The precise way in which LPRD develops is not known, but there are 2 proposed means of laryngeal injury--direct and indirect.
(5) In some cases, this occurs as often as 50 times a day, although as few as 3 episodes per week have been known to cause LPRD. (5)
It is reported by little more than a third (35%) of those with LPRD, (5,6) however, (which is why it is sometimes called the "silent" reflux disease).
When reflux occurs is another thing that distinguishes LPRD and GERD.
Most patients with LPRD seek treatment from their primary care physician, typically reporting symptoms that they don't associate with gastric reflux, such as hoarseness, a chronic cough or sore throat, or the sensation of a lump in the throat (TABLE 1).
Diffuse erythema, edema, and interarytenoid hypertrophy/cobble-stoning are the most useful findings for an LPRD diagnosis.
Clinicians who have used the RFS report that a score higher than 7 identifies LPRD with 95% sensitivity.
* Ambulatory dual probe pH monitoring was considered to be the gold standard test for LPRD at one time, but newer studies have raised questions about its validity and usefulness, especially in patients taking proton-pump inhibitors (PPIs).
LPRD is often called a diagnosis of exclusion, because of the nonspecific nature of its signs and symptoms and the importance of considering a range of other etiologies.
* Acid suppression therapy with either PPIs or histamine-2 (H2) receptor blockers such as ranitidine or famotidine is the mainstay of treatment for LPRD. But medical societies offer conflicting advice.
* Lifestyle and dietary changes (TABLE 2), such as smoking cessation, weight loss, and avoidance of alcohol are an important part of LPRD treatment, and may be used as a first-line therapy before prescribing medication.
* Fundoplication surgery, a procedure in which the gastric fundus of the stomach is wrapped around the lower end of the esophagus and stitched in place to prevent reflux, may be an option for patients who do not respond to, or cannot tolerate, aggressive medical treatment for LPRD. A 2006 prospective controlled study found that surgical fundoplication did not consistently relieve laryngeal symptoms.