Should H2-Blockers Be Used for the Treatment of Laryngopharyngeal Reflux?

Laryngopharyngeal reflux (LPR) is a highly prevalent condition in otolaryngology practice, characterized by reflux of gastric contents into the pharynx and larynx. Although proton pump inhibitors (PPIs) remain first-line therapy, many patients report persistent symptoms. In refractory cases, histamine-2 receptor antagonists (H2RAs) are often employed as adjunctive or standalone therapy due to their rapid onset and accessibility. However, their utility as daily therapy is limited by tachyphylaxis, with significant loss of acid suppression within days of continuous use. Despite longstanding evidence from gastroenterology literature discouraging daily H2RA therapy, these agents remain frequently prescribed in otolaryngology practice. Contemporary ear, nose, and throat (ENT)-specific guidance on their role in LPR is lacking. In patients with ongoing laryngopharyngeal symptoms despite optimized PPI therapy, a systematic, phenotype-driven approach is recommended, incorporating objective testing with hypopharyngeal-esophageal pH-impedance monitoring, alternative agents including alginates, and consideration of surgical or endoscopic interventions. Greater adherence to evidence-based recommendations may improve outcomes.