Laryngopharyngeal manifestations of reflux: diagnosis and therapy

Abstract

Acid reflux--most often associated with heartburn--may also cause a wide range of laryngopharyngeal symptoms, including laryngitis and chronic cough. Symptoms of laryngopharyngeal reflux (LPR), like those of gastrooesophageal reflux disease, result from abnormal exposure of tissues to acid refluxate. Deranged sensorimotor function of the upper oesophageal sphincter appears to play a key role in the aetiology of LPR, but the disease is not completely understood. Among the significant long-term complications of LPR are bronchopulmonary disorders, recurrent pneumonia, chronic cough, chronic or recurrent laryngitis, and oral cavity disorders. It also appears to be a risk factor for the development of laryngeal carcinoma. Diagnosis of LPR is based on physical examination, medical history, and results of specific tests. At present, the test of choice for LPR diagnosis is intraluminal oesophageal pH monitoring. Barium contrast oesophagography, intraoesophageal acid perfusion challenge, and flexible endoscopic evaluation of swallowing with sensory testing may also be used in LPR diagnosis. Treatment for LPR includes changes to the diet and lifestyle, and acid-suppressing therapy. The Therapeutic Working Party at the First Multi-Disciplinary International Symposium on Supraesophageal Complications of Gastroesophageal Reflux Disease has recommended twice-daily dosing with a proton pump inhibitor as an initial therapy for LPR, with treatment continued between 4 weeks and 6 months. Such treatment has been found highly effective in resolving symptoms of LPR, and it may also prevent the serious long-term complications of this condition.