The retrograde movement of gastric contents beyond the upper esophageal sphincter into the larynx, pharynx, and upper aerodigestive tract was characterized as a clinical condition called LPRD [1]. It mainly affects the esophagus, with distinct classical Gastroesophageal Reflux Disease (GERD). The laryngeal and pharyngeal mucosa are predominantly involved in LPRD, which are vastly sensitive to acidic and non-acidic gastric secretions [2]. With a minimal exposure to refluxate containing acid, pepsin, and bile salts can outcome in important mucosal inflammation, important to a wide range of upper airway symptoms. In LPRD, the lower and upper esophageal sphincters are defective and the laryngeal tissues are more susceptible to injury due to the lack of preventive mechanisms including bicarbonate secretion and vigorous peristalsis [3].

LPRD are multifactorial due to its pathogenic mechanisms. Due to acid and pepsin exposure direct mucosal injury occurred; vagally mediated reflexes triggered by distal esophageal acidification are included in indirect mechanisms [4]. In LPRD pathogenesis, Pepsin plays an important role and remain active within the laryngeal epithelial cells even at neutral pH, which leads to the ongoing cellular damage and inflammation. Edema, erythema, posterior commissure hypertrophy, and other structural changes of the larynx are due to chronic exposure and contribute to determined symptoms and voice disorders [5]. LPRD is distinguished as a unique clinical entity requiring focused attention in otolaryngology practice by these pathophysiological features.

The same etiological basis involving gastric reflux are shared by LPRD and GERD, their clinical presentation, diagnostic approach, and management strategies are different [6]. Heartburn, regurgitation, and esophagitis are typically present in GERD, but these classical symptoms are often absent in LPRD patients [7]. In contrast, LPRD patients typically describe throat symptoms such as continuous throat clearing, globus pharyngeus, hoarseness, coughing, excess mucus, and a feeling lump in the throat. Most GERD symptoms increase at night, whereas LPRD symptoms worsen throughout the day, especially when standing or walking [8]. Esophagogastroduodenoscopy may also provide normal results in many LPRD patients, confounding the diagnosis. These findings show that LPRD is a distinct clinical entity, not just GERD.

LPRD is becoming a common diagnosis in ENT outpatient departments worldwide. Approximately 10–30% of ENT encounters involve persistent throat or voice difficulties, suggesting it is a key cause [9]. LPRD is rising due to dietary changes, increased fatty and spicy food intake, lack of exercise, obesity, smoking, excessive alcohol consumption, and stress. LPRD mostly affects middle-aged persons in the tertiary care ENT centres [10]. LPRD remains a clinical burden to both patients and healthcare providers due to its chronic nature and impact on quality of life.

The symptoms of LPRD might coincide with those of other upper airway disorders include functional voice issues, allergic rhinitis, vocal abuse, chronic sinusitis, and chronic rhinovirus, making diagnosis challenging [11]. LPRD is not diagnosed by any test, symptom based questionaries like the Reflux Symptom Index (RSI) and laryngoscopic grading systems like the Reflux Finding Score observe the outcome vary in patients. The dual probe testing and Ph monitoring are not available in many clinical settings because it is expensive [12], so empirical diagnosis and PPI are used for diseases characterization.

Due to diagnostic uncertainty, retrospective analyses are required to understand LPRD presentation, diagnosis, and treatment outcomes in real-life situations. Retrospective clinical data studies can evaluate PIP and lifestyle changes utilised in ENT practice. Tertiary care centres treat a variety of patients and may not always follow diagnostic guidelines, making these examinations crucial. Treatment response, recurrence, and patient management issues, improving clinical decision-making are analysed in the Retrospective study.

This study examined all PMCH otorhinolaryngology patients with laryngopharyngeal reflux illness from February to December 2025. The clinical presentation, diagnostic procedures, treatment strategies, and patient outcomes of 40 LPRD patients in a tertiary care ENT setting are evaluated in this study to find PIP and lifestyle adjustment.

Objectives

1. To analyze clinical performance of LPRD patients
2. To assess diagnostic tools are used
3. To evaluate treatment outcomes of PPIs and lifestyle modifications

