5.5 Acid Reflux Disorders
Key Features
Laryngopharyngeal reflux is distinct from classic gastroesophageal reflux disease (GERD).
The work-up may involve an endoscopy, barium studies, and a pH probe.
Extraesophageal manifestations relate to the pharynx, larynx, and lungs.
Epidemiology
Twenty-five to forty percent of healthy adult Americans experience symptomatic gastroesophageal reflux disease (GERD) manifested as heartburn. Laryngopharyngeal reflux (LPR) typically does not cause heartburn or esophagitis. Certain foods, medications, hormones, and physical states (e.g., obesity) can decrease the pressure of the lower esophageal sphincter, thus worsening LPR or GERD symptoms.
Clinical
Signs
GERD: esophagitis, Barrett′s esophagus
LPR: coughing, throat clearing, laryngeal erythema
Symptoms
GERD symptoms typically include postprandial heartburn and regurgitation. LPR symptoms may be more subtle and include hoarseness, globus sensation, dysphagia, chronic throat clearing, halitosis, sensation of postnasal drainage, chronic cough, laryngospasm, and otalgia.
Evaluation
A suggestive history and exam findings usually prompt a “therapeutic trial” of behavioral changes and twice-daily use of a proton pump inhibitor. Ancillary testing should be employed if this regimen fails or if symptoms are atypical or worsening, due to risk of malignancy.
Physical Exam
Nasolaryngopharyngoscopy may reveal laryngeal erythema and edema of arytenoids and interarytenoid space, laryngeal pachydermia, and vocal fold granulomas.
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