Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Gastric juice (pepsin and acid) has long been known to be one of the main aggressors in peptic ulcer disease, with changes in pepsin type being a major factor. LPR is a condition that is being recognized more frequently as the cause of many symptoms localized to the upper aerodigestive tract. These include globus pharyngeus, hoarseness, postnasal drip, chronic cough, dysphagia, and throat pain. However, these are all common symptoms in numerous voice disorders and may all be caused by voice abuse, smoking, asthma, allergy, associated infections, or chronic alcohol abuse. Thus, the proportion of patients with laryngeal symptoms who have reflux as the primary aetiology may be overestimated in some studies. The typical symptoms of gastroesophageal reflux, heartburn, and acid regurgitation occur in a minority of these patients, and the laryngeal symptoms vary.

LPR can be difficult to diagnose because the symptoms and findings are often unappreciated and not always specific, which makes it unreliable to base the diagnosis on history and examination alone. The focus of this special issue will be on the new and existing beliefs on LPR diagnosis and treatment, focusing in particular on advances in immunology, pharmacology, and technology. We will also cover the controversies regarding the evidence base of empiric treatment of LPR. The topics to be covered include, but are not limited to:

• LPR: new advances in diagnosis
• Empiric treatment of LPR: revisited
• The role of pepsin in LPR diagnosis
• Chronic cough and LPR
• Globus pharyngeus and LPR
• Transnasal esophagoscopy and LPR
• Eosinophilic esophagitis

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