Laryngopharyngeal Reflux Disease (LPRD)

Overview

Laryngopharyngeal reflux disease (LPRD)  refers to a medical condition in which the inflammatory reaction of the mucous membrane of pharynx, larynx and other associated respiratory organs takes place. It is  caused by a reflux of stomach contents into the oesophagus.

Gastroesophageal Reflux Disorder (GERD) is a common problem which occurs when the acid from the stomach comes back up to the oesophagus. When the acid spills over into the larynx from the oesophagus, you may develop symptoms of Laryngopharyngeal reflux disease (LPRD)

Causes

1. Laryngopharyngeal reflux disease (LPRD) is caused due to the stomach acid rising up into the throat.
2. When you eat and swallow food, it passes down your pharynx and the oesophagus before reaching the stomach.
3. There is a muscle known as the oesophageal sphincter that controls the opening of the oesophagus and the stomach.
4. The muscle is closed at all times except when you are eating food.
5. When the muscle does not close, the acid can come back up to the oesophagus and then spill into your pharynx.

Causes

1. Laryngopharyngeal reflux disease (LPRD) is caused due to the stomach acid rising up into the throat.
2. When you eat and swallow food, it passes down your pharynx and the oesophagus before reaching the stomach.
3. There is a muscle known as the oesophageal sphincter that controls the opening of the oesophagus and the stomach.
4. The muscle is closed at all times except when you are eating food.
5. When the muscle does not close, the acid can come back up to the oesophagus and then spill into your pharynx.

Signs & Symptoms

While there are instances where Laryngopharyngeal reflux disease (LPRD) is asymptomatic, most of the time the symptoms cannot be missed. The symptoms of LPRD include:[3]

1. Chronic cough
2. Throat irritation
3. Dysphagia or trouble with swallowing
4. Constant throat clearing
5. Sensation of something stuck in your throat
6. Phlegm in your throat
7. Weak and hoarse voice
8. Post-nasal drip
9. Cracking voice
10. Heartburn and acidity
11. Swallowed food comes back up
12. Spasm of the larynx (voice box)
13. Blockage of your breathing pipe
14. Wheezing
15. Redness and swelling of larynx (voice box) due to irritation

Diagnosis 

1. Patient history

Your physician will conduct the diagnosis of Laryngopharyngeal reflux disease (LPRD) by asking you questions about your condition. All your symptoms of pain, discomfort and acid reflux need to be mentioned to your doctor. Symptoms of irritation, swelling in the throat and discomfort at the back of the vocal cords can give a complete picture of your condition.

2. Clinical examination

A physical examination helps rule out other causes of the reflux. With the help of a clinical examination, your physician can identify any structural abnormality that is causing the reflux or any other dietary habits that could be the cause.

3. Investigations

Three common investigations are conducted to diagnose Laryngopharyngeal reflux disease (LPRD).

a. Barium swallow

You will be made to drink a special liquid known as barium. This coats your inner linings of the pharynx, oesophagus, stomach and intestines. An x-ray image is taken after you drink the liquid barium. The x-ray shows an outline of the entire system and allows the doctor to see the food pass through the digestive system.

b. Endoscopy

An endoscope with a camera on one end is inserted into the stomach through the oesophagus. This helps visualize the insides of the pharynx, oesophagus and stomach.

c. Oesophageal pH

The oesophageal pH test is a test to measure and record the pH levels in the oesophagus.

Treatment

1. Most cases of Laryngopharyngeal reflux disease (LPRD) are managed on their own and do not require any medical intervention. However, some severe cases may need the following: [1]
2. Eat a bland diet that is low in spice, fats and acid.
3. Eat smaller, frequent meals.
4. Avoid drinking alcohol, chewing tobacco and drinking caffeine.
5. Lose weight and maintain your ideal body weight.
6. Try to keep your head raised while sleeping. This will help keep your head at a higher angle to ensure that the stomach acid does not come back up.
7. Stop clearing your throat.
8. Avoid eating food just before bedtime.
9. Medications that reduce your acidity or lower the acid levels in your stomach are also helpful.
10. Surgical treatment includes fundoplication in which the surgeon will wrap the upper portion of your stomach and attach it above the lower end of the oesophagus. This helps create a stronger valve and the faulty oesophageal sphincter can rest. 

Nissen Fundoplication is done laparoscopically by using small incisions in your abdomen. The laparoscope is inserted into one of the incisions and every issue is visible through the laparoscope. In some cases, a titanium beads ring is placed outside the lower oesophagus to strengthen the valve and allow the food to pass safely.

How to prepare for the doctor's consultation? 

1. Consult your physician when you experience any of the above symptoms, like severe reflux, coughing, acidity or nausea.
2. Your physician will inquire about your medical history, family history and dietary habits.
3. You may need to get a series of tests done for the physician to understand your clinical condition. 
4. Sort your queries with your physician regarding the status of your condition. Understand from your doctor what signs you need to be wary of and when you need to consult in case of an emergency.

1. Untreated LPR can lead to chronic sore throat, chronic hoarseness, and chronic cough.
2. More than these nuisances, there is an association between reflux and cancer both of the swallowing tube and of the throat.
3. In some patients, even after being treated for reflux a Trans-Nasal Esophagoscopy (TNE) is indicated.