Gastroesophageal and Laryngopharyngeal Reflux

Laryngopharyngeal reflux and gastroesophageal reflux

Gastroesophageal reflux (GERD) occurs when the gastric contents flow back into the esophagus; when this material reaches the throat and larynx, we call it laryngopharyngeal reflux (LPR). The mucosa of the pharynx and vocal folds is very sensitive to acid and digestive enzymes, so even mild episodes can cause chronic irritation, coughing, and voice changes.

Symptoms in the throat and voice

The most common symptoms include a sensation of something stuck in the throat, constant throat clearing, the need to clear the throat, dry cough, pharyngeal burning or stinging, recurring sore throat, and the production of thick mucus. In the voice, hoarseness, vocal fatigue, loss of projection, and changes in tone appear, often worse upon waking or after speaking for long periods. Bad breath, occasional choking, and a sensation of difficult swallowing may also occur.

Causes and risk factors

Several factors contribute to reflux, such as inadequate relaxation of the lower esophageal sphincter, hiatal hernia, being overweight, large and late meals, and lying down right after eating. Coffee, alcohol, chocolate, fried foods, very fatty foods, citrus fruits, soft drinks, and smoking promote irritation. Stress, certain medications, and chronic mouth breathing can worsen the inflammatory condition of the upper airways.

Recurring pharyngitis

Repeated exposure of the pharynx to acid and pepsin damages the mucosa and makes it more susceptible to recurrent inflammation. Many conditions labeled as pharyngeal infections behave, in practice, like chemical inflammation caused by reflux, with a sore throat that comes and goes, worsening at night or upon waking, and little response to antibiotics. Treating the reflux usually reduces the frequency and intensity of these episodes of pharyngitis.

Hoarseness as a warning sign

The evaluation begins with a detailed clinical history and an ENT physical examination. Laryngoscopy, performed in the office with a thin, flexible endoscope, allows the pharynx and larynx to be viewed in high definition, identifying signs such as redness, swelling of the posterior commissure, thickening of the mucosa, and granulomas related to reflux. In selected cases, complementary tests such as pH monitoring with impedance, esophageal manometry, and upper digestive endoscopy help to quantify the reflux, assess motility, and rule out associated lesions. In specific situations, a structured therapeutic trial, with lifestyle changes and medications, can also support the diagnosis through the clinical response.

How the ENT can help

The otolaryngologist (ENT) is the specialist who correlates the pharyngeal symptoms and voice changes with the laryngoscopy findings, distinguishing reflux from other causes such as allergies, sinusitis, benign vocal fold lesions, and incorrect voice use. Based on this, they define an integrated plan, which may include lifestyle adjustments, drug treatment, speech therapy for vocal hygiene, and, when necessary, joint follow-up with gastroenterology. Close follow-up is essential to monitor the healing of the mucosa and prevent recurrences.

Treatment and practical care

Habit changes are the foundation: dividing meals into smaller portions, avoiding lying down after eating, raising the head of the bed, preferring light and non-irritating preparations, reducing alcohol and caffeine, quitting smoking, and staying well hydrated. Weight control and stress management help keep the condition stable. Medications such as proton pump inhibitors (PPIs), alginates, antacids, and, in selected cases, prokinetics may be prescribed for an appropriate period, with periodic reassessment. Patients with high vocal demand benefit from speech therapy for technique and vocal economy, speeding up recovery. When there is a significant hiatal hernia or refractoriness, a surgical approach is discussed with the gastro and surgery team.

When to seek evaluation

Warning signs such as persistent hoarseness, pain when swallowing, choking episodes, blood in the saliva, involuntary weight loss, or chest pain require prompt evaluation. Even without heartburn, the presence of daily throat clearing, chronic dry cough, and a sensation of mucus in the throat indicates possible laryngopharyngeal reflux and warrants investigation with laryngoscopy.

Personalized care in São Paulo (Itaim and Morumbi) and in Alphaville

Dr. José Eduardo Marcondes’s office offers a thorough evaluation and high-definition endoscopic examinations during the appointment itself, with a precise, welcoming approach geared toward those who value vocal performance, well-being, and quality of life. With more than two decades of experience in otolaryngological care, the focus is on restoring throat comfort and vocal clarity with the least impact on daily life.

Schedule your appointment

If you have had hoarseness that does not improve, recurring pharyngitis, constant throat clearing, or any of the symptoms described, schedule an evaluation. An accurate diagnosis, with laryngoscopy and a tailored treatment plan, is the most efficient way to resolve the problem and prevent new flare-ups.