Voice Articles

Laryngopharyngeal Reflux (LPR)

What is reflux?

When eating, food and liquid travels from the mouth to the stomach through the stomach tube (or “esophagus”). There are 2 sphincter muscles in this tube: one at the top and one at the bottom. The top one opens to let food in, then closes behind the food to keep it moving down. Then the bottom opens to let food into the stomach and closes behind it to prevent the food from coming back up. REFLUX means the food flows backward, returning up the esophagus, sometimes through the top sphincter into the throat.

Two types of REFLUX

1. GERD (Gastro-Esophageal Reflux Disease): Contents from the stomach returns through the bottom esophageal sphincter and back into the esophagus. This causes swelling and irritation of the tissue in the esophagus. People with GERD feel like they have “heartburn” or indigestion. These symptoms become especially prominent when the person lies down.

2. LPRD (Laryngo-Pharyngeal Reflux Disease): When the reflux makes it all the way up through the top sphincter and into the back of the throat, it is called LPRD. The throat, voice box, and lungs are much more sensitive to stomach acid so smaller amounts of reflux into this area can result in more damage.

WHY DON’T I HAVE HEARTBURN OR STOMACH PROBLEMS?

People with LPRD rarely feel like they have heartburn or indigestion. In fact, approximately 70% of people with LPR do not report any heartburn at all.
LPR can damage the throat without a person ever knowing it is happening.

Reflux Symptom Index:

Within the past month, how did the following affect you?
0= no problem 5= severe problem

1. Hoarseness or other voice problem 0 1 2 3 4 5
2. Clearing your throat 0 1 2 3 4 5
3. Excess throat mucous or post nasal drip 0 1 2 3 4 5
4. Sensation of a lump in your throat 0 1 2 3 4 5
5. Difficulty swallowing food, liquids, pills 0 1 2 3 4 5
6. Coughing after you ate or after lying down 0 1 2 3 4 5
7. Breathing difficulties or choking episodes 0 1 2 3 4 5
8. Troublesome or annoying cough 0 1 2 3 4 5
9. Heartburn, chest pain, indigestion,
Stomach acid coming up 0 1 2 3 4 5
*A score of 14 and above is highly suggestive of LPRD

How is LPRD diagnosed?

The 24-hour Pharyngo-Esophageal pH monitoring is highly specific and sensitive to the accurate diagnosis of LPRD. A small tube is passed through the nose into the esophagus in order to monitor the amount and type of reflux during a typical day. This way, it can document if you have LPR as you go through your daily routine.

TREATMENT

1. Dietary modification—The following foods have been found to show an increase in reflux for many people. It is recommended that you avoid the following foods:
• Spicy, acidic and tomato-based foods
• Acidic fruit juices, such as orange juice, grapefruit juice, cranberry juice, etc.
• Fast foods and other fatty foods
• Caffeinated beverages (coffee, tea, soft drinks) and chocolate
• Alcohol
• Tobacco
• Strongly flavored mints

2. Life-style modification
• Avoid reclining right after meals
• Eat meals and/or snacks at least 3 hours before bedtime
• Don’t exercise immediately after eating
• Try to maintain a healthy body weight. Being overweight can dramatically increase reflux
• Elevate the head of your bed 4-6 inches with books, bricks, or a block of wood to achieve a 10-degree slant.
• Avoid tight belts and other restrictive clothing
• If you smoke, stop, or at least reduce the amount of smoking.

3. Medication
• Liquid antacids—1 tablespoon 1 hour after each meal and at bedtime
• Your physician may prescribe medications, such as Pepcid, Zantac, Nexium, Prilosec, Prevacid.