Objective <p>Laryngopharyngeal reflux (LPR) is a common disease, and various medications are employed clinically for its management, with variable efficacy. Therefore, this study aimed to assess the efficacy of different pharmacological treatments for LPR, thereby providing evidence-based guidance for its treatment.</p> Methods <p>Embase, Web of Science, Cochrane Library, and PubMed were comprehensively searched from inception to July 31, 2025, for studies on LPR. Two reviewers independently reviewed full texts and appraised the quality of eligible studies using the RoB 2.0 tool and the Newcastle–Ottawa Scale. R version 4.5.1 was employed to analyze data.</p> Results <p>In total, 23 studies involving 1,958 individuals were included. The reflux symptom index (RSI) and reflux finding score (RFS) of these participants were analyzed at weeks 4, 8, and 12, respectively. According to league table results, for the RSI at week 4, compared with placebo, alginate yielded a weighted mean difference (WMD) of − 4.69 (95% credible interval [CrI]: − 8.97, − 0.28). For the RSI at week 8, compared with placebo, alginate yielded a WMD of − 6.27 (95% CrI: − 10.13, − 2.19). For the RSI at week 12, compared with placebo, proton pump inhibitors (PPIs) plus mucolytics yielded a WMD of − 9.75 (95% CrI: − 17.76, − 1.63). For the RFS at week 4, compared with potassium-competitive acid blockers (P-CABs), PPIs, and placebo, alginate yielded WMDs of − 3.55 (95% CrI: − 5.28, − 1.79), − 3.53 (95% CrI: − 4.83, − 1.90), and − 3.75 (95% CrI: − 4.87, − 2.56), respectively. For the RFS at week 8, compared with placebo, alginate yielded a WMD of − 4.12 (95% CrI: − 7.88, − 0.53). For the RFS at week 12, compared with placebo, alginate yielded a WMD of − 5.66 (95% CrI: − 10.25, − 1.14). According to the surface under the cumulative ranking curve (SUCRA), for the RSI at week 4, alginate ranked first (89.66%) and P-CABs ranked third (62.82%). For the RSI at week 8, alginate ranked first (84.50%). For the RSI at week 12, PPIs plus mucolytics ranked first (87.47%) and alginate ranked second (63.67%). For the RFS at week 4, alginate ranked first (99.43%). For the RFS at week 8, alginate remained the top-ranked treatment (88.30%). For the RFS at week 12, alginate ranked first (89.87%) and P-CABs ranked third (50.69%).</p> Conclusion <p>This study revealed that alginate demonstrated the greatest efficacy in the treatment of LPR.</p>