Laryngopharyngeal reflux (LPR)
Laryngopharyngeal reflux (LPR) is when stomach acid comes back up (refluxes) through your oesophagus. This stomach acid may enter your throat, voice box and nasal passages.
LPR is similar to gastro-oesophageal reflux disease (GORD or GERD). But unlike GORD, it tends not to cause heartburn. In fact, for many people, LPR causes no or few symptoms. For this reason, it is often referred to as silent reflux.
Overview | Symptoms | Causes | Tests | Treatments
Often people who experience LPR or silent reflux, do not realise until the damage from the stomach acid starts to cause secondary symptoms.
Symptoms
If you do experience symptoms from LPR, they may include:
- Hoarseness
- A chronic cough
- Feeling a lump in your throat
- Feeling like you need to clear your throat
- Trouble swallowing
- A bitter taste in your throat
- A sore throat
- A burning sensation in your throat
- A dripping feeling from your nose to the back of your throat
Causes
LPR happens when the muscle (sphincter) between the bottom of your oesophagus and the top of your stomach doesn’t close properly. This allows stomach acid to travel back up your oesophagus.
Anyone of any age can experience LPR, but certain risk factors make getting the condition more likely. For example, poor diet, smoking, drinking too much alcohol or being overweight. Some people may naturally have a malformed or weak oesophageal sphincter.
Left untreated, LPR can lead to scarring on the throat and voice box from chronic acid reflux. It may aggravate airway conditions like asthma, bronchitis or emphysema.
Tests
Many other conditions may cause similar symptoms to LPR. To diagnose LPR, you may need a type of endoscopy called a gastroscopy. This will help the doctor to see if you have any scarring from LPR on your throat or voice box.
You may also need a 24-hr PH impedance test or 96 hour wireless pH capsule (BRAVO). This will help the doctor monitor the amount of stomach acid refluxing into your oesophagus over a 24 to 96-hour period.
You may also need to be checked by an Ear, Nose, and Throat (ENT) doctor.
Treatments and symptom management
LPR is normally treatable through lifestyle changes. For example, losing weight, stopping smoking, drinking less alcohol, and avoiding fatty, rich or spicy foods. Stopping eating at least three hours before bed and sleeping with your head raised can also help.
If lifestyle changes aren’t effective, you may need medications to suppress or counteract acid or an anti-reflux procedure. This can be done via camera (gastroscopy) such as Stretta, or via keyhole surgery. Please remember each patient is different, therefore you need to see a specialist to give you the right advice based on the latest research.
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Silent reflux often causes no symptoms, but if you have a lump in your throat or often experience a bitter taste in your mouth, speak to a specialist to prevent complications.
Get in touch to arrange a consultation with one of our expert gastroenterologists.