Do you often experience dry throat, throat pain, and hoarseness, along with chest pain or heartburn? It might not just be pharyngitis. It could also be a condition that has recently garnered more attention from ENT doctors: laryngopharyngeal reflux (LPR). People at high risk for this disease should be particularly mindful of adjusting their diet and lifestyle to prevent “reflux” from being triggered.
This Disease Often Masquerades as Pharyngitis
Laryngopharyngeal reflux is a condition where the contents of the stomach abnormally reflux into the throat above the upper esophageal sphincter, causing a range of symptoms, signs, and diseases. The prevalence is between 10% and 35%.
Besides stomach acid and pepsin, the refluxed stomach contents can also include bile acids and pancreatic enzymes. These contents can irritate and damage the throat and laryngeal mucosa, causing inflammation, epithelial thickening, and viscous secretions, leading to symptoms like a foreign body sensation in the throat, excessive phlegm, chronic throat clearing, vocal fatigue, and hoarseness.
Most patients with laryngopharyngeal reflux experience hoarseness, which leads them to visit ENT clinics. However, due to the unique cause of this condition, it is often misdiagnosed as regular pharyngitis. As a result, patients may take antibiotics and traditional Chinese medicine for heat-clearing and detoxification without any improvement, resulting in prolonged illness that significantly affects their quality of life and mental well-being.
With the growing understanding of laryngopharyngeal reflux among ENT physicians, it is now recognized that this condition is quite common in clinical practice, with more than 50% of voice disorders related to it.
Poor Lifestyle Habits Can Also Cause Reflux
Medically, the discomfort caused by reflux of stomach contents leading to throat disease is due to various factors.
Disease factors are a significant cause of reflux, such as obstructive sleep apnea-hypopnea syndrome, which can easily induce reflux and harm throat health. From a lifestyle and mental health perspective, poor dietary and lifestyle habits, as well as depression and anxiety, can also easily cause reflux.
Additionally, from an anatomical perspective, the throat area is quite vulnerable and has low acid resistance. When stomach contents reflux into the throat, they naturally irritate and damage the throat mucosa. Correspondingly, the refluxed material stimulates the vagus nerve in the esophagus, leading to severe coughing that damages the vocal cord mucosa and causes the upper esophageal sphincter to relax, increasing the amount of stomach contents refluxing into the throat.
Currently, laryngopharyngeal reflux syndrome is associated with various diseases, including chronic pharyngitis, chronic laryngitis, laryngeal contact granuloma, subglottic stenosis, paroxysmal laryngospasm, vocal cord leukoplakia, asthma, and more. Recently, this condition is also suspected to be a risk factor for laryngeal cancer in non-smokers and non-drinkers.
High-Risk Groups Should Seek Medical Attention for Symptoms
High-risk groups for laryngopharyngeal reflux include long-term smokers and drinkers, patients with gastroesophageal reflux disease, hiatal hernia, obesity, habitual vomiting, and those who consume high-sugar, high-fat, and irritating foods. If symptoms persist, they should promptly visit an ENT clinic for specialized evaluation and examination.
The diagnosis of laryngopharyngeal reflux relies on patient symptom inquiries and endoscopic examinations. The most closely related endoscopic findings include erythema, edema, and hyperplasia in the interarytenoid and posterior commissure regions, as well as extensive edema of the vocal cords and tracheal mucosa.
Currently, the academic community has established reflux symptom index (RSI) and reflux finding score (RFS) scales based on patient symptoms and the severity of laryngeal findings. An RSI greater than 13 and an RFS greater than 7 are considered abnormal.
Laryngopharyngeal reflux syndrome is a complex disease involving multiple specialties, including ENT, respiratory medicine, and gastroenterology. There is considerable debate about its treatment, and no universally effective treatment protocol exists. The recommended treatment approach involves anti-reflux therapy, including behavioral and pharmacological treatments.
Avoiding Reflux Requires Changing Four Habits
Behavioral treatment involves changing diet and lifestyle habits related to reflux, including:
- Changing Eating Habits: Quit smoking and alcohol, reduce the intake of high-sugar and high-fat foods, acidic fruits, strong tea, and coffee. These foods can stimulate gastric acid secretion and increase gastric pressure, leading to reflux.
- Adjusting Meal Patterns: Adopt a small, frequent meal pattern, strictly avoid eating 2 to 3 hours before bedtime, and elevate the head of the bed by 5 to 8 centimeters. This can effectively reduce gastric acid secretion and reflux during sleep.
- Avoiding Tight Belts: Wearing tight belts can increase gastric pressure, promoting reflux of stomach contents.
- Controlling Weight: Enhance exercise to avoid obesity. Obesity can cause upper airway narrowing, and the negative pressure in the throat during sleep can lead to reflux of stomach contents.