Reflux pharyngitis is a type of chronic pharyngitis, accounting for about 70%-80% of pharyngology outpatient visits. Patients often present with foreign body sensation, itching, burning, dryness, pain, hoarseness, bad breath, and bitterness in the throat. In severe cases, patients have a dry cough all day long, clearing their throat, and nausea and vomiting when brushing their teeth. The chronic pharyngitis is a chronic inflammation of the pharyngeal mucosa, submucosal tissue and lymphatic tissue caused by various external irritants, and there are many causes of chronic pharyngitis, but many patients tend to ignore one cause of pharyngitis when treating it, which is pharyngitis caused by gastroesophageal reflux, and this pharyngitis is generally ineffective with throat treatment alone, and will still recur. Gastroesophageal reflux should be treated. In addition to the clinical manifestations of chronic pharyngitis, it can be accompanied by symptoms of GERD of varying degrees, such as chest pain, heartburn, acidity, belching, gas, bloating, and stomach pain. For those patients with chronic pharyngitis that is persistent and recurrent, attention should be paid to the presence of gastroesophageal reflux gastritis. If this disease is present, drugs to neutralize gastric acid should be taken under the guidance of a doctor, and anti-reflux surgery should be tried if medical treatment is ineffective. Medication is often used to suppress gastric acid such as ranitidine, famotidine or omeprazole, with the addition of morpholine, cisapride or mosapride to promote the emptying of the esophagus and stomach and reduce reflux. Clinical observation reveals that bad mood and smoking are among the top triggers for the development of the disease. Examination 1, laryngoscopy Patients with laryngopharyngeal reflux have some specific manifestations under laryngoscopy. Interarytenoid edema, pseudo-vocal fold groove, edematous erythema in the posterior cricoid region, mucosal hypertrophy, vocal fold polyps and ulcers, shallow or absent laryngeal chambers, pebble-like changes in the pharynx, diffuse laryngitis, granuloma, subglottic stenosis, and stiffness of the cricoarytenoid joint are thought to be frequently seen in patients with laryngopharyngeal reflux. However, there is a lack of recognized specific microscopic manifestations that can be used for definitive diagnosis. 2, pH monitoring and impedance monitoring Currently, movable multichannel intracavitary impedance and pH monitoring equipment is considered to be a better diagnostic method for laryngopharyngeal reflux because it can combine impedance changes and pH monitoring of different flowing substances (gas, liquid, mass) between two metal electrodes, which can give a complete description of acid reflux, non-acid reflux, liquid, gas, etc. and more objective and realistic records. 3. Behavioral changes and empirical treatment are effective Some scholars believe that empirical treatment with proton pump inhibitors has a high sensitivity for diagnosing laryngopharyngeal reflux, but patients who do not respond to acid suppression therapy cannot be considered as not having laryngopharyngeal reflux disorders for this reason. The diagnosis of patients with laryngopharyngeal reflux can be made based on the patient’s symptoms and ancillary tests. At present, the diagnosis of laryngopharyngeal reflux still relies on a combination of these methods to be more convincing. Diagnostic treatment is available for some highly suspected patients (1-2 weeks of treatment with acid suppressants, with symptomatic improvement confirming the diagnosis). Differential diagnosis and gastroesophageal reflux: Although laryngopharyngeal reflux often coexists with gastroesophageal reflux, there is still a tendency to consider laryngopharyngeal reflux and gastroesophageal reflux as two distinct entities. For example, laryngopharyngeal reflux often occurs during daytime, standing or sitting, and is often characterized by dysphonia, hoarseness, throat clearing, pharyngeal foreign body sensation, prolonged cough, laryngeal secretion, and dysphagia, etc. The fiberoptic laryngoscope has specific manifestations of the corresponding arytenoids and vocal cords, and is related to the malfunction of the upper esophageal sphincter, while gastroesophageal reflux often occurs at night when lying down, and is characterized by acid reflux, heartburn, chest pain, and dysphagia. Gastroscopy shows corresponding manifestations such as esophagitis, gastroesophageal hernia and Barrett’s esophagus, which are mainly related to the abnormal function of the lower esophageal sphincter. Complications Laryngopharyngeal reflux may be associated with laryngeal