Evaluation and Management of Laryngopharyngeal Reflux Disease: An Updated State of the Art Review.

Authors

Jerome R Lechien, Nikki Johnston, Edoardo Savarino, Abdul Latif Hamdan, Maria Rosaria Barillari, Jonathan M Bock, Young-Gyu Eun, Jinrang Li, Michael F Vaezi, Jacqueline E Allen, Karol Zelenik, Peter C Belafsky, Giovanni Dapri, Claudia A Eckley, Toshitaka Hoppo, Robert T Sataloff, Lee M Akst, Antonino Maniaci, Luigi A Vaira, Petros D Karkos, Walter W Chan, Inna A Husain, Thomas L Carroll

Published in

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

To review the updated literature about epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux disease (LPRD) and to provide a practical management for clinical practice.
PubMED, Cochrane Library, and Scopus.
Four authors conducted the literature review on LPRD epidemiology, clinical presentation, diagnosis, and treatment according to the PRISMA statement. A critical analysis of the literature and a related management algorithm for clinical practice were provided.
Studies from the last 5 years provided increased evidence about the gaseous and alkaline profile of LPRD at 24-hour hypopharyngeal-esophageal impedance-pH monitoring, and the presence of alkaline-activated enzymes in the upper aerodigestive tract mucosa. Three consensuses emerged, emphasizing the importance of objective testing to demonstrate LPRD in patients with laryngopharyngeal symptoms. The recent literature suggested that LPRD may be associated with atypical presentations, including posterior nasal inflammation, dry eyes, and middle ear disorders. The predominantly alkaline nature of LPRD has prompted clinical studies supporting alginate and magaldrate over proton pump inhibitors (PPIs), which only target gastric acidity, for managing acid, weakly acid, and alkaline pharyngeal reflux events. Despite a growing literature, there was no randomized controlled trial comparing alginate, magaldrate, diet, and PPIs conducted in the last 5 years.
The increased evidence about alkalinity of pharyngeal reflux events and the detection of alkaline-activated enzymes in saliva may shift the current PPI-based therapy to alginate therapy. Multicenter international randomized controlled studies with standardized protocols could improve the scientific knowledge about LPRD.

PMID:
42647076
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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