Laryngopharyngeal reflux

Laryngopharyngeal reflux: Description, Causes and Risk Factors: Laryngopharyngeal reflux disease is the backflow (retrograde) of stomach contents (acid or non-acid) into the voice box (larynx) or the throat (pharynx). LPRD can occur during the day or night, in an upright position, or while lying down. Laryngopharyngeal refluxThe cause of laryngopharyngeal reflux is poorly understood. It is thought that an abnormality of the upper or laryngeal sphincter of the esophagus malfunctions, allowing a small amount of stomach secretions to touch the larynx and pharynx. The reflux has devastating effects, however, because the larynx and pharynx have no defense mechanisms to these substances. It is known that refluxing as little as two times per week can have significant effects on the voice. The long-term consequences of laryngopharyngeal reflux include severe degradation of the voice, and even larynx cancer. Risk Factors: Drinking caffeinated beverages.
  • Eating before bedtime.
  • Eating foods that are high in fat, tomato-based, or spicy.
  • Lying down after eating.
  • Obesity.
  • Alcohol use.
  • Smoking.
  • Wearing tight clothing.
The prognosis for laryngopharyngeal reflux is very good because most of the causes can be controlled if a healthy lifestyle is followed. However, if laryngopharyngeal reflux goes undiagnosed, the person affected can experience the medical conditions mentioned above as well as delayed healing. Symptoms: The above three symptoms, globus sensation, chronic throat clearing, and gravelly voice, are the most common presenting symptoms of laryngopharyngeal reflux. Chronic throat pain, or the sensation of choking as well as chronic cough, may also be experienced. Heartburn is not commonly associated with laryngopharyngeal reflux, and studies suggest that perhaps only 6% of patients with laryngopharyngeal reflux have heartburn or gastroesophageal reflux disease (GERD). Other symptoms may include: Mild hoarseness.
  • Sensation of a lump in the throat.
  • Need to clear the throat.
  • Sensation of mucous sticking in the throat and/or postnasal drip.
  • Chronic cough.
  • Difficulty swallowing.
  • Sore throat.
  • Red, swollen, or irritated voice box.
Diagnosis: Diagnosis is usually made based on the findings of irritation or swelling in the throat, more specifically in the back part of the voice box. Most of the time, no further testing is needed to make the diagnosis. If testing is needed, three commonly used tests are a swallowing study, a direct look at the stomach and esophagus through a scope, and a pH test. In the swallowing study, special liquid called barium is swallowed. It coats the esophagus, stomach, and intestine so they are outlined on an x-ray. This allows the movement of food - as it passes from the mouth to the esophagus - to be viewed. Another method used to diagnosis laryngopharyngeal refluxis to pass a specific type of scope through the mouth, down the esophagus and into the stomach. The scope allows the doctor to directly view the inside of the stomach and esophagus. A third test determines the level of acid in the throat. Although cancer is rare, tests may be ordered to rule out cancer. At other times, you may have to undergo a dual-channel pH probe test to diagnose your condition. This involves placing a small tube (catheter) through your nose and down into your swallowing passage (esophagus). The catheter is worn for a 24-hour period and measures the amount of acid that refluxes into your throat. This test is not often necessary, but can provide critical information in certain cases. Treatment: One of the first things you must do is make some changes in your lifestyle. Many foods and drinks can make your symptoms worse, and it is important that these be eliminated. In addition, being overweight, smoking, and drinking alcohol are all factors that worsen reflux disease. Medication protocol starts with a proton pump inhibitor, or PPI (Nexium, Prevacid, Protonix, Aciphex, Prilosec, etc). It is essential that PPIs be taken 30-40 minutes before meals so that they may be fully absorbed into the blood stream before the first bite is taken. The preferred meal is dinnertime. If twice a day dosing is required to control symptoms, then breakfast and dinnertime are used. The proton pump inhibitor should never be taken with food. Its effect on reducing stomach acid production is lost if taken more than two hours before eating.
  • The second medication used is an H2 blocker antacid. These are now over-the-counter, but prescriptions are also available. They include Zantac, cimetidine, Pepcid AC, etc. These can be taken with or without food, allowing them to be taken before going to bed. The usual protocol is to take the proton pump inhibitor 30-40 minutes before dinner and the H2 blocker at bedtime. Again the H2 blocker does not require a meal to activate its effects and so can be safely taken at bedtime. The emphasis on evening (dinnertime) and bedtime dosing addresses the fact that while sleeping flat, the stomach, esophagus, and larynx are in the same plane, thus worsening reflux into the throat.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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