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What laryngopharyngeal reflux (LPR) is, how it differs from GERD, how it is diagnosed, and the diet, medicines and lifestyle changes used to treat it.
By Editorial Team · Updated · 3 min read
This article is awaiting review by a qualified medical professional.
Quick answer
Laryngopharyngeal reflux (LPR), often called silent reflux, is when stomach contents travel all the way up to the throat and voice box, causing hoarseness, throat clearing, cough and a lump-in-the-throat feeling, often without heartburn. It is diagnosed by symptoms and examination by an ENT specialist, sometimes with reflux testing. Treatment combines diet and lifestyle changes, alginates, and acid-reducing medicine when appropriate.
Laryngopharyngeal reflux (LPR) happens when stomach contents, including acid, digestive enzymes such as pepsin, and sometimes bile, reach the back of the throat (pharynx) and the voice box (larynx). Because these tissues are much more sensitive to acid than the esophagus, even small amounts can cause irritation. Many people with LPR do not feel heartburn, which is why it is called silent reflux.
| LPR (silent reflux) | GERD | |
|---|---|---|
| Where it acts | Throat and voice box | Esophagus |
| Main symptoms | Hoarseness, throat clearing, cough, lump in the throat | Heartburn, regurgitation |
| Heartburn | Often absent | Usually present |
| Typical timing | Often daytime, when upright | Often after meals, and at night when lying down |
The two conditions overlap, and one person can have both. See our guide to GERD.
The most common symptoms are hoarseness, frequent throat clearing, a lump in the throat, a sensation of mucus, chronic cough and difficulty swallowing. See our full guide to LPR symptoms.
The diagnosis of LPR can be challenging, because throat symptoms have many causes, including allergies, postnasal drip, infections, voice misuse and smoking. Doctors may use:
Anti-reflux surgery, such as Nissen fundoplication, is rarely used for LPR and only when reflux has been proven and medicines have not worked.
Long-term irritation can cause chronic laryngitis, vocal cord granulomas, and rarely narrowing below the voice box. Persistent hoarseness needs to be examined to rule out other serious causes.
See a doctor if you have hoarseness lasting more than 4 weeks, or a persistent cough, throat clearing or lump in the throat. Seek urgent care if you have difficulty breathing, noisy breathing, coughing blood, trouble swallowing, a lump in the neck or unexplained weight loss.
GERD mainly affects the esophagus and causes heartburn and regurgitation, often when lying down. LPR affects the throat and voice box, causes hoarseness, throat clearing and cough, usually with little or no heartburn, and often happens during the day when upright. The two can occur together.
LPR can usually be controlled with treatment and lifestyle changes, and symptoms often improve within weeks to months, though it can return. Treatment is often needed for at least a few months.
Results are mixed. Some people improve with a course of acid-reducing medicine, but many do not, and throat symptoms can have other causes. Guidelines increasingly recommend confirming reflux before long courses when only throat symptoms are present.
The throat can take longer to heal than the esophagus. It is common to need 2 to 3 months or more of treatment before symptoms settle.
Hoarseness that lasts longer than 4 weeks needs an examination of the voice box, particularly in smokers or heavy drinkers, to rule out other conditions including cancer.
This article is for educational purposes only and does not replace advice from a doctor or other qualified health professional. See our medical disclaimer.
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