LPR, How Common Is It in HEDS

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Laryngopharyngeal reflux (LPR) is a condition that affects many people, yet it remains less understood than its close relative, gastroesophageal reflux disease (GERD). For individuals with hypermobile Ehlers-Danlos syndrome (hEDS), LPR can present unique challenges.

LPR occurs when stomach acid and digestive enzymes flow back up into the larynx (voice box) and pharynx (throat). Unlike GERD, which primarily causes heartburn and acid indigestion, LPR often does not produce these classic symptoms. Instead, it can cause:

• Hoarseness or voice changes

• Chronic cough

• Throat clearing

• Sensation of a lump in the throat (globus sensation)

• Difficulty swallowing

• Postnasal drip

  
  

These symptoms arise because the tissues in the throat and voice box are more sensitive to acid exposure than the esophagus. LPR can be harder to diagnose since it lacks the typical heartburn symptoms and may be mistaken for allergies or infections.

While both conditions involve acid reflux, the main difference lies in the location and symptoms:

• GERD affects the esophagus and causes heartburn, chest pain, and regurgitation.

• LPR affects the throat and voice box, causing throat irritation and voice problems without heartburn.

  
  

This difference means treatments may vary, and LPR often requires a more targeted approach to manage symptoms effectively.

Several factors contribute to the increased prevalence of LPR in individuals with hypermobile EDS:

• Weak connective tissue in the throat and esophagus

Collagen abnormalities can weaken the muscles and tissues that normally prevent acid reflux. This weakness may allow stomach contents to travel further up into the throat.

• Impaired esophageal motility

Many people with hEDS experience delayed or uncoordinated esophageal muscle contractions, which can reduce the clearance of acid from the esophagus and throat.

• Autonomic nervous system dysfunction

Dysautonomia, common in hEDS, can affect the nerves controlling the digestive tract, leading to symptoms like reflux.

• Increased sensitivity to acid

The tissues in the throat may be more sensitive to acid exposure in hEDS, causing more severe symptoms even with mild reflux.

Research on the exact prevalence of LPR in hypermobile EDS is limited but growing. Studies suggest that gastrointestinal symptoms, including reflux, affect a significant portion of people with hEDS. One study found that up to 60% of individuals with hEDS reported symptoms consistent with reflux, including LPR-like symptoms.

Clinical experience also supports that LPR is more frequent in this group compared to the general population. Many patients with hEDS report chronic throat irritation, voice changes, and cough that do not respond well to standard treatments for GERD, indicating the presence of LPR.

Diagnosing LPR can be challenging because symptoms overlap with other conditions. For people with hEDS, diagnosis often requires:

• Detailed symptom history

Discussing throat symptoms, voice changes, and reflux signs without heartburn.

• Laryngoscopy

A procedure where a specialist examines the throat and voice box for signs of acid damage.

• pH monitoring

Measuring acid levels in the throat and esophagus over 24 hours to detect reflux episodes.

• Trial of treatment

Sometimes doctors start treatment based on symptoms and response to medication.

Because hEDS affects connective tissue, doctors may also evaluate for related conditions that can worsen reflux symptoms.

Treatment of LPR in people with hypermobile EDS involves a combination of lifestyle changes, medication, and sometimes therapy:

• Lifestyle adjustments

Avoiding foods and drinks that trigger reflux, such as caffeine, alcohol, spicy foods, and acidic items. Eating smaller meals and not lying down soon after eating can help.

• Medications

Proton pump inhibitors (PPIs) or H2 blockers reduce stomach acid production. In some cases, alginate-based medications create a barrier to prevent reflux.

• Voice therapy

Working with a speech therapist can help reduce throat irritation and improve vocal function.

• Addressing underlying hEDS issues

Managing autonomic dysfunction and improving muscle tone through physical therapy may reduce reflux severity.

• Surgical options

In rare cases where conservative treatment fails, surgery to strengthen the lower esophageal sphincter may be considered.

Managing LPR alongside hEDS requires attention to both conditions. Here are some practical tips:

• Keep a symptom diary to identify triggers.

• Maintain good posture to reduce pressure on the stomach and throat.

• Stay hydrated to soothe irritated throat tissues.

• Avoid smoking and exposure to secondhand smoke.

• Work with healthcare providers familiar with hEDS and reflux disorders.

• Consider multidisciplinary care involving gastroenterologists, ENT specialists, and physical therapists.