Case Report : Laryngopharyngoreflux (LPR)

Laryngopharyngoreflux (LPR) was actually my case report that i presented today..
The presentation was not so good...but i'm still praying that i can get the good marks.cause i was tried my best..

Not all the people who had LPR was having GERD...actually, researches shows that most LPR's patient didn't had history of GERD..
LPR can happen when the upper esophageal sphincter was loosed and the gastric content will reflux into the pharynx and the posterior of larynx...why it will affect the posterior larynx first not the other side of larynx? it is because pharynx located at the back side of larynx...so, the gastric content in the pharynx will overflow into the posterior of larynx...

another questions...why pharynx did not irritated or not have been effected with the reflux compared to the larynx?? and why the patient having the symptom of laryngitis instead of pharyngitis??

Because the mucosa of larynx was thinner compared to the pharynx...it will be 1: 40 to affect the pharynx..that means, people should having 40times reflux to the pharyx to get pharyngitis compared just once reflux to the larynx, the patient will get the symptoms of laryngitis, such as hoarseness, excessive throat clearing, postnasal drip, and dysphonia..so a person will get the laringitis first before faringitis if the reflux happen.

why the laryngitis patient will experience post-nasal drip and throat clearing?

The delicate ciliated respiratory epithelium of the posterior larynx which normally functions to clear mucus secretions from the trachea fails when directly affected by the caustic gastroduodenal chemicals which may result in mucus stasis. This in turn, promotes the sensation of post-nasal drip and furthermore, throat clearing.

Actually, there are many etiologies that can lead to LPR, not just because of the loosen of esophagus spinchter. sila baca sendiri nanti eh...kat google...hehe.. google knows everything... ;))

Why doctor will give lanzoprazole 2x30mg daily instead of normal dosage which 1x30mg daily?

Lanzoprazole is the PPI (proton pump inhibitor) that will suppress the production of gastric acid..The ENT doctor normally give 2x30mg of lanzoprazole to the patient with LPR because LPR  is extragastric condition..so, the patient will need high dosage than usual to neutralize the pH in the larynx...

Why H2 antagonist do not be the choice..? Because lanzoprazole works on the proton pump..so the effect will be faster than H2 antagonist..H2 antagonist is the competitive inhibitor to the histamin receptor..the route to suppress the acid secreation is more further than PPI to take effect.. ;)

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