What are LPR symptoms?
Laryngopharyngeal reflux symptoms include:
- Hoarseness and/or lowering of your voice register.
- A lump or a feeling of something stuck in your throat.
- Throat clearing.
- Chronic cough.
- Excessive mucus or phlegm.
- Difficulty swallowing.
- Chronic sore throat.
- Laryngitis (inflammation of your vocal cords or losing your voice).
- Wheezing.
- Postnasal drip.
- Frequent upper respiratory infections.
- New or worsening asthma.
What is the main cause of LPR?
For gastric juices to travel from your stomach all the way up through your esophagus and into your throat, they have to get past two important guards. These are your upper and lower esophageal sphincters — the muscular valves that seal off your esophagus at the top and bottom. The lower one separates your esophagus and stomach, while the upper one separates your esophagus and throat.
Normal acid reflux happens when something weakens your lower esophageal sphincter (LES), allowing stomach juices to flow back up into your esophagus. LPR happens when your upper esophageal sphincter (UES) also relaxes inappropriately. This allows reflux that’s already in your esophagus to creep up higher into your throat. Different things can affect these two sphincters and cause them to relax.
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What are some specific causes that can lead to laryngopharyngeal reflux?
A lot of things can affect how well your esophageal sphincters close to keep substances out. Some of these factors weaken the muscles gradually over time, while other factors can affect them temporarily. Most people have more than one factor affecting them. Healthcare providers don’t always know exactly which ones caused LPR, but they often find that if you reduce these factors, your reflux reduces.
1. Breaching your LES
Your lower esophageal sphincter (LES) is the first guard against acid reflux from your stomach into your esophagus. Frequent, substantial acid reflux will cause symptoms of GERD, but you can have a small amount of reflux in your esophagus without feeling it. Your esophagus has many layers of protection against acid reflux, so it takes a lot to wear it down. Your throat doesn’t have the same protection.
Common factors that may weaken your LES temporarily include:
Medications. Certain medications can have a relaxing effect on your LES, including:
- Benzodiazepines, a type of sedative.
- Calcium channel blockers, which treat high blood pressure.
- Tricyclic antidepressants, which treat depression and pain.
- NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen.
- Theophylline, a common asthma medication.
- Hormone therapy (HT) medications for menopause.
Foods and drinks. Foods and drinks that may have a relaxing effect on your LES include:
- Coffee.
- Chocolate.
- Alcohol.
- Mint.
- Garlic.
- Onions.
Lifestyle habits. Simple things can temporarily weaken your LES by increasing abdominal pressure against it, or by taking away the advantage of gravity, which helps keep it closed.
- Lying down or reclining too soon after eating.
- Sleeping on your back, which submerges your LES inside your stomach contents.
- Eating larger meals, which expands your abdomen and increases digestion time.
- Wearing tight clothes or belts around your abdomen, especially when sitting.
Common factors that may weaken your LES progressively over time include:
- Hiatal hernia. When your stomach bulges up through a hole in your diaphragm, your LES also moves above your diaphragm and loses some of its muscle support system.
- Pregnancy. Lots of people get temporary acid reflux during pregnancy when abdominal pressure pushes against your diaphragm and LES. Hormones also contribute.
- Obesity. Obesity is another cause of constant abdominal pressure that can weaken your LES over time. It can also affect your hormone levels.
- Smoking. Tobacco smoke has a relaxing effect on your LES. It’s also associated with coughing, which can put chronic pressure on your LES. It’s a common cause of hiatal hernia.
2. Breaching your UES
Once stomach juices are in your esophagus, it’s up to your upper esophageal sphincter (UES) to keep them out of your throat. You may only have a small, unnoticeable amount of reflux in your esophagus, but it doesn’t take much to irritate your throat tissues. They don’t have the same protective lining as your esophagus, and they also don’t have the same mechanisms that wash reflux out, so it stays longer.
Common factors that may weaken or relax your UES include:
- Lying down. Some people have LPR during the night because their esophageal sphincters both relax a little when they lie down.
- Burping. Burping is one reflex that can trigger both your LES and your UES to open. Gas bubbles can carry small amounts of stomach juices into your throat.
- Bending over, exercising or singing. These activities build pressure under your UES, which may weaken it.
- Smoking and alcohol use. These substances have a relaxing effect on both of your esophageal sphincter muscles.
What are the complications of LPR?
Laryngopharyngeal reflux may cause:
- Excessive mucus and frequent infections. Stomach acid interferes with the normal mechanisms that clear mucus and infections out of your throat and sinuses. Mucus exists to trap infections and help clear them out. When mucus doesn’t get cleared out, infections don’t, either.
- Chronic voice and throat irritation. Chronic voice and throat irritation can interfere with your ability to speak and swallow. Over time, it can cause vocal cord lesions (growths) to develop. Long-term vocal inflammation (laryngitis) is also a risk factor for developing laryngeal cancer.
- Respiratory complications. Acid in your larynx may pass through your trachea (windpipe) into your bronchial tubes and lungs. You can inhale tiny acid particles without realizing it, especially in your sleep (silent aspiration). This can cause bronchial inflammation and infections.
