Laryngopharyngeal Reflux Disease
What is Reflux?
The word reflux literally means "backflow." Ordinarily, food reaches the stomach by traveling down a muscular tube called the esophagus. The esophagus has two sphincters (bands of muscle that close off the tube) that keep the stomach contents where they belong. Laryngopharyngeal reflux, or LPR, is the backflow of stomach contents up the esophagus, past the sphincters, and into the throat. The injurious agents in the refluxed stomach contents (refluxate) are primarily acid and activated pepsin, an enzyme needed to digest food in the stomach. The damage to the tissues in the throat caused by these materials can be extensive. This problem is often now referred to in the media as silent reflux.
GERD? LPR? What’s the difference?
LPR is different than gastroesophageal reflux disease (GERD). Patients with GERD typically suffer from heartburn and many persons with GERD have esophagitis. Although some persons with LPR do suffer from heartburn or esophagitis (12%), most persons with LPR do not. The reason for this is that the refluxate spends very little time in the esophagus and does most of its damage in the larynx. The anatomic abnormality in patients with LPR is thought to exist at the level of the upper esophageal sphincter. Esophageal motility and esophageal acid clearance are usually normal. The esophagus is very well equipped to handle small amounts of reflux and little, if any esophageal injury occurs in patients with LPR. Because patients with LPR do not suffer from heartburn, the diagnosis may be difficult to make for some clinicians.
Common Symptoms of LPR:
|Hoarseness||Bad/bitter taste in mouth|
|Chronic cough||Asthma-like symptoms|
|Frequent throat clearing||Referred ear pain|
|Pain or sensation of lump in throat||Post-nasal drip|
|Problems while swallowing||Singing difficulties|
LPR is diagnosed by clinical history, physical examination, and, sometimes, by special testing. A history of characteristic symptoms directs the physician to look closely for tale-tale physical exam findings to support the diagnosis. These findings may include: redness or irritation of the larynx (the voice box area), swelling in the larynx, or reactive growths (called granulomas). A special test called a 24-hour pharyngo-esophageal pH probe study may be ordered to accurately document reflux events which are occurring. Most of the time, the diagnosis is confirmed by a positive response to a trial of medication and lifestyle modification.
Treatment for LPR:
- Stress: Take significant steps to reduce stress! Even moderate stress can dramatically increase the amount of reflux you experience.
- Foods: You should pay close attention to how your system responds to various foods. Make note of foods which increase reflux and avoid those foods. The following foods are known common culprits:
- Spicy, acidic, and tomato-based foods
- Fried and fatty
- The 4 C’s: Caffeine, Citrus, Colas, and Cocktails (alcohol)
- Mealtime: Do not overeat and eat 3 to 4 hours before bedtime. Avoid bedtime snacks. Do not exercise immediately after eating.
- Body weight: Try to maintain a healthy body weight. Being overweight can dramatically increase reflux.
- Avoid wearing tight, restrictive clothing around your waist.
- Nighttime Reflux: If nighttime reflux is a problem for you, elevate the head of your bed 4-6 inches with books, bricks, or a block of wood to achieve a 10 degree slant. Do not prop the body up with extra pillows. This may increase reflux by kinking the stomach.
- Smoking: If you smoke, STOP!!!. This dramatically causes reflux and many other evils to your body.
- Medications: You may be given a prescription for one or more medications aimed at reducing the amount of acid you produce. Less acid production means less acid irritation to the larynx and pharynx.
*Be aware that this treatment regimen will take at least 8 weeks before you see significant change, and six to nine months to resolve. Hang in there, though, and it will pay off.
Reflux Symptom Index
Within the last month, how did the following problems affect you?
Circle your answer with one of the following:
0 – No problem
1 – Occasional
2 – Mild
3 – Moderate
4 – Moderate to Severe
5 – Severe
|1. Hoarseness of problem w/ your voice||0||1||2||3||4||5|
|2. Clearing your throat||0||1||2||3||4||5|
|3. Excess throat mucous or postnasal drip||0||1||2||3||4||5|
|4. Difficulty swallowing food, liquids, or pills||0||1||2||3||4||5|
|5. Coughing after you ate or after lying down||0||1||2||3||4||5|
|6. Breathing difficulties or choking episodes||0||1||2||3||4||5|
|7. Troublesome or annoying cough||0||1||2||3||4||5|
|8. Sensations of something sticking I your throat or a lump in your throat.||0||1||2||3||4||5|
|9. Heart burn or indigestion.||0||1||2||3||4||5|
|10. Awaking at night coughing or choking||0||1||2||3||4||5|
Total Score: ___________
LPR Checklist for Diet/Lifestyle Management
PATIENT: ________________________________ DATE: _________________
Answer YES or NO to each of the 10 questions below. If you answer YES to any part of the question, the entire question is YES.
_____1. I eat spicy, acidic, tomato-based, fatty foods, chocolate, peppermint, citrus fruits, and fruit juices.
_____ 2. I am overweight and have extra weight around my waist.
_____ 3. I only eat 2-3 large meals a day.
_____ 4. I exercise right after I eat.
_____ 5. I wear tight, restrictive clothes around my waist.
_____ 6. I drink coffee, tea, alcohol, and colas.
_____ 7. I smoke.
_____ 8. I lie down right after I eat.
_____ 9. I lie flat in my bed and do not elevate the head of my bed except for pillows.
_____ 10. I do not take the medication as prescribed by my physician.
Current compliance rating: __________
Previous compliance rating: __________