LARYNGOPHARYNGEAL REFLUX AND ITS RELATIONSHIP WITH CHRONIC COUGH

Abstract

Laryngopharyngeal reflux (LPR) is characterized by the retrograde flow of gastric contents into the upper airway, distinguishing it from classic GERD by affecting structures that lack robust mucosal defenses. Tissue damage is mediated by the enzymatic action of activated pepsin and direct chemical irritation, triggering a chronic inflammatory process in the larynx. Chronic cough associated with LPR stems primarily from the activation of vagal afferent fibers and the development of peripheral and central neural hypersensitization of laryngeal receptors. Since many patients do not exhibit classic esophageal symptoms, diagnosis requires a high index of clinical suspicion, supported by symptom questionnaires, laryngoscopy, and dynamic tests such as pH-impedance monitoring. Therapeutic management is multimodal and challenging. It requires rigorous lifestyle and dietary modifications, prolonged acid suppression with proton pump inhibitors or P-CABs, the use of protective alginates, speech therapy, and—in refractory cases with established neural hypersensitivity—the use of central neuromodulators to break the cough cycle.