Laryngopharyngeal Reflux Definition: What Is Laryngopharyngeal Reflux?
Laryngopharyngeal reflux (LPR) occurs when contents (acid and enzymes) from the stomach enter the throat and is not associated with heartburn or a “burning” sensation in the chest, earning it the nickname “silent reflux.”
Patients may complain of a recurrent cough or throat and swallowing problems, but assume it is not acid reflux because they don’t have heartburn.
Gastroesophageal reflux disease (GERD), on the other hand, is acid reflux that enters into the esophagus and is often associated with heartburn.
Causes of LPR and GERD
Valves are located above the stomach in the lower esophageal sphincter (LES) and below the throat in the upper esophageal sphincter (UES) that allow food and liquids to flow downward to the stomach. If these valves malfunction, stomach contents may flow backward, with LES weakness causing GERD and UES weakness causing LPR.
Common Symptoms of LPR
Common symptoms of laryngopharyngeal reflux include:
- Throat clearing or scratchy throat: Frequent throat clearing occurs as the acid may overstimulate the nerve endings in the throat.
- Recurrent cough: A reflux cough is a common chronic condition that is different from many other types of cough. Almost like a choking spell or gagging cough, it is often annoying and even embarrassing for patients. Reflux coughing may occur throughout the day (worse in the morning) for months and may produce a clear or thick phlegm. A post-viral cough (cough after an upper respiratory infection) is also associated with LPR and may last for months after the infection resolves. The cause is essentially from a hyper-reflexive cough reflex from hyper-sensitized nerves injured from the stomach acid.
- Globus sensation or a “lump in the throat”: When the acid injures the lining of the throat, the throat will feel like there is “something stuck.” This foreign body sensation may cause you to frequently clear your throat.
- Hoarseness: The vocal cords are susceptible to injury from stomach content that causes them to swell or aggravates vocal cord nodules and polyps.
- Recurrent choking or laryngospasm: When the acid strongly irritates the nerves in the throat, it can trigger a throat spasm that feels like choking. For the most part, it is very temporary, although it can be quite scary when it occurs. In children and in more extreme conditions, laryngospasms may cause cyanosis (turning blue) until they subside.
- Difficulty swallowing: Swelling from the acid burning the entrance to the esophagus can cause a sensation that food is getting stuck in the throat.
- Recurrent sore throat: The recurrent acidity in the throat may irritate the lining of the back of the throat, causing a noninfectious irritation or a burning pain.
- Sour or acid taste in the mouth: If the acidity reaches the mouth, one may actually taste the bitterness.
- Bad breath: Occasionally, LPR can cause halitosis or bad breath.
Diagnosing LPR is not easy! Unlike GERD, which often causes characteristic changes that can be visualized on endoscopy or by acid testing, LPR does not have a single hallmark test.
Dr. Pasha may suspect LPR after reviewing your health history and completing a physical examination.
Physical examination may include placing a flexible viewing tube through the nose and into the voice box (larynx). Signs of reflux include redness or ulceration of the vocal folds (cords) or swelling in the area around the entrance to the esophagus. Occasionally, we may order a pH probe, a barium swallow, or a scope carried out by a gastroenterologist:
- A PH probe is a sensitive test especially for GERD that measures acid by placing a probe through the nose and into the esophagus. The probe measures the frequency, severity, and duration of acid reflux by detecting changes in the acid content of the esophagus. However, stomach acid isn’t the only potential cause of LPR, which can also be brought on by stomach enzymes and other content. Therefore, LPR may have a normal pH probe.
- A barium swallow or upper gastrointestinal study is completed by drinking a chalky substance (barium). Barium can be seen with an X-ray when refluxing from the stomach back into the esophagus. However, this test is not very specific for acid reflux.