Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR), also known as silent reflux, is when acid that is made in the stomach travels up the esophagus (swallowing tube) and up to the throat. Of course when a baby is suffering and crying, it isn't so silent.

The laryngeal tissues are sensitive to the acid exposure and then become swollen with an excessive accumulation of fluid. Increased swelling and ulceration results in further collapsing of these tissues into the airway and further obstructive symptoms. This is a vicious cycle of increased obstruction, GERD, and swelling.

Long term acid exposure also inhibits laryngeal sensation which decreases the motor response to swallow in response to secretions. Decreased laryngeal sensation explains the coughing and choking during feedings which are commonly seen with laryngomalacia. The vagal reflex responsible for laryngeal tone is also responsible for lower esophageal sphincter tone and esophageal motility. (Vagovagal reflex refers to gastrointestinal tract reflex circuits where fibers of the vagus nerve coordinate responses to the gut)

Laryngopharyngeal Reflux Symptoms

The symptoms of LPR are felt in the throat and include the following:

• Sore throat
• Mild hoarseness
  
• Wheezing, Stridor (noisy breathing)
  
• Sinusitis
• The sensation of mucus sticking in the throat, and/or post-nasal drip
• Apnea
• Difficulty swallowing
  
• Laryngomalacia

Upright positioning during feeding and bottles may decrease the number of reflux episodes but acid suppression therapy improves symptoms and may shorten the duration of events. Most babies respond well to this therapy and are typically weaned off medications within 12 to 18 months. That's where Marci Kids dosing comes in and working with one of our infant GERD specialty doctors. There are other treatment options and you should decide what fits into your values as a family.