Acid reflux, or Gastroesophageal Reflux Disease (GERD), occurs when stomach contents flow back into the esophagus, typically causing heartburn. This issue can extend beyond the chest, affecting the nose and sinuses through a specific variant: Laryngopharyngeal Reflux (LPR). LPR causes irritation in the throat and nasal passages. Recognizing this connection is often the first step toward finding relief for chronic, unexplained nasal symptoms.
Laryngopharyngeal Reflux and the Upper Airway
Laryngopharyngeal Reflux (LPR) is a form of extraesophageal reflux where stomach contents travel up through the esophagus into the pharynx and larynx (the back of the throat and voice box). LPR is often called “silent reflux” because less than half of people experience heartburn, unlike GERD. The tissues of the throat and voice box are more sensitive to acid exposure than the protective lining of the esophagus.
The mechanism involves two protective muscular rings, or sphincters, that fail to close properly. The upper esophageal sphincter, located at the top of the esophagus, allows stomach juices to enter the upper airway. This refluxate contains hydrochloric acid and the digestive enzyme pepsin.
Pepsin is the primary irritant once it reaches the upper respiratory tract. It can remain dormant in the tissues of the larynx and nasal cavity. Subsequent, even weakly acidic, reflux events or exposure to dietary acids can reactivate the pepsin. This enzyme then begins to digest the protective proteins within the airway lining, initiating inflammatory changes in the larynx, nasopharynx, and nasal cavity.
Specific Nasal and Sinus Manifestations
The irritation caused by acid and reactivated pepsin leads to symptoms often mistaken for allergies or recurring colds. A common manifestation is chronic post-nasal drip, where mucus constantly drains down the back of the throat. This occurs because the body produces excess mucus in an attempt to protect the irritated tissues from inflammation.
The inflammation can also cause chronic rhinitis, which is persistent irritation and swelling of the nasal lining not linked to typical allergens. This swelling results in persistent nasal congestion or stuffiness. Furthermore, the stomach contents can compromise the protective mucous membranes throughout the upper airway, making them susceptible to infection.
LPR is associated with chronic sinusitis, marked by long-term inflammation of the sinus linings. Irritation from the refluxate causes tissue swelling that blocks the small drainage pathways of the sinuses. This blockage traps mucus and creates an environment where bacteria can thrive, leading to recurrent or difficult-to-treat sinus infections. If these nasal and sinus symptoms do not respond to standard treatments, LPR should be considered as an underlying cause.
Confirmation and Treatment Approaches
Diagnosis of LPR-related nasal issues often begins with a specialist, such as an otolaryngologist, evaluating symptoms and performing a physical examination. A flexible laryngoscopy may be performed using a small camera passed through the nose to inspect the throat for signs of inflammation, swelling, or tissue damage. While these findings are not exclusive to LPR, they strongly suggest the presence of reflux.
Since there is no single definitive test, diagnosis is frequently supported by an empirical trial of medication. This involves prescribing acid-reducing medications, such as Proton Pump Inhibitors (PPIs) or H2 blockers, to see if nasal and throat symptoms improve over several weeks or months. Advanced diagnostic tools, like ambulatory pH or impedance monitoring, can also measure the frequency and type of reflux events reaching the upper airway.
Treatment for LPR relies on a combination of lifestyle changes, medication, and targeted symptom relief. Lifestyle modifications are foundational and include avoiding trigger foods like spicy, acidic, or fatty items, and minimizing caffeine and alcohol. Elevating the head of the bed by six to eight inches and avoiding eating within three hours of lying down can help prevent nocturnal reflux events.
Medications like PPIs and H2 blockers reduce the production of stomach acid, making any refluxate less irritating. PPIs are often the medical therapy of choice, typically requiring a longer course of treatment than is needed for GERD. While controlling the reflux is the long-term goal, nasal symptoms like congestion or chronic rhinitis may be managed concurrently with saline nasal irrigation or nasal steroid sprays to reduce local inflammation.