Should a patient with Laryngopharyngeal Reflux (LPR) follow up with their provider?

Follow-Up for Laryngopharyngeal Reflux (LPR)

Yes, patients with LPR should follow up with their provider to document resolution, improvement, or worsening of symptoms and to ensure appropriate management of this chronic condition. 1

Initial Follow-Up Timing

• Document symptom status within a few weeks of treatment initiation to assess response to therapy and determine if the underlying condition is being appropriately managed 1
• The managing clinician should follow up after any intervention (medications, dietary changes, lifestyle modifications) and document treatment outcomes 1
• Follow-up may occur in person or through telephone communication as appropriate for the clinical situation 1

Monitoring Treatment Response

Treatment effectiveness should be systematically assessed using validated tools:

• The Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) are useful diagnostic and monitoring tools for LPR patients 2
• Major improvement in symptoms typically occurs after 2 months of treatment, while laryngoscopic signs improve after 1 month 2
• Median RSI scores decrease from baseline (13) to lowest levels at 2 months (2), with potential complete resolution by 3-6 months 2
• Treatment duration should be at least 6 months with regular follow-up for complete resolution of signs and symptoms 2

What to Monitor During Follow-Up

Clinicians should assess for:

• Resolution or persistence of primary LPR symptoms including chronic cough, throat clearing, hoarseness, dysphonia, and dysphagia 3, 4
• Response to proton pump inhibitors, prokinetic drugs, and lifestyle/dietary modifications 2
• Adherence to dietary changes, stress management, and lifestyle regularization 2
• Development of atypical symptoms (subjective hearing loss, gait disturbance, nonpositional vertigo) that may indicate underlying or concurrent vestibular or CNS disorders 1

When Symptoms Persist

If LPR does not resolve with initial treatment:

• Perform or refer for laryngoscopy to evaluate persistent dysphonia and rule out other pathology 1
• Consider that LPR is a complex syndrome without a gold standard for diagnosis or uniform treatment protocol 3
• Refer to an otolaryngologist if voice loss or other symptoms persist despite standard therapy 5
• For drug-resistant or intolerant patients, alternative treatments may be needed, though effective options remain limited 3

Communication Between Providers

The clinician who ultimately treats the patient should:

• Document the outcome of therapy clearly 1
• Communicate treatment results back to the referring clinician 1
• Ensure rationale for any referrals is clearly documented 1

Common Pitfalls to Avoid

• Do not assume LPR will resolve without follow-up, as this is a chronic condition requiring extended treatment duration (typically 6 months) 2
• Do not confuse LPR with classic GERD, as they differ in patterns, mechanisms, manifestations, and treatment approaches 6
• LPR patients often lack heartburn ("silent reflux") and have predominantly upright daytime reflux, making diagnosis more challenging 6
• Do not stop treatment prematurely before 6 months to prevent incomplete resolution and potential recurrence 2