Laryngopharyngeal reflux (LPR) is a very common problem which affects the throat. It occurs when stomach acid travels backwards up the esophagus into the throat. LPR is essentially the same problem as the more commonly known gastroesophageal reflux disease (GERD), or “acid reflux.”
Acid reflux occurs when stomach acid backs up into the esophagus and throat rather than moving forward into the intestines as it should.
Classic symptoms of acid reflux are heartburn, bloating, stomach pain, burping, and bad acid taste in the mouth. Patients with LPR may have these classic symptoms of GERD but many times they do not.
If the stomach acid backs up into the esophagus and stops there, patients typically experience heartburn. If the acid backs all the way into the throat, many patients will not have heartburn but rather common throat symptoms associated with LPR.
The most common symptom associated with LPR is a sensation of something caught in the throat, or a lump in the throat. The medical name for this complaint is “globus sensation.”
Other very common symptoms of LPR are hoarse voice, difficulty swallowing (usually worst with pills or large bites of food), frequent throat clearing, cough, lots of phlegm in the throat, chronic cough, and post-nasal drip sensation. These symptoms are frequently worst in the early mornings after patients have been lying flat all night. When lying flat, it is easier for stomach liquid to reflux back up the esophagus into the throat.
Smokers and people with nasal allergies can also have similar throat symptoms and may also have LPR at the same time.
LPR is diagnosed by a patient history consistent with the above symptoms (though not all patients have all symptoms). In addition, I will perform an endoscopic exam where I pass a small camera through the patient’s nose to see the back of the throat and the voice box (larynx). There are several classic abnormalities I can see during the endoscopic exam which are associated with reflux.
There is good news and bad news about LPR.
The good news is that while LPR is annoying and unpleasant, it is not a serious or life-threatening issue. Many patients have a sensation of a lump in their throat because of the acid reflux, and they are worried about the possibility of a tumor.
The bad news is that LPR can sometimes be a difficult problem to treat. Medicines and diet/lifestyle changes usually help the symptoms and make them happen less often, but it is a challenge to completely get rid of the throat symptoms forever.
The first recommendation I make for patients with LPR is to adjust their diet to foods that are less likely to cause acid reflux. An excellent book on this subject is “Dropping Acid” by Dr. Jamie Kaufman. It educates about LPR but also provides a great meal plan and recipes. The most important thing is to not eat or drink within 2 hours of going to bed. Lying flat with a full stomach is very likely to cause reflux.
Overweight or obese patients should lose weight because excess weight around the stomach makes reflux more likely.
Anyone with LPR who smokes should quit smoking for this and many other reasons. If patients with LPR also have nasal allergies, I will treat those as well.
Finally, I will prescribe an anti-reflux medication such as prilosec, nexium, protonix, dexilant, or other similar drugs. This medication should be taken in the morning before breakfast every day. Give it 3-4 weeks to have a full effect. If there is not enough improvement after 3-4 weeks, the medication can be increased to twice daily.
For certain patients with reflux that does not improve with the above treatments, I will refer them to a gastroenterologist for further evaluation.
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