Laryngopharyngeal Symptoms & Reflux Disease
The San Diego Consensus: separating LPS from LPRD, laryngoscopy's role, empiric trials, ambulatory reflux monitoring, and laryngeal recalibration therapy.
LPS vs LPRD
LPS ≠ LPRD
The consensus replaces the ambiguous term 'LPR' with two distinct concepts: laryngopharyngeal symptoms (LPS) — a symptom state — and laryngopharyngeal reflux disease (LPRD) — LPS plus objective evidence of reflux. Up to 60% of patients diagnosed with LPR have normal ambulatory reflux monitoring, and only ~35% of those evaluated have objective LPRD.
LPS — Qualifying Criteria
- Frequent: at least twice weekly (96% agree)
- Chronic: 8 weeks or more (93% agree)
- Throat/upper-airway symptoms with potential to be reflux-induced
- Term does not implicate reflux as the cause (93%)
LPRD — Requires Both
- Chronic, troublesome LPS AND
- (i) Concurrent esophageal reflux symptoms that respond to an antireflux trial, OR
- (ii) Diagnostic evidence of reflux on endoscopy or ambulatory reflux monitoring (82% agree)
| Symptom | Agreement | Comment |
|---|---|---|
| Cough | 89% | Included |
| Regurgitation-type throat symptoms | 89% | Reported as "regurgitation (89%)" in the text list |
| Throat pain / sore throat | 89% | Included |
| Throat clearing | 86% | Included |
| Excess throat phlegm | 82% | Included |
| Hoarseness / voice change | 80% | Included |
| Globus | 88% (warrants evaluation) | Did not reach LPS inclusion; often a negative predictor of reflux physiology |
Symptoms that did NOT reach agreement as LPS
Tongue burning, nasal burning, postnasal drip, halitosis, belching, and dysphagia. All LPS are poorly specific for true LPRD.
Why it matters
LPS is highly prevalent and empirically treated far more often than LPRD is proven (92%). Costs are ~5.4× higher than GERD, driven by prolonged therapeutic trials and diagnostic uncertainty; quality-of-life impact is significant (anxiety, depression, impaired social function).
Phenotype at presentation
Categorize every LPS patient as isolated LPS or LPS with concurrent esophageal reflux symptoms (heartburn, regurgitation, chest pain; 100% agreement) — the algorithms differ.
Yadlapati R, et al. The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease. Am J Gastroenterol. 2026;121:322–336.