A Patient’s Story
Luca, a 46-year-old manager, was referred after months of hoarseness, throat clearing, and a constant sore throat. He had seen his GP multiple times and even changed his voice use at work. Despite this, his symptoms persisted. He had no heartburn, no chest pain, and no obvious reflux symptoms.
A specialist assessment revealed the underlying cause: laryngopharyngeal reflux, often referred to as silent reflux.
What Is Laryngopharyngeal Reflux?
Laryngopharyngeal reflux (LPR) occurs when stomach acid travels up beyond the oesophagus and irritates the throat, voice box, and airways. Unlike typical acid reflux or GORD, LPR often does not cause heartburn, which is why it can be difficult to recognise.
The tissues of the throat and larynx are far more sensitive than the oesophagus. Even small amounts of acid exposure can lead to significant symptoms.
Common Symptoms of LPR
People with LPR may experience:
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Hoarseness or voice loss
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Chronic throat clearing
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Persistent cough
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Trouble swallowing (dysphagia)
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A lump sensation in the throat (globus)
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Ongoing sore throat
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A constant urge to clear the throat
Symptoms are often worse in the morning or after speaking for long periods.
Why LPR Is Often Missed
LPR is more difficult to diagnose than classic GORD because symptoms overlap with:
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ENT conditions
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Allergies
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Asthma
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Anxiety-related throat symptoms
Without proper assessment, LPR can remain untreated and may lead to chronic laryngeal inflammation, voice problems, and in severe cases, aspiration-related lung issues.
How Is LPR Diagnosed?
Diagnosis starts with a detailed symptom assessment and examination. Depending on findings, investigations may include:
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Flexible laryngoscopy to assess vocal cord inflammation
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24-hour pH impedance testing to detect acid and non-acid reflux
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Endoscopy to assess the oesophagus and stomach
Accurate diagnosis is essential to guide effective treatment.
Treatment Options for LPR
Lifestyle and Dietary Changes
Initial treatment focuses on reducing reflux triggers, including:
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Avoiding late meals
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Reducing caffeine and alcohol
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Weight optimisation
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Elevating the head of the bed
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Quitting smoking
Medications
Acid suppression therapy may be prescribed to reduce acid exposure and allow the throat to heal. Treatment often requires longer duration than standard reflux therapy.
Surgical Options for Reflux
For patients with persistent or severe symptoms despite optimal medical treatment, anti-reflux procedures may be considered.
Options include:
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Fundoplication, reinforcing the lower oesophageal sphincter
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Nissen fundoplication, a full 360-degree wrap for severe reflux
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Transoral Incisionless Fundoplication (TIF), a minimally invasive option
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LINX Reflux Management System, using magnetic beads to support the sphincter
Surgery is typically reserved for carefully selected patients after thorough evaluation.
When to Seek Specialist Advice
If you have ongoing throat symptoms without a clear cause, especially hoarseness, cough, or throat clearing that does not improve, LPR should be considered.
At LSDC Healthcare, we specialise in diagnosing complex reflux conditions using advanced investigations and tailored treatment plans.