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Laryngopharyngeal Reflux

This commonly presents with globus, cough or hoarsness. Some patients also have asthma which may be triggered by the reflux of gastric contents which may or may not be acidic, into the throat, above the oesophagus. It may or may not be associated with symptoms of gastro-oesophageal reflux (GORD). In fact probably less than 50% of patients with laryngo-pharyngeal reflux (depending on which study you read!) complain of the typical GORD symptoms  of heartburn, acid and or water brash. Laryngo-pharyngeal reflux is a consequence of gastric (stomach) contents moving against the normal direction of flow and moving up the oesophagus and into the back of the throat. The laynx is particularly sensitive even to proteins and other irritants from the stomach, which may cause irritation even when the contents are not acidic. As a result of the fact that the larynx may be irritated by a variety of proteins and chemicals from the stomach acid suppression in the form of conventional PPIs, such as omeprazole may not resolve symptoms in the same way as they usually do (80-90% of the time) in people with gastro-oesophageal reflux. As well as liquid the larynx may also be irritated by vapour from the stomach. This is because it contains proteins and chemicals (including acid) which may cause inflammation even in very small quantities. Management can be challenging, particularly when conventional acid suppression fails to control symptoms.

Laryngopharyngeal reflux may be diagnosed on impedance testing, as well as other tests such as peptest. However there are not currently any internationally  agreed parameters for the diagnosis of this condition.

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