cancer, esophageal adenocarcinoma, secretory otitis media, laryngeal stenosis, laryngeal wheezing, chronic rhinosinusitis, obstructive sleep hypoventilation syndrome, dental enamel damage, infant death syndrome, etc. Treatment 1. Acid suppression therapy combined with lifestyle changes is still the mainstream treatment method: lifestyle changes mainly include avoiding eating before bedtime, elevating the head of the bed, reducing dinner intake, avoiding overeating, abstaining from smoking, alcohol, tea, coffee and high-fat foods, sweets, acidic fruits (oranges, prunes, etc.), weight loss, etc. Even studies have found that simple lifestyle improvements can lead to significant relief of laryngeal discomfort. This has led to the idea that lifestyle improvement is the main treatment. (1) Proton pump inhibitors (PPIs) omeprazole, etc. The relief of symptoms often precedes the improvement of laryngoscopic manifestations. Side effects of long-term proton pump inhibitors: inhibition of calcium absorption leading to osteoporosis and fractures (common in hip and vertebrae), Clostridium difficile infection causing diarrhea, tolerance, rebound increase in acid secretion after discontinuation, increased risk of cardiovascular disease recurrence when combined with clopidogrel, increased risk of gastric cancer (especially in the presence of Hp infection), and whether it causes VitB12 and iron deficiency remains to be proven. (2) H2 receptor blockers are used to antagonize histamine-induced gastric acid secretion, mainly cimetidine, ranitidine, famotidine, etc.. They are often applied at bedtime. Conclusions about their effectiveness are mixed. It can be tried for patients who fail to obtain significant remission despite proton pump inhibitors and lifestyle improvement therapy. In cases of relapse or poor outcome, the presence of non-acid reflux, more severe types of laryngopharyngeal reflux, and the possibility of increasing the dose of the treatment course should be considered. Histamine receptor blockers and gastroprokinetic agents can be added, and lifestyle adjustments can be made. 3. Esophageal reflux In clinical practice, empirical acid suppression therapy has no significant effect on a significant proportion of patients, so esophageal pharyngeal reflux (EPR) has been proposed as a possible cause. It is mainly associated with poor motility of the esophagus, decreased sphincter tone, and decreased volume contouring function. Common symptoms include chronic cough, dysphagia, dysphonia, throat clearing, abdominal distention, and hiccups. It can be diagnosed by barium esophagogram in ambulatory position to see esophageal hernia, esophageal loss of retardation, abnormal swallowing activity of oropharynx, etc. Prevention 1. Avoid over-filling, too much dinner or late night snacking. 2.Do not rest immediately after the meal and should elevate the head of the bed appropriately. 3, Quit smoking and alcohol, and eat less spicy, coffee and strong tea. 4.Avoid tight waist belt. 5.Reduce high-fat and high-sugar foods. 6.Reduce the intake of citrus, prunes, etc. and other acidic fruits. The time required for internal treatment is more than 3 months, and it usually takes 2-4 weeks to show the effect. Too much salt in meals will lead to a reduction in saliva secretion, which is conducive to the survival of various bacteria and viruses in the upper respiratory tract; secondly, a high-salt diet may reduce the ability of the mucous membrane to resist disease, leading to a decrease in immunity, and various bacteria and viruses take advantage of the opportunity to enter and cause pharyngitis. Therefore, the autumn and winter season, to ensure that you and your family eat less salt, but also to protect the health of the throat is the key. In addition, the daily diet should also pay attention to less spicy and irritating food, fried goods such as melon seeds, peanuts and so on to eat less, these foods are salty and dry, is the great enemy of the throat. Foods rich in B vitamins are much better, such as animal liver, lean meat, fish, fresh fruits, green vegetables, dairy, beans, etc., which help promote the repair of the damaged pharynx and eliminate inflammation of the respiratory mucosa. Eat more food rich in collagen and elastin, such as pig’s feet, pig skin, hoof tendons, fish, beans, seafood, etc., which is conducive to the repair of the damaged parts of chronic pharyngitis. In addition, you should also eat more moistening food, such as pear, lily, lotus root, loquat, honey, pig lung, sage, maitake, etc. These foods can be made into honey green tea drink, silver fungus lily soup, almond snow pear soup, etc., both simple and easy and have good health benefits.