Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease: Presentation, Health Care Burden, and Risk Stratification.

Walter W Chan, Jennifer C Myers, Thomas L Carroll, Stephanie Misono, Chien-Lin Chen, Enrique Coss-Adame, Philip Weissbrod, Rena Yadlapati, C Prakash Gyawali

Journal: Neurogastroenterology and motility 2026;38(5):e70339

PMID: 42108738

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Abstract

BACKGROUND

Throat and airway symptoms are common, but only a small proportion are reflux-related. The term "laryngopharyngeal reflux" has variable definitions in the literature and has been used to describe symptomatic patients with or without objective reflux, often leading to prolonged/unnecessary treatment trials.

PURPOSE

The San Diego consensus introduced the term laryngopharyngeal symptoms (LPS) to describe upper aerodigestive symptoms with potential relationship to reflux physiology, including cough, regurgitation, throat pain, throat clearing, excess phlegm, and hoarseness/voice change. This review describes presentation, health care burden and risk stratification of throat and airway symptoms in light of the San Diego consensus definitions and clinical approach. Laryngopharyngeal reflux disease (LPRD) requires objective evidence of pathologic reflux in addition to LPS. Importantly, LPS alone do not predict LPRD. While various validated patient-reported outcome instruments are available, only some are LPS/LPRD-specific, and all lack specificity for making a diagnosis of LPRD. These instruments may have value in tracking symptoms over time and post-treatment. Concurrent typical reflux symptoms may prompt empiric anti-reflux medication trials as initial therapy. Risk stratification scores have been developed for the purpose of directing upfront therapy for high-risk patients and investigation for intermediate/low-risk patients, but their clinical use needs further validation. Objective diagnosis of LPRD provides confidence in escalation of reflux interventions. Life-threatening long-term sequelae are infrequent in LPS/LPRD, although impact on quality of life and healthcare burden can be profound.

Address: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Oesophageal Function, the Queen Elizabeth Hospital & Discipline of Surgery, Adelaide University, Adelaide, South Australia, Australia.; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA and Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.; Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.; Department of Gastroenterology, GI Motility Lab, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.; Department of Otolaryngology, University of California San Diego, La Jolla, California, USA.; Center for Esophageal Diseases, University of California San Diego, La Jolla, California, USA.; Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.

DOI: 10.1111/nmo.70339

MeSH Terms: Humans, Laryngopharyngeal Reflux, Risk Assessment, Cost of Illness