Laryngopharyngeal reflux

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Laryngopharyngeal reflux (LPR) is a common condition characterized by a globus feeling in the throat secondary to the passage of gastric contents into the supraoesophageal aerodigestive tract.

Epidemiology

Laryngopharyngeal reflux comprises up to 1 in 10 of all referrals of otorhinolaryngology services . However the lack of a consistent agreed set of diagnostic criteria means that the true incidence and prevalence of laryngopharyngeal reflux remains unknown .

Risk factors
  • dietary
    • fatty foods
    • citrus fruits
    • chocolate
    • tomato
    • mint
    • caffeinated beverages
    • fizzy drinks
  • alcohol
  • smoking
  • stress

Clinical presentation

Globus pharyngeus, the feeling that there is a lump in throat is the commonest symptom. Typically it is experienced when swallowing saliva and not when eating and drinking . Other symptoms include:

  • chronic clearing of the throat
  • surplus mucus
  • hoarseness of the voice
  • dry cough
  • unpleasant taste
  • sore throat
  • heartburn

Studies have shown little difference in prevalence of these symptoms compared to a non-symptomatic general population showing how non-specific the presentation of laryngopharyngeal reflux is.

Definitive diagnosis of laryngopharyngeal reflux is difficult but is usually thought to require a typical clinical presentation coupled with multichannel intraluminal impedance–pH monitoring (MII-pH).

Pathology

Laryngopharyngeal reflux results from stomach contents refluxing up the esophagus and through the upper esophageal sphincter leading to inflammation of the laryngopharynx (including the tonsils, posterior tongue and vocal folds).

Radiographic features

Often the first line test performed - if any imaging test is performed at all - will be a barium swallow and in laryngopharyngeal reflux it will usually be normal.

Treatment and prognosis

Management of laryngopharyngeal reflux rests upon lifestyle modification plus possible pharmacotherapy.

First line drug treatments used are proton pump inhibitors (PPIs) and sodium alginate solutions. H2 antagonists tend to be reserved for those who struggle to control their symptoms with other drugs.

Differential diagnosis