Acid Reflux and ENT manifestations: A review of Laryngopharyngeal Reflux

Abstract

Laryngopharyngeal reflux disease (LPRD), an extraoesophageal manifestation of gastroesophageal reflux disease (GERD), occurs when gastric contents reach the larynx and pharynx, frequently without classic heartburn or regurgitation (“silent reflux”). This condition accounts for up to 10% of otolaryngology consultations and affects 15–30% of patients with laryngeal complaints. The laryngopharyngeal mucosa is highly susceptible to injury from acid, pepsin, bile acids, and trypsin, leading to direct mucosal damage and vagally mediated reflexes. Common ENT manifestations include hoarseness, chronic cough, throat clearing, globus pharyngeus, excessive mucus, and sore throat, with less frequent associations such as chronic rhinosinusitis, subglottic stenosis, and laryngeal granulomas. The diagnosis incorporates clinical history, the Reflux Symptom Index (RSI >13), the Reflux Finding Score (RFS >7) on laryngoscopy, and objective testing using 24-hour hypopharyngeal–esophageal multichannel intraluminal impedance-pH monitoring as the reference standard. The multimodal, step-by-step management process begins with dietary and lifestyle modifications and progresses to proton-pump inhibitors, alginates, and, in refractory cases, anti-reflux surgery or adjunctive therapies. Recent international consensus statements emphasize the importance of objective confirmation of reflux to reduce overtreatment. This review compiles the latest information on pathophysiology, diagnosis, and treatment to enhance patient outcomes.