Laryngopharyngeal reflux disease is a disorder pertaining to the voice box, vocal cords, and the upper esophagus. Acid backing up from the stomach and into the esophagus can sometimes reach the upper esophagus (pharynx) and affect structures in the area (voice box and vocal cords). Acid can cause irritation to the tissues and result in symptoms in some patients. Typical symptoms include upper respiratory problems such as asthma and chronic cough. Other symptoms may include frequent need to clear the throat, a "lump" sensation in the throat (called "globus" sensation), hoarseness, sour taste, recurrent sore throat or sensations of choking or trouble swallowing.
Eliminating the possibility of other causes for symptoms such as allergies, sinus problems and pulmonary disease is important to be sure the correct treatment is started.
This problem can be caused by stomach contents backing up into the esophagus. This is allowed to occur if areas of specialized muscle tissue called the lower esophageal sphincter (LES) and upper esophageal sphincters (UES) are weakened. The LES is located at the junction of the esophagus and the stomach. The job of the LES is to act as a one-way valve, allowing food to enter the stomach and prevent it from coming back up into the esophagus. Reflux occurs when the LES is too relaxed and does not prevent stomach fluids and food from backing up into the esophagus. The UES performs the same function as the LES, but in the upper esophagus. The lining of the esophagus is not protected from stomach acid, unlike the stomach's lining. The acid contact with the esophagus, voice box, and vocal cords causes inflammation and may cause irritation of the structures leading to the symptoms of reflux.
Treatment with twice per day Proton Pump Inhibitors: These include omeprazole (Prilosec), lansoprazole (Prevacid), dexlansoprazole (Kapidex), pantoprazole (Protonix), rabeprazole (Aciphex) and sodium bicarbonate (Zegerid) and esomeprazole (Nexium). These medications work by stopping the production of acid by certain cells in the stomach that make acid.
If medications fail to resolve symptoms, endoscopic or surgical interventions may be necessary. New endoscopic treatment options are available to control acid reflux as an alternative to chronic medications or to avoid surgery. These options can be discussed with your gastroenterologist.
This option is reserved for when the above measures aren't working. It can also be used as an alternative to chronic medication therapy. The surgery is called "Nissen Fundoplication". This is a surgical procedure where the upper portion of the stomach is wrapped around the lower esophageal sphincter area to prevent reflux.
When to seek medical advice?
In cases of chronic hoarseness or no improvement in symptoms with treatment, please call your doctor for additional advice. You may be referred to ENT for additional testing to rule out other problems. If heartburn, significant trouble swallowing or chest pain occurs, please call your doctor to discuss symptoms as this is atypical for laryngopharyngeal reflux disease and may indicate other problems and a need for additional testing such as an esophagogastroduodenoscopy (EGD). If significant weight loss has occurred medical attention should be sought.