Definition of Laryngopharyngeal Reflux (LPR).
There are two sphincter muscles located in the esophagus: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES). When the lower esophageal sphincter is not functioning properly, there is a back flow of stomach acid into the esophagus. If this happens two or more times a week, it can be a sign of gastroesophageal reflux disease, or GERD.
But what happens when the upper esophageal sphincter doesn't function correctly either?
As with the lower esophageal sphincter, if the upper esophageal sphincter doesn't function properly, acid that has back flowed into the esophagus is allowed into the throat and voice box. When this happens, it's called Laryngopharyngeal Reflux, or LPR.
It usually occurs without heartburn, less than 15% of people with this problem have heartburn. The larynx, trachea, bronchi and lungs are much more susceptible to damage from the stomach juices than the esophagus.
The esophagus is better able to handle the acid than the larynx and pharynx because it has built in protective mechanisms. It also means that it takes even smaller amounts of stomach juices to do the damage.
Digestive juices can get into the upper throat at night as with regular acid reflux or GERD, but more people with LPR have damage occur during the day than at night.
How is LPR different from GERD?
Are the symptoms the same for both diseases? Can people suffer from Laryngopharyngeal Reflux (LPR) without having any symptoms of Acid Reflux (GERD)? Can LPR occur without any heartburn at all? This is totally possible. Some of the people who suffer from LPR do not suffer from heartburn at all! How is this possible? Heartburn occurs when the acids stays in the esophagus and burns the surface. But in LPR, these stomach acids are not staying in the esophagus long enough to cause heartburn. In this case, acid goes past the esophagus and rests in the person’s throat or voice box. As the throat is more sensitive than esophagus, this will result in Laryngopharyngeal Reflux symptoms and not heartburn associated with GERD.
Symptoms of Laryngopharyngeal Reflux are:
* Hoarseness
* Chronic throat-clearing, excessive mucous
* Chronic cough
* Stridor (noisy breathing)
* Difficulty swallowing
* “Lump in the throat “(globus)
* Reactive airway disease (wheezing)
* Chronic bronchitis
* Chronic airway obstruction
* Wheezing
* Apnea
* Aspiration pneumonia
* Nasal obstruction
* Ear pain
* Chronic nasal congestion
* Sore throat
* Gagging
These symptoms are also related to many conditions thought to be aggravated or caused by LPR. These conditons include:
* Otitis media (ear infections)
* Sinusitis
* Chronic nasal congestion
* Vocal cord nodules
* Chronic laryngitis
* Laryngomalacia
* Apnea
* Subglottic stenosis
* Arytenoid fixation
* Laryngospasm
* Recurrent pharyngitis
* Chronic cough
* Exacerbation of asthma or reactive airway disease
Diagnosis of Laryngopharyngeal Reflux
Most often, your doctor can diagnose LPR by examining your throat and vocal cords with a rigid or flexible telescope. The voice box is typically red, irritated, and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months.
At other times, you may have to undergo a dual-channel pH probe test to diagnose your condition. This involves placing a small tube (catheter) through your nose and down into your swallowing passage (esophagus). The catheter is worn for a 24-hour period and measures the amount of acid that refluxes into your throat. This test is not often necessary, but can provide critical information in certain cases.
Your doctor may do one of the following tests to determine if you have LPR:
* Laryngoscopy
This procedure is used to see changes of the throat and voice box.
* 24-hour pH testing
This procedure is used to see if too much stomach acid is moving into the upper esophagus or throat. Two pH sensors are used. One is located at the bottom of the esophagus and one at the top. This will let the doctor see if acid that enters the bottom of the esophagus moves to the top of the esophagus.
* Upper GI Endoscopy
This procedure is almost always done if a patient complains of difficulty with swallowing. It is done to see if there are any scars or abnormal growths in the esophagus, and to biopsy any abnormality found. This test will also show if there is any inflammation of the esophagus caused by refluxed acid.
Treatment of Laryngopharyngeal Reflux
Treatment for LPR is generally the same as that for GERD. Laryngopharyngeal reflux can be managed effectively with proper treatment.
Lifestyle modifications that may be prescribed include:
* Elevation of the head of the bed four to six inches
* Avoiding alcohol, chocolate and caffeine
* Avoiding overeating
* Eating or drinking nothing two to three hours before bed
* Avoiding greasy, fatty foods
* Losing weight
Medical treatments may include one or a combination of the following:
* Antacids to neutralize excess stomach acid
* Anti-secretory medications that decrease acid production by the stomach
* Surgery to tighten the junction between the stomach and esophagus. The most commonly performed surgery is called the Nissen Fundoplication. It is done by wrapping the top part of the stomach around the junction between the stomach and esophagus and sewing it in place.
Sources:
Charles N. Ford, MD, "Evaluation and Management of Laryngopharyngeal Reflux." JAMA. 2005;294:1534-1540.. The Journal of the American Medical Association. 11 Sep 2007 http://heartburn.about.com/od/gastrictractdisorders/a/whatis_LPR.htm
1 comment:
The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.
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