Larygnopharyngeal Reflux Changes Laryngeal Mucosa

How does reflux affect laryngeal tissue quality?

Background: Laryngopharyngeal reflux has deleterious effects on the larynx. Due to the poor intrinsic protective mechanisms in this tissue, damage occurs at a higher pH and leads to the commonly known throat symptoms. The authors in this study have used endogenous acid and pepsin to study the mucosal changes in an animal model.

Study design: Randomized trial.

Setting: Animal care facility in a research hospital in Turkey.

Synopsis: The study was conducted on rats that were exposed to acid reflux for various time periods (one, four and 12 weeks). Reflux was induced by creating pyloric stenosis in these experimental rats and then studying the effects of acid reflux over the course of several weeks. Researchers confirmed the presence of reflux in the oropharynx by instilling barium into the stomach. The larynges, including the lamina propria, vessels and epithelium, were then histologically studied. Statistically significant changes were identified, with lamina propria inflammation being the earliest change, followed by subepithelial edema. Significant vascular engorgement and epithelial keratinization occurred by the 12th week.

Bottom line: Laryngopharyngeal reflux does indeed lead to significant changes in the laryngeal mucosa. This well-designed study substantiates the belief that gastric acid leads to laryngeal damage.

Citation: Habesoglu M, Habesoglu TE, Gunes P, et al. How does reflux affect laryngeal tissue quality? An experimental and histopathologic animal study. Otolaryngol Head Neck Surg. 2010;143(6):760-764.

—Reviewed by Natasha Mirza, MD