If you have any of the following symptoms, you may have laryngopharyngeal reflux (LPR).
- Chronic throat clearing
- Excess throat mucous or post-nasal drip
- Difficulty swallowing food, liquids, or pills
- Coughing after you ate or after lying down
- Breathing difficulties or choking episodes
- Troublesome or annoying cough
- Sensations of something sticking in your throat or a lump in your throat
- Heartburn, chest pain, indigestion, or stomach acid coming up
What is laryngopharyngeal reflux?
Acid is normally produced by the stomach. It is prevented from backing up of refluxing into your esophagus and throat by two bands of muscle fibers, known as sphincters. One sphincter is at the top of the esophagus (at the junction with the throat) and one is at the bottom of the esophagus (at the junction of the stomach). If these bands of muscle are not functioning well, you can have a backflow of acid into your esophagus and into your throat and voice box. This is called laryngopharyngeal reflux (LPR).
What is the difference between GERD (Gastroesophageal Reflux Disease) and LPR?
Some people have an abnormal amount of reflux of stomach acid up through the lower sphincter and into the esophagus. This is referred to as GERD. If the reflux makes up to and through the upper esophageal sphincter and into the back of the throat, it is called LPR. The throat is much more sensitive to stomach acid and digestive enzymes, therefore smaller amounts of the reflux can lead to more damage.
Why don't I have heartburn or stomach problems?
Very few patients with LPR have heartburn or stomach problems. Compared to the esophagus, the voice box and back of the throat are significantly more sensitive to the effects of acid and digestive enzymes. Acid that passes quickly through the esophagus does not have a chance to irritate the area. However, acid that pools in the throat and voice box will cause prolonged irritation resulting in LPR symptoms.
What to expect with the doctor's examination?
After a detailed history, a head and neck examination will be performed. Attention will be placed on the nose and throat area. The doctor will most likely use an instrument called a flexible fiberoptic laryngoscope to allow a detailed exam of the voice box and throat. If the area is inflamed and red, you may have LPR.
What other tests may the doctor order?
Sometimes if the symptoms of LPR fail to resolve with medical treatment or are very severe, an ambulatory 24-hour pH probe may be performed. If problems swallowing are present, a barium swallow test could be indicated. Also, if there is concern of damage to the esophagus an esophogoscopy might be recommended.
What treatment will the doctor recommend?
There are four general treatments for LPR:
- Posture changes and weight reduction
- Dietary modification
- Medications to reduce stomach acid or to promote motility
- Surgery to prevent reflux
Most patients will see some relief of their symptoms within two weeks. However, many times it might take two months for full resolution of LPR symptoms. Patients will usually continue medication for three months then taper off the medications. Patients will occasionally have to be treated for relapses of symptoms. Those patients who don't respond or have severe symptoms may need additional testing, prolonged medical therapy, or surgery to tighten the lower esophageal sphincter.
How to prevent reflux:
- Reduce stress. Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount of reflux.
- Do not smoke.
- Avoid laying down immediately after meals and avoid eating three hours prior to bedtime.
- Avoid large meals.
- Avoid fatty or spicy foods. Eat fewer acidic foods, such as citrus or tomato-based foods. Limit alcohol, caffeine, and carbonated beverages. Limit chocolate and peppermint.
- Lose weight if you are overweight.
- Exercise, but not around bedtime or immediately after meals.
- Avoid tight fitting clothes.
- For patients with severe reflux, elevate the head of the bed 4-6 inches with books, wood, or bricks.