Laryngopharyngeal reflux, also known as LPR, is a condition that can occur in patients who have been diagnosed with gastroesophageal reflux disease, also known as GERD. Acid from the stomach rises upward, towards the esophagus, and enters the back of the throat. Patients with LPR report experiencing a bitter taste and the feeling that something is caught in the back of their throat. In some cases, LPR can cause breathing difficulties.
Causes Of LPR
It is believed that the abnormal relaxation of the lower esophageal sphincter, or LES, which allows the liquid to pass back up to the esophagus, may contribute to the cause of the condition. The backflow of acid from the stomach into the esophagus enters the lower throat and voice box.
Symptoms Of LPR
The symptoms of LPR are isolated to the throat. Patients experiencing symptoms of LPR may experience the following:
- Difficulty breathing
- Hoarseness of the voice
- Difficulty swallowing
- A feeling that something is caught in the back of the throat
- A chronic cough
- Throat clearing
- A sore throat
- Increased or thickened mucus
Diagnosis Of LPR
Diagnosis of LPR is usually made after a thorough medical and physical examination of the throat. Testing, to confirm the diagnosis of LPR, may include the following:
- Barium swallow study
- Esophageal acid testing
- Endoscopic examination of the throat and vocal cords
Treatment Of LPR
There are numerous treatment options that may reduce the severity and frequency of the symptoms of LPR. They include lifestyle changes, medications, surgery or complementary and alternative therapies to control symptoms. Some of the treatments include the following:
- Avoiding lying down for 3 hours after a meal
- Wearing clothing that is not snug
- Losing weight
- Keeping the upper body slightly elevated while sleeping to keep reflux down
- Eating small, frequent meals
- Avoiding foods known to promote reflux such as chocolate, peppermint, citrus food, spicy food, coffee, and alcohol
- Stopping smoking
- Taking proton pump inhibitors
- Undergoing surgery, for severe cases
Are Laryngopharyngeal Reflux and GERD the Same Thing?
It's commonly misunderstood that laryngopharyngeal reflux and GERD are two names for the same condition. While both are forms of acid reflux, they can be quite different. Heartburn is the primary symptom of GERD, the condition in which stomach acid rises up into the esophagus. Laryngopharyngeal reflux can occur without any symptoms. When symptoms do occur, they may feel somewhat like the common cold. People with GERD may feel a burning sensation in the chest and throat. People with laryngopharyngeal reflux may feel like they often have a sore throat or that they have mucus lodged in the back of the throat. The reason why symptoms differ is that, with laryngopharyngeal reflux, also called "silent reflux," acid from the stomach passes through the esophagus so quickly that irritation does not occur in that area.
Can I Manage LPR on My Own?
You may be able to manage the symptoms of laryngopharyngeal reflux using lifestyle habits. It's difficult to say how effective these strategies will be for every person. Your doctor may suggest that you take medication in addition to the following:
- Do not use tobacco products
- Limit or avoid alcohol consumption
- Manage stress levels through healthy daily habits
- Drink at least 64 ounces of water daily
- Eat small meals
- Eat at least three hours before bedtime
- Do not exercise or lie down for at least one hour after eating
- Limit the consumption of tomato-based foods, chocolate, and citrus fruits
- Avoid foods that are very spicy or greasy
Are there Medical Treatments that can Help Reduce Laryngopharyngeal Reflux?
In addition to making necessary lifestyle changes to manage the symptoms of laryngopharyngeal reflux, your doctor may recommend or prescribe medication to reduce acute symptoms. It is important to take all medications as directed by your doctor. With LPR, it is especially important to time the administration of medications properly (30 to 60 minutes before meals). Some of the pharmaceutical treatments that may be recommended include:
- Histamine blockers such as Tagamet® or Pepcid®.
- Proton pump inhibitors such as Prevacid® or Nexium®. These inhibit the formation of stomach acid.
- Alginates, which block acid reflux from entering the esophagus. Products such as Gaviscon Advance® are derived from kelp and act as a safe physical barrier against GERD
LPR can be a challenging condition to manage on your own, even with the use of over-the-counter medications. It's important to understand that some medications can increase the production or levels of stomach acid, ultimately aggravating GERD and LPR symptoms. Consulting with a specialist, you have the opportunity to review your current medications, lifestyle, and health history to better understand what may be causing laryngopharyngeal reflux and what you can do to improve your comfort.
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