Laryngopharyngeal Reflux: 

Practical Tips

What is Laryngopharyngeal Reflux (LPR) ?

Acid is normally produced in the stomach. It is prevented from backing up or refluxing into your esophagus (or food pipe) and throat by a band of muscle at the entrance of the stomach known as the lower esophageal sphincter. If this band of muscle is 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).

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But I don't have heartburn; how can I have LPR?

Many people with LPR do not have symptoms of heartburn. Compared to the esophagus, the voice box and the back of the throat are significantly more sensitive to the affects of the acid on the surrounding tissues. Acid that passes quickly through the food pipe does not have a chance to irritate the area for too long. However, acid that pools in the throat and voice box will cause prolonged irritation resulting in the symptoms of LPR.

What are the Symptoms?

The symptoms of laryngopharyngeal reflux can consist of a dry cough, chronic throat clearing and globus sensation (sensation of something being stuck in the throat). Some people will also complain of heartburn, while others may have intermittent hoarseness or loss of voice. Another major symptom of LPR is "postnasal drip". The patients often have been told that their symptoms are abnormal nasal drainage or infections, however, this is rarely the cause of the irritation. In order for the "postnasal drip" to cause the complaints described, signs and symptoms of active nasal infection or allergy would also be present. It is more likely that the larynx and surrounding tissues secrete more mucous to protect the larynx from damage inflicted by stomach acid and other chemicals that are active in the digestive process.

What Should I Expect During the Doctor's Examination?

After a detailed history is taken, a head and neck examination will be performed. Particular attention will be placed on the nose and throat area. The doctor will use an instrument called a Flexible Fiberoptic Laryngoscope. This is a thin flexible fiber lens that allows the doctor to look at your voice box and throat. If the area is very inflamed and red, you might have LPR.

Sometimes if the symptoms of LPR are very severe or if the symptoms fail to resolve with medical treatment your doctor might order a test called Ambulatory 24-hour pH Monitoring to verify the diagnosis. This test involves inserting a tiny tube through the nose into your esophagus.

 

This small tube has monitors which measure the amount of acid that backs up into your esophagus and throat. The tube is connected to a small pocket size computer which records the activity in a 24 hour period.

What Other Tests Might the Doctor Order?

What Treatment Will the Doctor Recommend?

There are four general treatments for LPR:

  • Posture changes and weight reduction.

  • Diet modifications.

  • Medications to reduce stomach acid or to promote normal motility.

  • Surgery to prevent reflux

Your doctor might prescribe medications to either reduce or completely shut off the amount of acid in the stomach. Sometimes a medication that promotes motility might also be prescribed. Rarely, there are individuals who have a severe resistant to medical management. Surgery is then recommended to tighten the lower esophageal sphincter.

How Long

Do I Need Medication?

Most patients will begin to notice some relief in their symptoms in about two weeks. However, it is generally recommended that the medication be continued for about two months. If the symptoms completely resolve, the medication can then begin to be tapered. Some people will be symptom free without the medication while other people may have relapses which require treatment again.

Things That You Can Do To Prevent Reflux

  • Do not smoke. Smoking will cause reflux.

  • Avoid tight fitting clothes around the waist.

  • Avoid eating three hours prior to bedtime. In fact, avoid eating a large meal at

    night.

  • Eat small, frequent meals, about six per day.

  • Eat slowly and chew your food well.

  • Eat in a relaxed, calm atmosphere.

  • Avoid physical exercise and straining after eating.

  • Avoid tight-fitted clothing, especially belts.

  • Avoid constipation.

  • Weight loss. For patients with recent weight gain, shedding a few pounds is often

    all that is required to prevent reflux.

  • When your symptoms are severe, choose bland foods.

  • Sleep with the head of your bed elevated. Eight to twelve inches of bed elevation

    will decrease reflux significantly.

Diet

These foods can cause discomfort for many people. SOME OF THESE FOODS MAY NOT BOTHER YOU. IF NOT, GO AHEAD AND ENJOY THEM. Remember, however, that high fat foods should be eaten in moderation.

Caffeinated Foods

and Beverages

  • Coffee

  • Tea

  • Chocolate

  • Sodas, unless caffeine-free

  • Citrus Juices

  • Alcoholic Beverages

High-fat Foods

  • Ice cream

  • Whole milk

  • 2% milk

  • Whole milk cheese 

  • Cream Sauces

  • Cream soups

  • Gravies

  • Olives,

  • Avocado

  • Coconut 

  • Nuts and Seeds

  •  Peanut butter

  • Rich desserts

  • Pastries,

  • Muffins

  • Biscuits

  • Party Crackers

  • Dinner Rolls

  • Fried Eggs and Meats

  • Cream Cheese

  • Bacon

  • Sausages

  • Oil packed fish

  • Goose 

  • Duck

  • Spareribs

  • Poultry skin

  • Ground beef

Spicy Foods

  • Peppers

  •  Pickles

  •  Chili powder

  • Cold cuts

  •  Ketchup

  • Corned Beef

  • Mustard

  • Hot dogs

  • Steak Sauce

  • Ham

  • Sausages

  •  Hot Sauce

  • Peppermint

  •  Cajun spices

  •  Asian food spices

High Fiber or Strong flavored foods

  • Bran Cereals

  • Raw vegetables

  • Raw Fruit with peel or Seeds

  • Dried Fruit

  • Raisins

  • Dried Beans and Peas

  • Brussels Sprouts

  • Broccoli

  • Cabbage

  • Cauliflower

  • Cucumber

  • Green Peppers

  • Onion

  • Garlic

  • Sauerkraut

  • Okra

  • Corn

  • Hominy

  • Rutabaga

  • Melons

  • Turnips

  • Tomatoes

  • Radishes