Study Design The study was done as a retrospective observational analysis, which aims to evaluate the treatment strategies, diagnostic approaches and clinical outcomes of patients diagnosed with LPRD. The systematic review allows a retrospective design, which involves existing medical records of patients managed for LPRD in routine clinical practice, of treatment protocols without any direct intervention or modification. Study Setting A study was conducted in the Department of Otorhinolaryngology (ENT) at Patna Medical College and Hospital (PMCH), a tertiary care training hospital that serves a diverse and large patient population. In ENT departments, a high volume of patients is managed for presenting with throat symptoms, upper airway complaints and voice disorders, making it a good place for looking into LPRD cases. Study Period During the period from February 2025 to December 2025, patients diagnosed with LPRD were studied, and their medical records were reviewed. During this study duration, an adequate timeframe was provided to assess the treatment response and short-term outcome that followed the medical management. Sample Size In the study, a total of 40 patients were included who fulfilled the inclusion criteria. Based on the complete medical records and adequate follow-up data, the availability of the sample size was determined, which defines the study period. Inclusion Criteria • Patients were aged 18 years or older. • Clinically diagnosed through LPRD by an ENT consultant. • The presence of complete medical records, which can include symptoms describing, laryngoscopic findings, treatments recommended and follow-up examinations. • At least 6 weeks of follow-up for proper assessment of response to treatment. Exclusion Criteria • Gastroesophageal reflux disease with esophagitis, as diagnosed by previous gastroenterological examination. • Presence of laryngeal or pharyngeal malignancies. • History of previous laryngeal surgery. • Incomplete or missing medical records that may influence the accuracy of data or the evaluation of outcome. Diagnostic Criteria The combination of clinical symptoms, specialist judgment and laryngoscopic findings was based on the LPRD diagnosis. Symptom assessment was conducted using patient-reported complaints, and where available, the RSI was used to quantify symptom severity. Examination of flexible or rigid laryngoscopic perform with all patients to assess characteristic findings suggestive of LPRD, such as edema, posterior commissure hypertrophy, erythema and vocal fold changes. In the RFS cases were documented and used to objectively grade laryngoscopic findings. Final diagnosis, which made the overall clinical judgement, was based by treating the ENT consultant. Treatment Protocol The study received medical management for LPRD, which includes all patients. Primary treatment was PPIs in standard therapeutic doses, with at least once daily and most often twice daily use up to 6 or 12 weeks according to symptom severity and response. In addition to medicinal treatment, the patients were instructed in lifestyle modification in the form of dietary (avoidance of spicy, fatty and sour food), postural measures (no lying down after a meal and head-end elevation while sleeping), no smoking and no alcohol consumption with voice rest and stress management strategies. Outcome Measures In the treatment, outcomes are measured based on the objective and subjective parameters. Symptom improvement can be evaluated by comparing pre-treatment and post-treatment symptom severity follow-up visits are documented. During follow-up examinations, changes were observed to a reduction or resolution and the Laryngoscopic improvement was measured. Patients are categorized into three groups based on the treatment response: defined as near-total resolution of symptoms with complete response; significant improvement but incomplete symptom resolution indicates a partial response; where minimal or no response or no improvement was observed. Data Collection The retrospective data were collected from the outpatient department and inpatient department records, which include detailed clinical notes, treatment prescriptions and laryngoscopy reports. When the follow-up notes are reviewed in the document, symptom progression with compliance therapy and response to treatment. When the relevant data was recorded in a structured format that ensures consistency and accuracy. Statistical Analysis The collected data were analyzed using SPSS software and Microsoft Excel. Descriptive statistics are used to summarize a demographic characteristics, treatment outcomes and clinical features. While categorical variables are presented by frequencies and percentages, continuous variables are expressed as mean and standard deviation. To evaluate the effectiveness of treatment modalities employed, pre-treatment and post-treatment outcomes were compared descriptively.

Demographic Profile

The study included 40 laryngopharyngeal reflux patients. The majority of instances happened in the 31-50 year age group, however patients ranged from 19 to 62. The economically active population had a higher prevalence. The average age was 42.6 years with a standard deviation of 10.8 in this study. Gender bias was evident, with 60% men and 40% women.

Table 1 Age Distribution of Patients

Table 2 Gender Distribution

 Clinical Presentation

Patients reported a variety of throat symptoms, some of which overlapped. Global pharyngeus was the second most common presenting symptom, appearing in 65% of patients. Chronic throat clearing was reported in 70% of patients. Over 50% of individuals exhibited persistent cough and hoarseness. Numerous patients had many symptoms, demonstrating that LPRD can take numerous forms.

Table 3 Clinical Symptoms Observed in LPRD Patients

Laryngoscopic Findings

Laryngoscopic findings exposed characteristic features suggestive of LPRD in the majority of patients. Laryngeal erythema was the most frequently observed finding, followed by posterior commissure hypertrophy, which characterises chronic reflux damage. It was also usual to have vocal cord oedema and voice problems. Multiple laryngoscopic abnormalities were found in most individuals.

Table 4 Laryngoscopic Findings

 Treatment Details

The main treatment for all patients was a PPI. Thirteen (37.5%) patients received PPI alone, whereas 25 (62.5%) received a combination of PPI treatment and lifestyle changes. The lifestyle interventions included food changes, head-end elevation, avoiding late-night meals, quitting smoking, and periodic voice rest.

