Diagnosing laryngopharyngeal reflux

PHILADELPHIA — There are important differences between laryngopharyngeal reflux and GERD that medical professionals should recognize, according to a presenter here at the annual meeting of the American Association of Nurse Practitioners.

While GERD is widely understood, laryngopharyngeal reflux (LPR) is not, Kelly Harden, DNSc, APRN, FNP-BC, FAANP, dean, Union University School of Nursing, Jackson, Tennessee, Harden wrote in her poster and accompanying abstract.

Kelly Harden

“It is imperative that LPR is recognized, diagnosed, and treated,” she told Healio Family Medicine.

“[Nurse practitioners (NPs)] must keep LPR in their list of differentials when patients present with cough, hoarseness, dysphonia, dysphagia, or what appears to be recurrent GERD. The culprit may be LPR,” she wrote.

Though both LRD and GERD have common risk factors, such as obesity and smoking, risk factors linked more to GERD include consuming spicy, fried and citrus foods; having medical conditions such as diabetes, hiatal hernia, pregnancy and scleroderma; and taking medications such as anticholinergics, calcium channel blockers, nitrates, sildenafil, and theophylline. Conversely, risk factors more associated with LRD include drinking alcohol, eating while lying down, exercising while eating, stress, and wearing tight clothing, Harden wrote.

The differences in pathophysiology between the conditions is important to recognize, she said.

“With LPR, stomach contents flow into the pharynx/throat/larynx, while in GERD they flow into the esophagus,” Harden said, noting that LPR can also occur without traditional signs of GERD, such as heartburn, burping, and chest tightness.

She also indicated that LPR should be suspected when a patient has GERD symptoms that do not resolve, such as chronic cough, heartburn, and hoarseness. “LPR patients often end up with [ear, nose and throat] referrals rather than [gastrointestinal] referrals, according to Harden’s poster.

Proper differential diagnosis is critical, as treatment may vary, Harden wrote.

“Some of the treatment measures are also the same, such as behavioral changes, H2 receptor blockers, proton pump inhibitors, and antacids. However, patients with LPR often need pro kinetic agents and treatment for a longer period of time.” – by Janel Miller

Reference:

Harden K. Poster: “Laryngopharyngeal reflux: Not your mama’s GERD.” Presented at: American Association of Nurse Practitioners National Conference; Jun. 20-25, 2017; Philadelphia.

Disclosure: Healio Family Medicine was unable to confirm relevant financial disclosures prior to publication.