GERD and Laryngopharyngeal Reflux (LPR): Symptoms, Risk Factors, and Treatment Options - Dr Bhuvan Shetty

Gastro-oesophageal reflux disease (GERD) is a very common digestive disorder worldwide, defined as a condition of troublesome symptoms and complications that result from the reflux of stomach contents into the esophagus. GERD is an important health concern as it is associated with decreased quality of life and significant morbidity.

The classic and most common symptom of GERD is heartburn where the patient presents with burning sensation in the chest, radiating toward the mouth, as a result of acid reflux into the esophagus.

Although classic symptoms of GERD are easily recognized, extraesophageal manifestations of GERD are also common but not always recognized. Extraesophageal symptoms are more likely due to reflux into the larynx also called as Laryngopharyngeal reflux, or LPR

This Laryngopharyngeal reflux can cause a range of symptoms and complications, including:

1. Chronic Cough: Acid irritation in the throat can lead to a persistent cough, often worsening at night or when lying down.

2. Sore Throat: The acidic content can cause inflammation and soreness in the throat, leading to discomfort or pain.

3. Hoarseness: GERD can irritate the vocal cords, resulting in a hoarse or raspy voice.

4. Laryngitis: Repeated acid exposure can lead to inflammation of the larynx (voice box), resulting in laryngitis.

5. Postnasal Drip: Acid reflux can cause the production of excess mucus, leading to a sensation of postnasal drip, where mucus trickles down the back of the throat.

6. Swallowing Difficulties: Chronic irritation and inflammation can make swallowing uncomfortable or difficult.

7. Throat Clearing: Frequent throat clearing can become a habit due to irritation caused by acid reflux.

Risk factors for LPR

1. Dietary choices like spicy food, citrus fruits, caffeinated beverages, chocolates, and alcohol.

2. Lifestyle factors like obesity, smoking and sedentary lifestyle.

3. Eating habits like large portion meals, and late-night binge-eating.

4. Medical conditions like Hiatal hernia, pregnancy, and asthma.

5. Physical factors like lifting heavy wights or activities which increase intra-abdominal pressure.

Complications of LPR

- Excessive mucus and frequent infection – Stomach acid interferes with normal mechanisms that clear mucus and infection out of your throat and sinuses

- Chronic voice and throat irritation – which can interfere with ability to speak and swallow, over time can cause vocal cord lesions, inflammations and increase the risk of laryngeal cancer.

- Respiratory complications – as the acid may pass into the lungs, especially while sleeping, leading to bronchial inflammations and infections.

Diagnostic Tests

• Laryngoscopy: This involves using a laryngoscope to view the throat and voice box directly. It helps identify signs of inflammation or damage caused by acid exposure.
• 24-Hour pH monitoring: This test measures the amount of acid in the esophagus over a 24-hour period.
• Oesophageal Manometry: This test evaluates the function of the esophagus and the lower oesophageal sphincter (LES). It measures the strength and coordination of muscle contractions in the esophagus.
• Barium Swallow Test: In this X-ray exam, you swallow a barium solution, which coats the esophagus and makes it visible on X-ray. It helps identify structural abnormalities or reflux.
• Impedance Monitoring: This measures the movement of substances (liquid, gas, or mixed) in the esophagus. It can detect non-acid reflux, which is sometimes involved in LPR

Treating laryngopharyngeal reflux (LPR) generally involves a combination of lifestyle changes, dietary adjustments, medications, and sometimes surgical interventions

Lifestyle and Dietary Changes: eat smaller more frequent meals, avoid trigger foods, having foods 2-3 hrs before sleeping, head end elevation of bed, avoid smoking and alcohol

Medications:

1. Proton Pump Inhibitors (PPIs):
   These medications reduce stomach acid production and are often effective in treating LPR. They are typically used for an extended period to allow the throat to heal.
2. H2-Receptor Antagonists: These drugs decrease acid production, though they are generally less effective than PPIs for LPR.
3. Antacids: Over-the-counter options can neutralize stomach acid and provide temporary relief.
4. Alginates: These medications create a protective barrier on top of stomach contents, helping to reduce reflux symptoms.

Getting an accurate diagnosis, discovering the contributing causes and targeting them with the right treatment can be a process. But once the way is clear, treatment for LPR is usually brief and effective.

Most people won’t need long-term prescription medications or other interventions. The key to recovery lies in making helpful lifestyle changes and taking care to protect your throat and voice while they heal.