Conditions that may underly or aggravate Laryngopharyngeal Reflux

When I was first diagnosed with LPR, I saw it as its own condition. It was a disease like any other, with its own causes and its own symptoms. As I’ve read more and more about LPR, I’ve started to see it differently. It actually seems that most (if not all) cases of LPR are connected to other medical conditions. Usually, the underlying cause will also have something to do with digestion.

It may sound like stating the obvious, but Laryngopharyngeal Reflux is usually a result of poor digestion. The reason that any substance is coming back up the oesophagus and reaching the larynx, is that it hasn’t been digested efficiently. Of course poor digestion in itself can have many causes. You could think of LPR as the canary in the coal mine. It’s a sign that something’s not right somewhere in your digestive tract.

If you’re trying to recover from LPR, it’s important to think about what the underlying cause(s) might be. You may actually find that there are several. At the end of the day, any type of reflux is the sign of an unhappy system. If you’re suffering from LPR, you should probably think about these root causes rather than just treating the symptoms.

Medical Doctor's Desk - Diagnosing Related Conditions

The types of conditions that may underly LPR

Almost all the conditions that are connected with LPR are digestion-related. These are some of the ones that you may come across most often in your reading, but this may not be a complete list. It’s worth learning a little about each, to see if they sound like something worth investigating.

It should go without saying that you shouldn’t rely on symptoms or the internet to diagnose yourself. However, going to a doctor with a hypothesis can be a good idea. They can then help you determine definitively if one of these conditions is an underlying cause of your LPR.

Gut Dysbiosis

Gut dysbiosis is one of those terms that you may have heard a few time. It’s actually a bit vague. It basically means that somewhere in your gut, you have an infection or even just an imbalance. This can refer to the presence of bacteria, fungus or even parasites, but it doesn’t necessarily mean that you have a foreign invader in your body. It may just be that the very normal microbes are present in the wrong quantity or in the wrong place.

Here are some of the most common types of dysbiosis that you may find in your research about digestion issues and LPR…

Small Intestine Bacterial Overgrowth (SIBO)

The large intestine is where a huge amount of bacterial (and fungal) organisms live in your body. This is natural. In fact, it’s healthy, provided that they are the right type of bacteria in the right proportions. That’s why these days some doctors even prescribe introducing more bacteria in the form of probiotics.

The small intestine on the other hand is meant to be a pretty sterile environment. Sitting between your stomach and your large intestine, it’s actually where a lot of your digestion happens. For reasons that no one has conclusively explained, some people wind up with bacterial overgrowth in this part of the body, and that can cause serious digestion issues. Above all, SIBO seems to slow everything down, and cause particular issues for carbohydrate absorption. This is because the bacteria often associated with SIBO feed on carbs and release gases.

Entire blogs (let alone individual blog posts) have been written on the topic of SIBO. It’s a condition that’s not perfectly understood, but is getting a lot of attention these days. However, quite a few scientists and doctors believe that SIBO is the main underlying cause of all types of reflux.

Fungal overgrowth

SIBO is a problem of bacteria in the wrong numbers, in the wrong place, but fungal overgrowth can also cause issues. Our bodies naturally contain fungus, including a well known type called Candida. When you wind up with too much fungus, particularly in the wrong part of your digestive tract, this can also cause issues. You may hear this problem referred to as Candidiasis, Small Intestine Fungal Overgrowth (SIFO) or even just Candida.

While it may sound quite similar to SIBO, it does seem like the condition is quite different because fungal organisms behave differently to bacteria. Specifically, there seems to be some evidence that fungus responds more slowly to treatment. Having said that, it seems that SIBO is getting more attention as a potential root cause of reflux and LPR these days than fungal overgrowth.


LPR can also be a symptom of a parasitic infection. With parasites, this could actually be the presence of an organism that isn’t supposed to be there at all. You can get parasites in lots of ways, including from food and water. If you have an undiagnosed parasitic infection, it can wreak havoc on your body and digestion, and LPR could just by a symptom of those issues.

