LPR is not GERD. LPR is the reflux of stomach contents into the region of the laryngopharynx. Although from the stomach, the symptoms, findings, and effects of LPR are vastly different from GERD. Most people with LPR do not have GERD symptoms. GI evaluation is often negative in patients with LPR.
Symptoms
- Change in Voice
- Throat Clearing
- Dysphagia
- Globus (Lump in throat sensation)
- Mucus (Phlegm)
- Post-Nasal Drip
Diagnosis
Unlike GERD, LPR is diagnosed primarily based on symptoms, physical findings, and response to treatment. The most common symptoms are those listed above, usually in combination. Physical findings vary and are visualized endoscopically – either with a flexible laryngoscope or video-stroboscopy (the gold-standard of laryngeal diagnosis). Symptoms typically improve before physical findings change. In addition, office-based Trans-Nasal Esophagoscopy can help with diagnosis and with surveillance for esophageal cancer and Barrett’s. Some studies have shown a higher association of esophageal adenocarcinoma with LPR than with GERD.
Treatment
As with GERD, the most important treatment regimen is a change in diet and behavior. Weight loss, exercise, eating small meals at least 3 hours before lying down are the first steps. Dietary changes include no coffee/caffeine (not even Decaf!), alcohol, chocolate, tea, greasy/fried food, mints, and spicy foods. These typically are triggers rather than causes of reflux. Diet is the most important change that can prevent and reverse reflux disease. A more Mediterranean diet, mostly plant based, will help to stop symptoms and reverse damage associated with reflux. The gold standard of medical therapy is proton pump inhibition. However, in recent years, PPI therapy has been linked to many chronic diseases, most recently to increased risk of having COVID. Some patients do require medical treatment and PPI therapy, for short periods of time, might be prescribed. H2 blockers such as ranitidine are another alternative. Other medications include pro-kinetics, baclofen, coating agents (Sucralfate, Maalox, Gaviscon) and alginates (Reflux Gourmet, Gaviscon Advance). Symptoms typically resolve before the physical findings improve. As patients symptoms diminish, medication can be tapered. Various foods may be restarted after symptoms have resolved, however, this must be done with caution as diet and behavior started this problem and LPR can certainly recur.
Voice Therapy
Often associated with LPR are voice changes. LPR can induce muscle tension dysphonia which is a maladaptive response of the larynx to chronic irritation. This causes inappropriate squeezing of the intrinsic and extrinsic laryngeal musculature leading to vocal fatigue, tension, neck pain, decreased projection, raspiness, and gravelly vocal quality. Voice therapy aimed at reducing muscular tension, promoting better closure of the glottis, and increasing efficiency of the phonatory system providing patients with improved vocal quality and stamina.
