From the Guidelines
The treatment for chronic Laryngopharyngeal Reflux (LPR) with an acute flare should prioritize proton pump inhibitors (PPIs) as the first-line therapy, with the addition of histamine 2 receptor antagonists (H2RAs) or alginate-based formulations as needed for symptom control. When managing chronic LPR with an acute flare, it is essential to consider the most recent and highest quality evidence, which suggests that PPIs are the most effective treatment option for reducing acid production and alleviating symptoms 1.
Key Treatment Components
- PPIs, such as omeprazole 20-40mg or esomeprazole 40mg, taken twice daily before meals for 8-12 weeks, are recommended as the primary treatment for acute flares.
- H2RAs, like ranitidine 150mg or famotidine 20mg, can be added at bedtime to control nighttime reflux, as they have been shown to improve nighttime reflux for patients on PPI therapy 1.
- Alginate-based formulations, such as Gaviscon Advance, can provide additional protection by forming a physical barrier on top of stomach contents, although their efficacy in LPR treatment is still debated, with some studies showing significant improvement of symptoms and laryngeal signs, while others found similar results compared to placebo 1.
Dietary and Lifestyle Modifications
- Avoiding acidic foods, spicy foods, alcohol, carbonated beverages, and chocolate is crucial in managing LPR symptoms.
- Eating smaller meals, avoiding eating within 3 hours of bedtime, and elevating the head of the bed by 6-8 inches can help reduce reflux episodes.
- Weight loss is recommended for overweight patients, and voice rest and adequate hydration can help reduce laryngeal irritation during flares.
Treatment Duration and Tapering
- Treatment may need to continue for several months, with gradual tapering of medication once symptoms improve.
- Maintaining dietary and lifestyle modifications long-term is essential to prevent recurrence of LPR symptoms.
From the Research
Treatment for Chronic Laryngopharyngeal Reflux (LPR) with Acute Flare
The treatment for chronic Laryngopharyngeal Reflux (LPR) with an acute flare typically involves a combination of medical therapies and lifestyle modifications.
- Medical therapies:
- Lifestyle modifications:
- Other treatment options:
- Antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication may be considered for patients who do not respond to medical therapy 3
- Neuromodulators and behavioral interventions may be used to treat functional laryngeal disorders and laryngeal hypersensitivity, which can present with LPR-like symptoms 3
Diagnosis and Treatment Algorithm
A treatment algorithm has been proposed to help clinicians diagnose and triage patients with LPR into appropriate therapy 3. This algorithm takes into account the patient's symptoms, medical history, and response to initial treatment.
- Empiric treatment trials with PPIs twice daily for 2-3 months may be used as an initial diagnostic and therapeutic approach 4
- Objective reflux testing, such as pH testing with or without impedance, may be considered if the patient's symptoms are refractory to empiric treatment or if an objective diagnosis is desired 4
- Evaluation for non-reflux etiologies of complaints, including laryngoscopy or videostroboscopy, should also be performed 4
Evidence for PPI Therapy
The evidence for PPI therapy in the treatment of LPR is mixed, with some studies showing significant improvement in symptoms 2, 3 and others showing no benefit compared to placebo 5.
- A systematic review and meta-analysis found that PPI therapy was not superior to placebo in improving LPR symptoms, although some studies did show a significant improvement 5
- Another study found that twice-daily PPI dosing was more effective than once-daily dosing in achieving clinical symptom response in suspected LPR 2