Laryngopharyngeal reflux: State of the art diagnosis and treatment

S. O. Ulualp, R. J. Toohill

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59 Scopus citations


Gastroesophagopharyngeal reflux has been implicated in the pathogenesis of a wide variety of otolaryngologic disorders. Patients with GER-associated otolaryngologic disorders infrequently have the classic symptoms of gastroesophageal reflux, such as heartburn. The clinical presence of laryngopharyngeal reflux most commonly is characterized by chronic intermittent symptoms. All patients should undergo complete otolaryngologic evaluation with the careful investigation of predisposing factors to GER and examination of the larynx. Esophageal endoscopy can be considered in patients with esophageal symptoms; otherwise esophagitis is uncommon in patients with GER-associated otolaryngologic disorders. Barium esophagram is an inexpensive and convenient technique to document the esophageal abnormalities; however, the role of barium esophagram to detect the gastroesophageal reflux in otolaryngologic disorders associated with GER is limited. Ambulatory 24-hour pharyngoesophageal pH monitoring provides the documentation of pharyngeal and esophageal acid exposure. Interpretation of the ambulatory pH monitoring results should consider the technical difficulties of the test and the different characteristics of gastroesophagopharyngeal acid reflux in this patient group. Real pharyngeal acid reflux events need to be identified from the spurious readings with detailed analysis of the data. Pharyngeal pH monitoring is important in this patient group since the minute amounts of acid may cause laryngeal injury. Because of the intermittent nature of esophagopharyngeal reflux, however, pharyngeal pH monitoring may not document acid reflux in all patients who suffer from the consequences of laryngopharyngeal reflux. Therefore, improvement of the laryngopharyngeal-associated signs and symptoms with the treatment supports the role of gastroesophagopharyngeal reflux. Treatment consists of combination of antireflux precautions and acid suppressive agents. Acid suppressive therapy includes H2 blockers and proton pump inhibitors. Proton pump inhibitors provide relief of symptoms even in cases unresponsive to H2 blockers. Patients who are intolerant to the acid suppressive therapy may benefit from surgical treatment with Nissen fundoplication. Until the development of more specific methods to document the role of esophagopharyngeal reflux in patients with otolaryngologic disorders, concurrent use of the information obtained from the complete otolaryngologic evaluation, diagnostic tests, and response to treatment are essential for the efficient management of patients with gastroesophagopharyngeal reflux-associated otolaryngologic disorders.

Original languageEnglish (US)
Pages (from-to)785-801
Number of pages17
JournalOtolaryngologic Clinics of North America
Issue number4
StatePublished - 2000

ASJC Scopus subject areas

  • Otorhinolaryngology


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