If you have symptoms of hoarseness, chronic sore throat, dry cough at night, or feel like there is mucus stuck in your throat for no apparent reason, these symptoms may be related to “Laryngopharyngeal Reflux” also known as Laryngopharyngeal Reflux (LPR) which is different from typical acid reflux (GERD) because it usually does not show heartburn symptoms, so it is often overlooked and not diagnosed in time.
Laryngopharyngeal Reflux (LPR) also called “Silent Reflux” is a condition where stomach acid flows back up to the throat, larynx, and pharynx without showing the typical heartburn symptoms like general acid reflux (GERD). This causes many patients to be unaware that they are facing a health problem that needs urgent care.
Common symptoms of stomach acid reflux into the throat Even without clear heartburn symptoms, the following symptoms may be signs of LPR
- Chronic hoarseness, especially in the morning
- Sticky mucus in the throat, frequent throat clearing
- Chronic cough without a clear cause
- Sore throat or constant throat irritation
- Difficulty swallowing or feeling a lump in the throat
- Occasional breathing difficulty
- Sour or bitter taste in the throat, especially upon waking
- Bad breath
How is LPR different from acid reflux (GERD)?
Gastroesophageal reflux disease (GERD) is caused by acid flowing back from the stomach into the esophagus, causing heartburn, sour belching, or chest tightness. However, in LPR, acid and digestive juices flow back up to the larynx, throat, or voice box, causing chronic symptoms related to the upper respiratory system without the heartburn symptoms typical of GERD
Causes and Risk Factors
The main cause is dysfunction of the upper esophageal sphincter (Upper Esophageal Sphincter) and lower esophageal sphincter (Lower Esophageal Sphincter) which normally prevent digestive juices from flowing back up. If these sphincters malfunction, digestive juices can reflux up to the pharynx and larynx. Factors that trigger LPR include
- Esophageal sphincter muscle dysfunction
- High stomach pressure, such as after a large meal
- Smoking, alcohol consumption, or caffeine-containing drinks
- Obesity or overweight
- Lying down immediately after eating
Possible Complications
If left untreated chronically, it may lead to other problems such as
- Chronic inflammation of the larynx
- Fibrosis or nodules on the larynx
- Permanent voice changes
- Increased risk of esophageal or throat cancer in the long term
Diagnosis
Doctors will ask detailed symptoms and may use flexible laryngoscopy through the nose or throat to observe inflammation of the larynx or pharynx. Additionally, acid measurement in the esophagus or specific symptom assessment for laryngopharyngeal reflux may be considered.
Treatment Guidelines for LPR
1. Behavioral modification
- Avoid foods or drinks that trigger reflux such as fried foods, chocolate, coffee
- Eat moderate portions and avoid lying down for at least 3 hours before bedtime
- Elevate the head of the bed about 6–8 inches
- Lose weight if overweight
2. Medication
- Antacids
- Acid secretion inhibitors such as Proton Pump Inhibitors (PPI) or H2 Blockers
(Medication use should be under doctor’s guidance)
3. Symptom monitoring
Treatment of LPR may take longer than typical acid reflux. Patients should follow up regularly with their doctor to adjust treatment appropriately.
Do not overlook minor symptoms as they may be “silent signals” of the disease
If you have hoarseness, chronic cough, sore throat, or a lump in the throat that does not go away within 2–4 weeks, you should see an ear, nose, and throat specialist for proper evaluation and diagnosis. If left untreated, complications such as chronic inflammation of the larynx, vocal cord polyps, chronic cough interfering with daily life or risk of chronic esophagitis may occur.
Laryngopharyngeal Reflux (LPR) may not be severe initially, but if not properly managed, it can affect quality of life. If you have hoarseness, chronic sore throat, or unexplained dry cough, it may be a sign of laryngopharyngeal reflux. Do not let these symptoms affect your quality of life in the long term.
We recommend you undergo evaluation and receive targeted care by a specialized medical team at the Ear, Nose, and Throat Center, Phyathai Hospital 2, ready to provide consultation, diagnosis, and personalized treatment planning to help you return to a fully functional life.
Assoc. Prof. Dr. Kiti Kanobthamchai
Director of the Ear, Nose, and Throat Center
Phyathai Hospital 2
