LPR (Laryngopharyngeal Reflux) Denver
When stomach juice refluxes back up through the esophagus and into the back of the throat, it can cause irritation in the vocal cords and lungs. Irritation resulting from reflux is called laryngopharyngeal reflux, or LPR.
Symptoms of laryngopharyngeal reflux include:
- Continual throat clearing, hoarseness, excess phlegm, a weak or cracking voice, vocal cord spasm, or irritation in the throat.
- Chronic cough, worsening of asthma, shortness of breath, or blockage of the breathing passage.
- Constant sensation of something in the throat.
- Recurring sinus infections not due to other causes.
Patients may experience these LPR symptoms with or without experiencing heartburn or other typical GERD symptoms. In fact, many people with LPR do not have symptoms of heartburn. This is because in order for refluxed stomach juice to cause heartburn, it needs to be acidic and stay in the esophagus long enough to cause irritation. The throat is sensitive to small quantities of acid and other irritants in stomach juice. Therefore, if stomach juice passes quickly through the esophagus but pools in the throat, heartburn symptoms will not occur, but LPR symptoms will. Medical GERD treatments that reduce stomach acid do not work as effectively in LPR for these reasons. In the past decade or so, with medication resulting in good control of acid-related GERD symptoms, we have been seeing increasingly frequent problems with LPR symptoms because reflux continues despite acid suppression, which is referred to as non-acid reflux.
The diagnosis of LPR typically is suspected when a patient is found to have irritation of the vocal cords or airway during an evaluation for throat or lung symptoms. Findings include swelling, thickening, and redness in the posterior portion of the vocal cords. These findings are about 60-70% accurate. We have had a great deal of experience working with patients who have laryngeal and pulmonary findings of LPR in order to determine if they do indeed have reflux, and to provide treatment recommendations based upon those findings. We will typically consult with a patient to obtain a complete understanding of their symptoms, and then recommend testing as we find it appropriate. Tests frequently considered include upper endoscopy, 24 hour impedance/pH testing, 48-96 hour capsule pH testing, esophageal manometry, and barium esophagrams. We have the expertise to perform and/or interpret all of these tests ourselves – this is something uncommon in a surgical practice, but we find it provides a very high level of patient care.
A scientific review of laryngopharyngeal reflux can be found here.