

When Both Esophageal Sphincters Don't Function Correctly

Man coughing at home
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There are two sphincter muscles located in the esophagus: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES). When the lower esophageal sphincter is not functioning properly, there is a backflow of stomach acid into the esophagus. If this happens two or more times a week, it can be a sign of gastroesophageal reflux disease or GERD.

But what happens when the upper esophageal sphincter doesn't function correctly either?

As with the lower esophageal sphincter, if the upper esophageal sphincter doesn't function properly, acid that has back flowed into the esophagus is allowed into the throat and voice box. When this happens, it's called laryngopharyngeal reflux, or LPR.

Can you experience LPR without any heartburn or other GERD symptoms? Yes! Many people with LPR do not have symptoms of heartburn. Why? In order for refluxed acid to cause heartburn, it has to stay in the esophagus long enough to cause irritation. Also, the esophagus isn't as sensitive to irritation as the throat is. Therefore, if the acid passes quickly through the esophagus but pools in the throat, heartburn symptoms will not occur but LPR symptoms will.

Symptoms of Laryngopharyngeal Reflux are:

  • Continual throat clearing
  • Chronic throat irritation
  • Chronic cough
  • Hoarseness
  • Excessive phlegm the throat
  • Dysphagia (difficulty swallowing)
  • Constant sensation of something in the throat
  • Swallowed food comes back up
  • Post nasal drainage
  • Weak voice
  • Cracking voice
  • Blockage of the breathing passage
  • Spasm of the larynx (voice box)
  • Wheezing
  • Heartburn

Diagnosis of LPR

Your doctor may do one of the following tests to determine if you have LPR:

  • Laryngoscopy: This procedure is used to see changes of the throat and voice box.
  • 24-hour pH testing: This procedure is used to see if too much stomach acid is moving into the upper esophagus or throat. Two pH sensors are used. One is located at the bottom of the esophagus and one at the top. This will let the doctor see if acid that enters the bottom of the esophagus moves to the top of the esophagus.
  • Upper GI EndoscopyThis procedure is almost always done if a patient complains of difficulty with swallowing. It is done to see if there are any scars or abnormal growths in the esophagus, and to biopsy any abnormality found. This test will also show if there is any inflammation of the esophagus caused by refluxed acid.

Treatment

Treatment for LPR is generally the same as that for GERD. There are basically four treatments for LPR

  • Surgery to prevent reflux. Surgery to tighten the junction between the stomach and esophagus. The surgery most commonly done is called the Nissen fundoplication. It tightens the junction between the stomach and esophagus by wrapping the top part of the stomach around the junction between the stomach and esophagus and sewing it in place.

Sources:

Priston J, Thoen R, Medeiros T, Assunção A, Campagnolo A. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. International Archives of Otorhinolaryngology. 2013;18(02):184-191. doi:10.1055/s-0033-1352504. ​

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