Laryngopharyngeal reflux (LPR) is a condition where stomach contents, including acid and enzymes, flow back into the oesophagus, throat, and voice box, causing symptoms like a chronic cough, hoarseness, throat clearing, a lump in the throat, and excess mucus.
Unlike typical acid reflux (GERD), laryngopharyngeal reflux often doesn’t cause heartburn and is sometimes called “silent reflux”.
Why is it called “Silent”
A key characteristic of LPR is the absence of the typical heartburn associated with GERD (gastroesophageal reflux disease). This lack of heartburn often leads people to seek help for lung or throat symptoms, instead of acid reflux.
What is laryngopharyngeal reflux?
LPR occurs when stomach contents, which contain digestive acids and the enzyme pepsin, travel up into the throat and voice box. While the stomach lining is designed to handle these substances, the delicate tissues of the throat and voice box are not, leading to irritation and damage.
Possible causes of laryngopharyngeal reflux
This condition is often due to a weak or poorly functioning upper oesophageal sphincter.
Another cause may be a hiatal hernia.
It can also be due to a motility problem in the oesophagus, such as achalasia.
What are the causes of achalasia?
- After the episode of acute or chronic stress.
- Alcohol can induce erosive oesophagitis by directly affecting the mucosal integrity.
- An autoimmune condition.
- An inherited genetic disorder.
- The presence of viral infection in achalasia has been confirmed by multiple studies which include the measles, varicella-zoster and herpes simplex viruses. There have also been reported cases of rapid-developing achalasia post-coronavirus disease 2019 (COVID-19).
- Achalasia can be caused by Chagas disease, a parasitic infection. This is most commonly found in rural parts of Mexico and Central and South America as well as parts of Asia and Africa.
For more details see>> Achalasia
NOTE: Nicotine exposure is known to induce loss of the lower oesophageal sphincter function so smoking or vaping tobacco should be avoided.
Symptoms of laryngopharyngeal reflux
- A sensation of food sticking or a feeling of a lump in the throat (globus sensation).
- A sore, dry throat, a persistent feeling of needing to clear the throat including a sensation of excessive mucus or phlegm in the throat.
- A chronic cough, or episodes of choking or coughing at night.
- Hoarseness, a tight or croaky voice.
- An occasional unpleasant or bitter taste in the mouth.
How can laryngopharyngeal reflux be treated?
- Change diet
- Control weight
- Reduce stress
- Stop smoking
What to avoid with laryngopharyngeal reflux
- Alcohol
- Caffeine
- Carbonated drinks
- Chocolate
- Fatty foods especially meat
- Late night meals
- Spicy foods
Conventional medical approaches
Proton pump inhibitors (PPIs) or H2 blockers may be prescribed to reduce stomach acid but this does not fix the root cause.
In severe or resistant cases, surgical procedures like laparoscopic nissen fundoplication may be considered but it is far better to try and reduce symptoms naturally.
Related subjects
- A-Z of ailments
- Achalasia
- Acid reflux, heartburn, indigestion and stomach ulcers
- Chagas disease
- Mosquito-borne infections
- Parasites
- Virus infections
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