Testing & treatment for gut dysbiosis

The good news is that there are treatments available for all types of dysbiosis. Most also have reasonably reliable tests that a medical practitioner can run. I would strongly recommend discussing these possibilities with your doctor. They can run tests and give you a conclusive answer, and then discuss treatment options with you. Usually there are both natural and pharmaceutical options available.


Whethere you have gut dysbiosis or not, another condition that could be causing or aggravating your LPR is gastroparesis. In simple terms, gastroparesis is a condition where your stomach empties too slowly. When food stays in your stomach too long, it can cause reflux, for obvious reasons.

There’s much less discussion about gastroparesis online in connection with LPR and GERD, but it is sometimes associated with reflux. Equally, any one of the other conditions mentioned in this article could aggravate gastroparesis. However, gastroparesis can also have neurological causes, such as damage to the vagus nerve.

Pancreatic issues and insufficient enzyme production

To digest your food properly, you need your pancreas (and to some extent your salivary glands) to produce enzymes. If this production is impaired, it can also cause digestion issues. That is at least one of the reasons that many LPR-sufferers turn to supplemental digestive enzymes.

Hypochloridia – low stomach acid

Similarly, to digest your food properly, you need to be producing sufficient stomach acid. Certain people suffer from a lack of sufficient stomach acid, and that of course can slow down your digestion. This is a potentially controversial suggestion as traditional medicine ascribes most reflux to an excess of acid rather than a lack thereof. However, the functional medicine community often favours the low stomach acid hypothesis, and actually recommends taking stomach acid supplements.

There are actually tests that a doctor can perform to measure your stomach acid levels. Hypochloridia tends to be more common among the elderly.

Bowel diseases

The waters start to get a little murkier as you move down the digestive tract in search of potential causes of LPR. However, it stands to reason that if your digestion is impaired at any stage, it can lead to symptoms elsewhere. Problems of the bowel (or large intestine) are numerous and common, but there are some scientists and doctors drawing a connection between some of these and all types of reflux.

Diseases of the bowel can include Crohns, Inflammatory Bowel Disease (IBD) and Diverticulitis. There are also other bowel diseases that could be at play, but the diagnosis that comes up most often in conjunction with LPR is IBS or Irritable Bowel Syndrome.

Irritable Bowel Syndrome (IBS)

IBS is a tricky topic, because it is a syndrome, rather than a disease. It’s a collection of symptoms that is offered as a diagnosis when other potential conditions are excluded as a possibility through testing. IBS can be debilitating, and is associated with constipation, diarrhoea or both. People who suffer from IBS, sometimes also suffer from some sort of reflux, including GERD or LPR.

It’s worth nothing that medical professionals have recently started linking IBS to SIBO, which in itself is considered a potential cause of LPR. If you have symptoms of both LPR and IBS, this could be worth considering as a potential explanation.

It’s all connected

Even just reading this article, you probably already get the sense that things are not clear cut. Many of these conditions are connected, and of course you can have more than one of these at the same time. Many people do! Trying to decipher which conditions your symptoms best match up with can be maddening. It also may be pointless. At the end of the day, all of these are signs of an unhealthy digestive system, and probably warrant dietary interventions and consultation with a doctor.

Seek help from a medical practitioner

The absolute best thing you can do is work with a doctor who can help you determine if any of the conditions mentioned here (or any others) are part of your problem. It’s much better to rely on conclusive testing than it is to rely on analysis of symptoms. Having said that, if you do need to work with symptoms, better to let someone with lots of experience interpret them than trying to do it yourself.

Many of the treatments prescribed by the conventional medical symptom focus more on symptoms than root causes, so you may want to consider seeing a functional medical practitioner, ideally one who can incorporate the best of traditional and alternative medicine in helping you work through your treatment plan.

The bottom line – think about the root cause

The bottom line here is that you should at least be thinking about the root cause of your LPR. In some cases, it may be an isolated condition, but it seems that for many, LPR may be the result of one or more related medical issues.

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