Medicines for Laryngopharyngeal reflux

What it is

Laryngopharyngeal reflux (LPR), sometimes called "silent reflux", is a condition in which stomach contents (acid and other substances) travel up and irritate the throat, voice box (larynx) and upper airway. It is related to acid reflux (GORD), but differs in an important way: many people with LPR do not have the typical heartburn of classic acid reflux (hence "silent"), because the irritation affects the throat rather than causing the usual chest burning. Instead, LPR tends to cause throat symptoms such as a persistent need to clear the throat, a feeling of a lump or something stuck in the throat (globus), hoarseness or voice changes, a chronic cough, a sore or irritated throat, post-nasal drip sensation, and sometimes difficulty swallowing or a sensation of mucus. Because these symptoms are non-specific and overlap with many other throat and airway conditions, LPR can be difficult to diagnose and is sometimes over- or under-diagnosed. It is generally not dangerous, but it can be persistent and affect quality of life and the voice. Recognising it allows targeted management, while ensuring other causes of the throat symptoms are considered.

How it is treated

Management centres on reducing reflux and irritation, mainly through lifestyle and dietary measures, along with addressing throat symptoms, and a doctor will also ensure other causes of persistent throat symptoms are considered (a persistently hoarse voice, for example, should be assessed). Lifestyle and dietary measures are the foundation and help many people: eating smaller meals and not eating late at night, avoiding foods and drinks that trigger reflux (such as fatty or spicy foods, caffeine, alcohol, fizzy drinks, and acidic foods), losing excess weight, not smoking, raising the head of the bed, and reducing throat clearing and staying hydrated (which help the throat). Medicines that reduce stomach acid are sometimes tried, though their role in LPR is less clear-cut than in classic heartburn, and are used judiciously. Because the symptoms overlap with other conditions, and a persistently hoarse voice can occasionally have another cause, examination of the throat (sometimes by an ENT specialist) is often helpful, particularly if symptoms persist. Managing the voice (for example with a speech and language therapist) can help voice symptoms. The reassuring message is that laryngopharyngeal reflux is generally not dangerous and often improves with reflux-reducing lifestyle and dietary measures, while ensuring other causes of throat symptoms are considered.