Digestive Health Heartburn Diagnosis What Is Laryngopharyngeal Reflux (LPR)? By Sharon Gillson Sharon Gillson Sharon Gillson is a writer living with and covering GERD and other digestive issues. Learn about our editorial process Updated on September 21, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Robert Burakoff, MD, MPH Medically reviewed by Robert Burakoff, MD, MPH LinkedIn Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment When the upper esophageal sphincter doesn't function properly, the acid that has back flowed into the esophagus enters the throat and voice box. When this happens, it's called laryngopharyngeal reflux, or LPR. Although they are each caused by a malfunction of esophageal sphincters, LPR is not the same thing as heartburn. Heartburn occurs when the lower (rather than the upper) esophageal sphincter malfunctions. In addition, LPR symptoms are concentrated in the throat and voice box, while heartburn is felt more in the chest. Getty Images / Michael Krasowitz This article explains the symptoms, causes, diagnosis, and treatment of LPR. Symptoms When acid passes quickly through the esophagus but pools in the throat, you may experience LPR symptoms. These symptoms are concentrated in your throat and voice box and include: Continual throat clearing Chronic throat irritation Chronic cough Hoarseness Excessive phlegm in the throat Dysphagia (difficulty swallowing) Constant sensation of something in the throat Consumed food comes back up Postnasal drainage Weak voice Cracking voice Blockage of the breathing passage Spasm of the larynx (voice box) Wheezing People with LPR don't typically experience classic heartburn symptoms (unless, of course, they also have gastroesophageal reflux disease or GERD). That's because, for refluxed acid to cause heartburn, it has to stay in the esophagus long enough to irritate. With LPR, acid usually passes quickly through the esophagus. Causes There are two sphincter muscles located in the esophagus. When either malfunction they result in different conditions and symptoms: Lower esophageal sphincter (LES): When the lower esophageal sphincter is not functioning correctly, it backflows stomach acid into the esophagus. This backflow causes acid reflux and chest pain. If this happens two or more times a week, it can be a sign of GERD. Upper esophageal sphincter (UES): When the upper esophageal sphincter doesn't function correctly, acid enters the throat, where it pools and irritates the throat and voice box. LPR occurs when the UES malfunctions and acid pools in the throat. Diagnosis To diagnose LPR, your healthcare provider will do a physical exam and take a medical history. Often, doctors do not need to order tests to make a diagnosis. However, they may do one of the following tests to determine if you have LPR: Swallowing test: In this test, you swallow a liquid that coats the esophagus, stomach, and intestines so your doctor can see them on an X-ray. Laryngoscopy: This procedure allows your doctor to see changes in the throat and voice box. 24-hour pH testing: If too much stomach acid moves into the upper esophagus or throat, this procedure may help your doctor see what's going on. This test uses two pH sensors—one at the bottom of the esophagus and one at the top. These sensors will let the healthcare provider see if the acid that enters the bottom of the esophagus moves to the top of the esophagus. Upper GI Endoscopy: If a person complains of difficulty swallowing, this procedure can show any scars or abnormal growths in the esophagus. Your doctor can then biopsy any abnormality found. This test will also show if there is any inflammation of the esophagus caused by refluxed acid. 5 Reasons Why Your Throat May Be Burning Treatment Treatment for LPR is generally the same as that for GERD. There are four treatments for LPR: Lifestyle changes: Quitting smoking, limiting alcohol, avoiding trigger foods, managing stress, and maintaining a weight that is healthy for you can reduce, and sometimes prevent, acid reflux. Diet modifications: You may want to pay attention to which foods tend to trigger your symptoms. Some common foods people need to avoid include citrus, tomatoes, spicy foods, greasy foods, coffee, and alcohol. Medications: Some drugs can reduce stomach acid or promote normal function. These can include proton pump inhibitors (PPIs), Histamine Receptor Antagonists, and over-the-counter (OTC) remedies like antacids. Surgery to prevent reflux: The most common surgery for reflux is called the Nissen fundoplication. During this procedure, a surgeon wraps part of the stomach around the lower esophageal sphincter and sews it in place. Recap Lifestyle and diet modifications may help you prevent symptoms of LPR. In addition, OTC and prescription medications can prevent or alleviate symptoms. In severe cases, surgery to tighten the connection between the esophagus and the stomach may be an option. Summary LPR is a form of acid reflux that occurs when the upper esophageal sphincter malfunctions, causing acid to pool in the throat. You may experience symptoms like coughing, throat clearing, sore throat, hoarseness, and weak voice when this happens. Often people find that certain foods trigger their symptoms. So, to manage symptoms, you may need to modify your diet. In addition, OTC and prescription medications can reduce or prevent symptoms. In more extreme situations, surgery is also an option. Was this page helpful? Thanks for your feedback! Get nutrition tips and advice to make healthy eating easier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 3 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Salihefendic N, Zildzic M, Cabric E. Laryngopharyngeal Reflux Disease - LPRD. Med Arch. 2017;71(3):215–218. doi:10.5455/medarh.2017.71.215-218 Vaezi MF, Hicks DM, Abelson TI, Richter JE. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clinical Gastroenterology and Hepatology. 2003;1(5):333-344. doi:10.1053/s1542-3565(03)00177-0 Priston J, Thoen R, Medeiros T, Assunção A, Campagnolo A. Laryngopharyngeal reflux: Diagnosis, treatment, and latest research. International Archives of Otorhinolaryngology. 2013;18(02):184-191. doi:10.1055/s-0033-1352504