Laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR), also extraesophageal reflux disease (EERD) refers to retrograde flow of gastric contents to the upper aero-digestive tract, which causes a variety of symptoms, such as cough, hoarseness, and wheezing, among others. It can be a relevant comorbidity of asthma.

Although heartburn is a primary symptom among people with gastroesophageal reflux disease (GERD), heartburn is present in fewer than 50% of the patients with LPR. Other terms used to describe this condition include atypical reflux,silent reflux, and supra-esophageal reflux.

Gastroesophageal reflux disease (GERD) was recognized as a clinical entity in the mid-1930s and now is the most prevalent upper gastrointestinal (GI) disorder in clinical practice. Around the same time, in 1934, Bray suggested a link between gut symptoms and airway disease. Acid-related laryngeal and granulomas were first reported by Chery in 1968. Subsequent studies suggested that acid reflux might be a contributory factor in other laryngeal and respiratory conditions. In 1979, Pellegrini and DeMeester were the first to document the link between these airway symptoms and reflux of gastric contents. They also proved that treatment of reflux disease results in elimination of these airway symptoms.

People who suffer from GERD usually have symptoms such as esophageal damage that result from the stomach acid shooting up into the esophagus. The acid can irritate the tissues of the esophagus resulting in a sore throat and persistent coughing. Patients who suffer from laryngopharyngeal reflux, or LPR, are more likely to experience symptoms as a result of stomach acid refluxing into the larynx.

In recent years, it became apparent that stomach acid is only a part of the equation. Research suggests that the stomach enzyme pepsin plays a crucial role in the complex mechanism behind LPR. The body produces pepsin in the stomach to digest proteins. During reflux episodes, pepsin is delivered into the airways where they are destroying proteins inside of mucosa cells and therefore creating damage. The activity of pepsin correlates with the acidity of the environment. Each time something acid is consumed or acid is refluxed, pepsins are activated and the symptoms worsen.

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