Laryngo- Pharyngeal Reflux (LPR) or commonly called silent reflux is a retrograde flow of gastric contents into the larynx, pharynx and nasopharynx. When the sphincters or the muscle ring at the both end of esophagus do not function properly, the stomach acids return back to larynx, pharynx and nasopharynx. It can cause inflammation.

LPR is mostly seen in infants as their sphincters remain undeveloped. But the cause of LPR is not known in case of adults.

Symptoms of LPR

Infants and children diagnosed with LPR, show certain symptoms which include:

• Hoarseness
• Chronic cough
• Asthma
• Noisy breathing or pauses in breathing (apnoea)
• Trouble feeding, spitting up, or inhaling food
• Trouble gaining weight

In most cases, the adults do not show any specific symptom of LPR and certain symptoms in adults are confused with other issues. However, some common symptoms include:

• Excessive throat clearing
• Persistent cough
• Hoarseness
• A “lump” in the throat that doesn’t go away with repeated swallowing

Some other symptoms include:

• A sensation of postnasal drip or excess throat mucus

Trouble swallowing

• Trouble breathing
• Sore throat

Complications Developed Due to LPR

During LPR, stomach acids pulls back to larynx and throat which can cause long term irritation and damage. The children and infants may develop complications such as:

• Narrowing of the area below the vocal cords
• Contact ulcers
• Recurrent ear infections
• Continuous build up of middle ear fluid

In adults it can also increase risk for cancer in throat and larynx, affect the lungs, and may aggravate certain conditions such as asthma, emphysema, or bronchitis.

Diagnosis of LPR

Diagnosis of LPR is done following physical exams and certain tests. These diagnostic tests include: Endoscopic Exam and pH monitoring.

Endoscopic exam: using a flexible or rigid viewing instrument, the doctor views the throat and vocal cords.

pH monitoring: During pH monitoring a small catheter is inserted through the nose into the throat and esophagus. The sensors attach to the catheter detect acid and a small computer worn at the waist records findings during a 24-hour period. New pH probes placed in the back of the throat or capsules inserted higher up in the esophagus are used for better diagnostic results.

Treatment of LPR

Treatment of LPR includes medication, changes in life style and certain exercises.

Infants and children suffering from LPR are advised to do certain things such as:

• Smaller and more frequent feedings
• Keeping an infant in a vertical position for at least 30 minutes after feeding
• Medications such as H2 blockers or proton pump inhibitors
• Surgery for any abnormalities that can’t be treated in other ways

For adults, the treatment procedure includes:

• Weight reduction, if needed.

• Quit smoking
• Avoid alcohol.
• Restrict consuming chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine, and caffeine.
• Stop eating at least three hours before going to bed.
• Elevate the head of the bed about 4 to 6 inches.
• Avoid wearing tight-fitting clothes around the waist.
• Try chewing gum to increase saliva and neutralize acid.

Generally, people diagnosed with LPR improve following medication and life style change programmes. But certain severe conditions require Fundoplication surgery. This can be done laparoscopically and using open surgery. During Fundoplication, the upper part of the stomach around the lower esophagus is wrapped to create a stronger valve between the esophagus and stomach. Often a ring of titanium beads around the outside of the lower esophagus is inserted ‘laparoscopically’ to strengthen the valve to let the food pass through.

About CURA

CURA, Multispeciality Hospital has all the state of the arrangements and set up to offer the best treatments for LPR.