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

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.