From the Guidelines
Treatment of laryngopharyngeal reflux (LPR) should prioritize proton pump inhibitors (PPIs) as the mainstay of treatment, with lifestyle modifications and consideration of alginate-based formulations for additional protection, as supported by the most recent evidence from 2023 1.
Key Considerations
- Patients should implement dietary changes, including avoiding caffeine, alcohol, spicy foods, acidic foods, and carbonated beverages, as well as eating smaller meals and elevating the head of the bed by 6-8 inches.
- PPIs, such as omeprazole 20-40mg twice daily, esomeprazole 40mg once daily, or pantoprazole 40mg once daily, should be taken 30-60 minutes before meals for optimal effect.
- Treatment duration typically ranges from 2-6 months, with many patients requiring at least 3 months for symptom resolution.
- H2 receptor antagonists like ranitidine 150mg twice daily may be added for breakthrough symptoms, but their use is limited due to tachyphylaxis and inferior efficacy compared to PPIs 1.
- Alginate-based formulations, such as Gaviscon Advance, can provide additional protection by forming a physical barrier against reflux, but their effectiveness in LPR treatment is still being studied, with mixed results 1.
Important Recommendations
- Clinicians should not prescribe antireflux medications to treat isolated dysphonia without visualization of the larynx, as recommended by the 2018 clinical practice guideline on hoarseness (dysphonia) 1.
- Patients with persistent symptoms despite appropriate therapy may require referral to an ENT specialist or gastroenterologist to rule out other conditions or consider additional interventions.
- Lifestyle modifications and medication adherence are crucial for successful treatment, and patients should be informed about control/preventive measures and the potential for longer symptom resolution times compared to typical GERD symptoms.
From the Research
Treatment Guidelines for Laryngopharyngeal Reflux (LPR)
The treatment of LPR involves a multi-faceted approach, including:
- Health education
- Lifestyle modification
- Dietary changes
- Medications
- Surgery
- Emerging novel treatment methods, such as external upper esophageal sphincter compression devices 2 The primary treatment for LPR is medication, supplemented with lifestyle and dietary changes 2.
Medication Treatment
Proton pump inhibitors (PPIs) are the main treatment for LPR, with twice-daily (BID) dosing appearing to be more effective than once-daily (QD) dosing 3. The use of PPIs, H2 receptor antagonists, alginates, and baclofen are common medical therapies for LPR 4.
Lifestyle and Dietary Changes
Lifestyle therapy, including dietary modifications, is an important aspect of LPR treatment 4. Patients may be prescribed an empirical treatment based on diet and behavioral changes, with or without medication, depending on symptom severity 5.
Diagnostic Approaches
Diagnosis of LPR can be approached through empiric treatment trials or objective reflux testing 6. An initial empiric trial of PPIs twice daily for 2-3 months may be convenient, but risks overtreatment and delayed diagnosis if patient complaints are not from LPR 6.
Treatment Algorithms
Several studies propose treatment algorithms to help clinicians diagnose and manage LPR, including the use of patient-reported outcome questionnaires and consideration of easy ways to diagnose LPR without special instrumentation oropharyngeal findings 5, 4. These algorithms aim to provide a practical approach for primary care physicians and other specialists to manage LPR.