An update on current treatment strategies for laryngopharyngeal reflux symptoms

Abstract

Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx, which leads to symptoms of throat clearing, hoarseness, pain, globus sensation, cough, excess mucus production in the throat, and dysphonia. LPR is a challenging condition, as there is currently no gold standard for diagnosis or treatment, and thus this presents a burden to the healthcare system. Strategies for treatment of LPR are numerous. Medical therapies include proton pump inhibitors, which are first line, H2 receptor antagonists, alginates, and baclofen. Other noninvasive treatment options include lifestyle therapy and the external upper esophageal sphincter compression device. Endoscopic and surgical options include antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication. Functional laryngeal disorders and laryngeal hypersensitivity can present as LPR symptoms with or without gastroesophageal reflux disease. Though there are minimal studies in this area, neuromodulators and behavioral interventions are potential treatment options. Given the complexity of these patients and numerous available treatment options, we propose a treatment algorithm to help clinicians diagnose and triage patients into an appropriate therapy.

Review article: Diagnosis and management of laryngopharyngeal reflux

“…Further, an enhanced brain-larynx interaction can coexist with true LPR, just as patients with GERD or oesophageal motility disorders can have concomitant oesophageal hypersensitivity. 94 For example, in one study, researchers evaluated the Oesophageal Hypervigilance and Anxiety Scale (EHAS) in patients with chronic laryngeal symptoms and identified similarly elevated EHAS scores across patient groups with or without objective GERD. 18 Similarly, Wong et al 95 identified increased oesophageal hypervigilance and symptom-specific anxiety in patients with both GERD and LPR symptoms, LPR predominant and GERD predominant symptoms when compared to controls, and once again, reflux burden did not differ across groups.…”

“…Secondly, most studies evaluating LPR use various diagnostic modalities, such as laryngoscopy and symptombased questionnaires, which are not recommended as diagnostic modalities in patients presenting with chronic laryngeal symptoms. 94 Furthermore, even when ambulatory reflux monitoring is used, it is unclear what type of reflux monitoring system should be used (prolonged wireless reflux monitoring or 24 h impedance-pH monitoring) nor if traditional pH and reflux thresholds for GERD can be applied to patients with chronic laryngeal symptoms. 14,94 Consequently, it is reasonable to reserve a PPI trial for patients with chronic laryngeal symptoms and concomitant GERD symptoms and perform up-front reflux testing in those with isolated laryngeal symptoms.…”

“…94 Furthermore, even when ambulatory reflux monitoring is used, it is unclear what type of reflux monitoring system should be used (prolonged wireless reflux monitoring or 24 h impedance-pH monitoring) nor if traditional pH and reflux thresholds for GERD can be applied to patients with chronic laryngeal symptoms. 14,94 Consequently, it is reasonable to reserve a PPI trial for patients with chronic laryngeal symptoms and concomitant GERD symptoms and perform up-front reflux testing in those with isolated laryngeal symptoms. If patients are proven to have pathological acid reflux based on traditional reflux parameters, it is worthwhile to trial a PPI to ascertain if patients experience symptom improvement.…”

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

“…The medical treatment of P-LPR was long-standing based on the use of histamine (H2) blockers or PPIs. PPIs and histamine (H2) blockers bind irreversibly to active proton pumps and increase the pH of gastroesophageal and esophago-pharyngeal reflux events without influencing the number and duration of events [ 4 , 99 ]. In adults, the superiority of PPIs over placebo is not demonstrated [ 100 ].…”

Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta‐analysis

“…By definition, LPR is a pharyngeal inflammatory disease directly or indirectly caused by gastroduodenal contents reflux, which could lead to symptoms of morning hoarseness and nocturnal coughing, sore throat, excessive mucus production, and foreign body sensation in the pharynx 4,5 . Current treatments for LPR mainly include lifestyle modifications and pharmacological treatments, such as proton pump inhibitors (PPIs) 6,7 …”