The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice

Posted On Jan 21 2015 by

Laryngopharyngeal reflux

Many people with LPR do not have symptoms of heartburn. Why? In order for refluxed acid to cause heartburn, it has to stay in the esophagus long enough to cause irritation.

However, limited data on their diagnostic accuracy and potential clinical application are available. Gastroesophageal reflux disease (GERD) is the long-term, regular occurrence of acid reflux.

Other medications work to decrease stomach acid secretion before it happens and are more effective at controlling symptoms. Medications should be discussed with your physician. Pregnancy will markedly increase symptoms of heartburn and sometimes throat symptoms as well.

The accumulation of mucus produces sensations that provoke chronic throat clearing. Direct irritation of the upper airway by gastric refluxate can cause laryngospasm, producing symptoms of chronic coughing and choking. The management of patients with suspected laryngeal manifestations of GERD continues to be controversial. Laryngopharyngeal reflux (LPR) is the term used in this article to discuss the pathogenesis of reflux laryngitis. Since the late 1960s, gastroesophageal acid reflux has been implicated in the pathogenesis of several extraesophageal disorders, including laryngitis.

On the other hand, some studies assessed that the presence of abnormal acid reflux on pH monitoring did not predict response to therapy [Vaezi et al. 2006b; Williams et al. 2004]. Laryngopharyngeal reflux (LPR) is similar to another condition — GERD — that results from the contents of the stomach backing up (reflux). But the symptoms of LPR are often different than those that are typical of gastroesophageal reflux disease (GERD). The upper esophageal sphincter keeps stomach acid out of the pharynx and larynx. When it doesn’t work properly, you can develop symptoms such as hoarseness, loss of voice, chronic cough, phlegm in the back of the throat, and a feeling that something is stuck in the throat.

After taking baseline biopsy samples of the larynx, the investigators applied a variety of gastric and duodenal enzymes at varying pH levels (pH 1-7) to the larynxes. After 9 to 12 applications, they took another biopsy and assessed the changes visually and histologically. In this article, we review the current understanding of the pathophysiology of LPR and evaluate current diagnostic tests and treatment regimens for patients with suspected LPR. To confirm LPR, the doctor may recommend a pharyngeal pH probe. This involves placement of a thin wire which secures behind the ear, enters through the nose, and sits in the back of the throat.

During gastroesophageal reflux (GER), stomach contents enter the esophagus. In the case of laryngopharyngeal reflux (LPR), stomach contents pass through the esophagus, through the upper esophageal sphincter (UES), and into the back of the throat, and may even reach the nasal cavity. Someone who has LPR will have symptoms typically in their throat. The is from the acid continuing to reflux fully up the esophagus and into the throat which usually doesn’t happen with a GERD patient.

  • Laryngoscopy revealed erythema of the arytenoids, the interarytenoid area and the laryngeal surface of the epiglottis, along with mild edema of the true vocal cords.
  • High-fat foods and chocolate are empirically indicated as foods able to reduce LES pressure or to prolong gastric emptying; however, there have been no cessation trials evaluating the impact on GERD outcomes [Murphy and Castell, 1988; Wright and Castell, 1975].
  • Respiratory physiotherapy can increase lower esophageal sphincter pressure in GERD patients .
  • Reflux occurs when the sphincters do not function well and therefore allow the strong contents to travel back up the esophagus.
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Reduction in RSI values for each single symptom before and after a 4 week-treatment with PPI + add-on in EMERGE and in RELIEF patients. For these reasons, two large surveys were conducted in Italy, involving both otolaryngologists and gastroenterologists.

Once this happens this acid can cause irritation and general inflammation in the chest area. It’s this irritation which causes most of the symptoms from a person with GERD. The most common symptoms are heartburn and chest pain. For more information on GERD check out – Acid Reflux / GERD – The Ultimate Guide.

Physical causes can include weak or abnormal muscles at the lower end of the esophagus where it meets the stomach, normally acting as a barrier for stomach contents re-entering the esophagus. Other physical causes include hiatal hernia, abnormal esophageal spasms, and slow stomach emptying. Changes like pregnancy and choices we all make daily can cause reflux as well. These choices include eating foods like chocolate, citrus, fatty foods, spicy foods or habits like overeating, eating late, lying down right after eating, and alcohol/tobacco use (see below).

In a large cross-sectional population-based study, consuming bread and fibers at least two meals per day caused a 50% reduction in reflux symptoms [Terry et al. 2001]. Likewise, in another cross-sectional study, high fiber intake correlated with a reduced risk of GERD symptoms [El-Serag et al. 2005]. The mechanism through which fiber is associated with a decreased risk is unknown, however increased gastric empting could be a reasonable hypothesis.

Marial® alone treatment induced a statistically significant higher reduction in each single symptom in RELIEF patients than in EMERGE patients, with the exception of heartburn, chest pain, indigestion, or stomach acid coming up (Figure 5). Similar results were obtained evaluating the reduction in RSI values in patients treated with PPI in add-on that was able to determine a higher statistically significant decrease in RELIEF than in EMERGE patients in each single symptom, with the exception of heartburn, chest pain, indigestion, or stomach acid coming up (Figure 6).

You’re at greater risk for developing GERD if you smoke, are obese, or are pregnant. These conditions weaken or relax the lower esophageal sphincter, a group of muscles at the end of the esophagus.

Although PPIs are the treatment of choice for GERD, still approximately one-third of patients with GERD fail to respond symptomatically to a standard dose PPI, either partially or completely [20]. Actually, NERD accounts for 60-70% of GERD patients and is considered the most common presentation of GERD. However, only approximately 30-40% of NERD patients respond to a standard dose of PPIs, much lower than that in erosive esophagitis, and the low response rate to PPIs in NERD patients is the main contributor to the high portion of PPI failure phenomenon in GERD, and also LPR, management [21]. The mechanisms of failure of PPI therapy are complex and multifactorial [20, 22, 23, 24]. Consequently, other medications should be considered and used.

Last Updated on: September 27th, 2019 at 12:35 am, by

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