Laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents (acid and enzymes such as pepsin) into the laryngopharynx leading to symptoms referable to the larynx/hypopharynx. Typical LPR symptoms include dysphonia, globus pharyngeus, mild dysphagia, chronic cough, and nonproductive throat clearing. Most patients are relatively unaware of LPR with only 35% reporting heartburn. LPR has been associated with such disease entities as vocal fold granulomas and laryngospasm and is believed to play a role in the formation of subglottic stenosis. Although not yet substantiated, chronic laryngeal irritation may lead to the formation of laryngeal carcinoma in those patients without a history of alcohol consumption or tobacco smoking. Many issues with respect to the diagnosis and treatment of LPR are considered controversial, including the clinical diagnostic criteria and the studies necessary to establish a diagnosis. LPR, like other forms of extraesophageal manifestations of reflux, is treated with a combination of diet changes, behavior modifications, and a regimen of high-dose, twice-a-day proton pump inhibitors. Allergists, as physicians who treat patients with chronic cough, globus sensation, and atypical asthma not responsive to medications, need to be familiar with the diagnosis and proper treatment of LPR to deliver optimal care to these patients.