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.

Keywords: extraesophageal reflux; gastroesophageal reflux; laryngopharyngeal reflux; treatment.

Figure 1:

Image of the External Upper Esophageal Sphincter Compression Device

Figure 2:

Conceptual diagram outlining both the diagnostic and therapeutic challenges of LPR.

Figure 3:

Proposed diagnostic algorithm for patients presenting with suspected LPR. Given the lack of a gold standard for diagnosis of LPR, we recommend flexible laryngoscopy and ambulatory reflux monitoring to assess the reflux burden. Pending the results, providers can treat patients with a sequential strategy for patients with LPR and GERD or Laryngeal hypersensitivity. For the LPR/GERD category, providers should initially start with a PPI trial with GERD lifestyle modifications, and if symptoms persist, move down the treatment algorithm trialing different therapies as outlined in the diagram.