What Is Laryngopharyngeal Reflux (LPR)?

When the upper esophageal sphincter doesn’t function properly, the acid that has backflowed into the esophagus enters the throat and voice box. When this happens, it’s called laryngopharyngeal reflux, or LPR.

Although they are each caused by a malfunction of esophageal sphincters, LPR is not the same thing as heartburn. Heartburn occurs when the lower (rather than the upper) esophageal sphincter malfunctions. In addition, LPR symptoms are concentrated in the throat and voice box, while heartburn is felt more in the chest.

This article explains the symptoms, causes, diagnosis, and treatment of LPR.

Symptoms

When acid passes quickly through the esophagus and pools in the throat, you may experience LPR symptoms. These symptoms are concentrated in your throat and voice box and include:

• Continual throat clearing
• Chronic throat irritation
• Chronic cough
• Hoarseness
• Excessive phlegm in the throat
• Dysphagia (difficulty swallowing)
• Constant sensation of something in the throat
• Feeling of food coming back up
• Postnasal drainage
• Weak voice
• Cracking voice
• Blockage of the breathing passage
• Spasm of the larynx (voice box)
• Wheezing

People with LPR don’t typically experience classic heartburn symptoms (unless, of course, they also have gastroesophageal reflux disease or GERD). That's because, for refluxed acid to cause heartburn, it has to stay in the esophagus long enough to irritate it. With LPR, acid usually passes quickly up through the esophagus.

Causes

There are two sphincter muscles located in the esophagus. When either malfunctions, it results in different conditions and symptoms:

• Lower esophageal sphincter (LES): When the lower esophageal sphincter is not functioning correctly, stomach acid can flow up into the esophagus. This backflow causes acid reflux and chest pain. If this happens two or more times a week, you may be diagnosed with GERD.
• Upper esophageal sphincter (UES): When the upper esophageal sphincter doesn’t function correctly, acid enters the throat, where it pools and irritates the throat and voice box.

Diagnosis

To diagnose LPR, your healthcare provider will do a physical exam and take a medical history. Often, doctors do not need to order tests to make a diagnosis. However, they may do one of the following tests to determine if you have LPR:

• Videofluoroscopy: In this test, you swallow a liquid that coats the esophagus, stomach, and intestines so your doctor can see them on an X-ray.
• Laryngoscopy: This procedure allows your doctor to see changes in the throat and voice box.
• 24-hour pH testing: If too much stomach acid moves into the upper esophagus or throat, this procedure may help your doctor see what’s going on. This test uses two pH sensors—one at the bottom of the esophagus and one at the top. These sensors will let the healthcare provider see if the acid that enters the bottom of the esophagus moves to the top of the esophagus.
• Upper GI endoscopy: If a person complains of difficulty swallowing, this procedure can show any scars or abnormal growths in the esophagus. Your doctor can then biopsy any abnormality found. This test will also show if there is any inflammation of the esophagus caused by refluxed acid.

Treatment

Treatment for LPR is generally the same as that for GERD. There are four treatments for LPR:

• Lifestyle changes: Quitting smoking, limiting alcohol, avoiding trigger foods, managing stress, and maintaining a weight that is healthy for you can reduce, and sometimes prevent, acid reflux. 
• Diet modifications: You may want to pay attention to which foods tend to trigger your symptoms. Some common foods people need to avoid include citrus, tomatoes, spicy foods, greasy foods, caffeine, carbonated drinks, chocolate, and alcohol.
• Medications: Some drugs can reduce stomach acid. These include proton pump inhibitors (PPIs), histamine receptor antagonists (H2 blockers), and over-the-counter (OTC) remedies like antacids.
• Surgery to prevent reflux: The most common surgery for reflux is called the Nissen fundoplication. During this procedure, a surgeon wraps part of the stomach around the lower esophageal sphincter and sews it in place.

Summary

LPR is a form of acid reflux that occurs when the upper esophageal sphincter malfunctions, causing acid to pool in the throat. You may experience symptoms like coughing, throat clearing, sore throat, hoarseness, and weak voice when this happens.

Often people find that certain foods trigger their symptoms. So, to manage symptoms, you may need to modify your diet. In addition, OTC and prescription medications can reduce or prevent symptoms. When these measures don't help enough, surgery is also an option.