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.

We report the case of a 43-year-old male with a history of gastroesophageal reflux, obstructive sleep apnea, and morbid obesity who underwent gastric band placement in 2007, with left thoracotomy in 2012 for a loculated empyema. He now presents in acute respiratory distress with fetid-smelling sputum, a leukocytosis of 19.5 K, and a complex left lower lobe lung abscess on imaging. He underwent a redo left thoracotomy, partial rib resection, and drainage/debridement of the lung abscess. Postoperatively, he experienced ongoing poor oral intake due to high-grade stenosis caused by a slipped gastric band, noted on an upper gastrointestinal series. He underwent removal of the gastric band with robotic assistance by the bariatric service and was subsequently discharged after his respiratory status and oral intake improved. Here, we highlight that recurrent lung infections in bariatric surgery patients secondary to chronic reflux and poor dietary compliance mandate long-term surveillance and thorough investigation.