Laryngopharyngeal reflux (LPR) occurs when stomach acid back-flows or refluxes into the food channel (oesophagus) and into the throat and voice box (larynx).
There are two sphincter muscles in the oesophagus – the lower oesophageal sphincter (LES) and upper oesophageal sphincter (UES).
The LES is a muscle that prevents back-flow of food and acid from the stomach into the oesophagus. The UES is a muscle that prevents food and acid in the oesophagus from back-flowing into the larynx. When the LES is weak and does not close tightly, you will have gastrooesophageal reflux disease (GERD), also known as chronic acid reflux.
If acid (and digestive enzymes) from the stomach back-flows into the larynx, you will have laryngopharyngeal reflux (LPR).
A diagnosis of LPR is achieved with a combination of detailed history, physical examination and occasionally some tests. Procedures that may be performed to diagnose this condition include:
The treatment of LPR is essentially similar to the treatment of gastrointestinal reflux disease (GERD) or chronic acid reflux. It consists of lifestyle modifications, dietary modifications, anti-acid medication, and rarely surgery.
Eat smaller, more frequent meals. A large meal will expand your stomach and increase upward pressure against the oesophageal sphincter.
Limit your intake of acid-stimulating foods and beverages. Refer to dietary modifications outlined on the following page.
Do not lie down for three hours after you eat. Lying flat makes it easier for the stomach contents to enter the oesophagus. When sleeping it sometimes helps to have the head higher than the stomach. This can be achieved by raising the head of the bed or using a mattress wedge.
Maintain a reasonable weight. Being overweight increases the pressure in the abdomen which can push the stomach contents against the LES.
Do not smoke. Nicotine in cigarettes relaxes the oesophageal sphincter. Smoking also stimulates production of stomach acid.
Do not wear tight clothing or belt around the waist. This can squeeze the stomach, forcing its contents into the oesophagus.
Avoid or reduce intake of spicy and ‘heaty’ foods such as chilli, peanuts and chocolate. Fried foods, oily foods and sugary foods like ice-cream should also be avoided. Drinks such as orange and grapefruit juice, fizzy drinks, milkshake, coffee, tea and alcohol can also worsen reflux and should be avoided.
Medications can help reduce acid production in the stomach, promote gastric emptying, or protect the oesophagus lining from injury.
Medications to reduce acid production include proton pump inhibitors (e.g. omeprazole) and histamine receptor agonists (e.g. ranitidine). Prokinetic agents such as domperidone can also be prescribed to promote gastric emptying, and help clear acid from the stomach. Antacids such as Gaviscon can create a protective layer that shields the oesophagus from injury by stomach acid and digestive enzymes.
Surgery may be indicated in severe LPR that does not respond to maximal medical therapy and lifestyle/ dietary modification. The surgery is performed to tighten the junction between stomach and esophagus. The procedure known as Nissen Fundoplication involves wrapping the top part of the stomach around the junction between stomach and esophagus and securing it in place.
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