Table 5 Treatment Modalities Used

 Treatment Outcomes

After therapy, 75% of patients improved symptomatically. Combined therapy with PPIs and other drugs improved clinical outcomes. 45% of patients observed with a complete response, while partial improvement 30% showed.  A minority of cases with Non-response to treatment were noted. In combination with lifestyle adjustment, PPI enhanced the rate of full symptom remission in LPRD patients, underscoring the importance of non-pharmacological methods.

Table 6 Treatment Outcomes

Table 7 Comparison of Treatment Response Between Modalities

Complications and Recurrence

Ten patients, 25% of the total, needed extra testing or longer treatment due to their inability to respond. Five individuals (12.5%) who did not make the recommended lifestyle changes had symptoms return during follow-up. No major ill effects were reported by research individuals taking the drugs.

The clinical profile of patients with Laryngopharyngeal Reflux Disease managed in a tertiary care hospital is able to understand by this retrospective study. From these patients, the diagnostic patterns and treatment outcomes were observed. Most of the patients are from the middle-aged group, especially male predominance, which is consistent with the higher exposure of this population to known risk factors such as smoking, consumption of alcohol, occupational voice use, and irregular dietary habits. The most common symptoms are throat clearing, globus sensation, and hoarseness. This underscores the nonspecific nature of Laryngopharyngeal Reflux Disease, with other upper airway disorders frequently overlapped by the condition. Laryngeal erythema and posterior commissure hypertrophy are the generally observed Laryngoscopic findings, supporting their diagnostic relevance in routine ENT practice.

Comparison with Previous Studies

The findings of this study is compared with previous studies. More than 60 % of the patients are affected by the LPRD with the throat clearing and globus sensation symptoms by Study 1 [13], and this aligns with this retrospective study. Study 2 [14] reported that male predominance and peak incidence are between 40 and 50 years. Posterior commissure hypertrophy and vocal cord edema are the features of Laryngoscopic, it has been broadly known findings of reflux-related laryngeal injury, which is supporting the validity of the diagnostic criteria used in Study 3 [15].

Effectiveness of Proton Pump Inhibitors

Medical management for Laryngopharyngeal Reflux Disease, Proton pump inhibitors is an essential part. A patient who received PPI therapy has a major symptomatic improvement, which was established in this study. From 75% of cases, complete or partial symptom resolution was observed, indicating a positive outcome to acid suppression. In LPRD management, the use of PPI is supported by multiple medical trials as well as observational studies, which are consistent with these findings. The complex and multifactorial nature of the disease is highlighted by the presence of non-responders, suggesting that acid reflux is not the only factor responsible in all patients. Incomplete treatment result may be accounted for by issues like non-acid reflux, pepsin-mediated injury, and poor medication compliance.

Importance of Lifestyle Modification

Patient who underwent both PPI and lifestyle modification therapy is compared to those on PPI monotherapy had a great treatment outcome which was an important observation in this study. Dietary regulation, avoidance of late-night meals, smoking cessation, alcohol restriction, head-end elevation, and voice hygiene are included in Lifestyle interventions, which play an important role in reducing reflux episodes and keeping symptoms from recurring. Patients who followed lifestyle changes got better results and were less likely to have symptoms return, showing that medicine alone may not be enough. This shows that for sustained symptom control, pharmacological therapy alone may be insufficient. Lifestyle modification should be an integral component of LPRD management, as these findings are supported by existing recommendations.

Diagnostic Challenges in ENT Practice

Despite its high prevalence, due to the lack of a definitive gold-standard test, LPRD continues to pose significant diagnostic challenges in ENT practice. Mostly, diagnosis became complicated by the nonspecific nature of symptoms and their overlap with allergic, infectious, and functional laryngeal disorders. Tools like the Reflux Symptom Index and the Reflux Finding Score are useful, but they are inherently subjective and can vary among clinicians. pH monitoring and impedance studies are the diagnostic techniques that are advanced and they are not available frequently in many tertiary care hospitals. Clinical judgement and empirical therapy trials are relied on by professionals.

Limitations of the Retrospective Design

This study has many limitations. The sample size is small and the follow-up duration may limit the applicability of the findings. Due to incomplete documentation information bias may occur, which results from reliance on medical records. Treatment compliance is not uniformly assessed. This study offers important real-life data that shows the daily routine practice of ENT, and underlines the demand for larger prospectively conducted studies in order to define standardized diagnostic and therapeutic strategies for LPRD.

Laryngopharyngeal Reflux Disease is a prevalent and frequently underdiagnosed disease in the ENT practice characterized by varied and nonspecific symptoms pertaining to the throat and voice, as shown in this retrospective study. Most of the patients had an improvement in PPI therapy, especially when supplemented with lifestyle changes. These findings highlight the clinical importance of a combined therapy which includes pharmacological management, but also behavioural and nutritional treatments. With larger sample sizes and objective diagnostic tools, to establish standardized guidelines for the diagnosis and management of LPRD are needed for well-designed prospective studies.

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