Laryngopharyngeal Reflux: What It Is and Why You Get Heartburn in the Throat

Do you feel a burning in your throat, as if a lump is stuck there, and is your voice hoarse? Sometimes the culprit is laryngopharyngeal reflux — the backflow of stomach or duodenal contents through the esophagus into the pharynx and larynx. Let's sort out what this is and how it differs from ordinary heartburn.

What laryngopharyngeal reflux is

Laryngopharyngeal reflux (also called laryngopharyngeal) is a pathological condition associated with the effect of refluxate on the mucosa of the pharynx and larynx. That is, stomach contents rise up through the esophagus and the upper esophageal sphincter and irritate not only the esophagus but also the sections above it. This is not a separate "type of heartburn" but a condition with its own manifestations.

How it differs from GERD and ordinary heartburn

Heartburn is a burning sensation in the middle of the chest that occurs when acid from the stomach moves toward the throat. If this happens frequently, it may be gastroesophageal reflux disease (GERD) — a chronic condition in which stomach contents regularly flow back into the esophagus. In laryngopharyngeal reflux, complaints are more often related to the throat and voice, not only to the chest. At the same time, GERD can also cause a dry cough or hoarseness.

Why heartburn in the throat occurs, including at night

The mechanism is the same: the muscular ring at the end of the esophagus does not close as it should, and stomach contents go back up. This can be triggered or worsened by coffee, tomatoes, alcohol, chocolate, fatty and spicy food, excess weight, smoking, pregnancy, stress, certain medications (for example, anti-inflammatory painkillers), hiatal hernia, stomach ulcer, and bacterial infection in the stomach. At night, burning in the throat often worsens: in a lying position, contents can more easily rise up, and symptoms are often worse after eating and when bending over.

Symptoms of laryngopharyngeal reflux

Manifestations vary, and it is not always classic heartburn. The most common are:

• hoarseness — in 71% of patients;
• cough — in 51%;
• a sensation of a lump in the throat — in 47%;
• the urge to "clear the throat" — in 42%.

This may be accompanied by an unpleasant sour taste in the mouth, bad breath, bloating, and nausea. Reflux can play a role in the development of vocal fold nodules, contact ulcers and granulomas, Reinke's edema, and other laryngeal conditions.

How reflux is identified and what complications are possible

The doctor asks about symptoms and may refer you for tests: upper endoscopy with examination of the esophagus and stomach, biopsy, X-ray, esophageal pH monitoring (measures how often and how long acid flows back), esophageal manometry (checks how the esophagus moves food), transnasal esophagoscopy. For laryngopharyngeal reflux there are no uniform pH criteria: some specialists consider at least one reflux episode with a pH below 4.0 significant, others below 5.0, and three episodes per day are often taken as normal. Without treatment, GERD can lead to inflammation and scarring of the esophagus, changes in its mucosa (Barrett's esophagus), worsen asthma, and cause prolonged cough or hoarseness.

When to see a doctor

You should see a doctor if lifestyle changes and over-the-counter remedies do not help, heartburn bothers you almost every day, or other symptoms appear — a sensation of food sticking in the throat, frequent vomiting, unexplained weight loss. The doctor will help rule out more serious causes of the complaints.

Burning in the throat by itself is not a reason to call an ambulance. Call 103 or 112 if chest pain appears together with shortness of breath or pain in the jaw or arm — these may be signs of a heart problem.

This material is for reference: it helps you understand the terms but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer