How do I know if I have Laryngopharyngeal reflux?
If you have any of the following symptoms, you may have Laryngopharyngeal Reflux.
• Thick or excessive mucous in throat
• Chronic throat irritation
• Throat clearing
• Chronic cough or night time cough
What is Laryngopharyngeal Reflux (LPR)?
Acid is produced in the stomach, and prevented from refluxing up into your food pipe (oesophagus) and throat by a muscle at the entrance of the stomach known as the lower oesophageal sphincter. If this muscle is not functioning well, you can have reflux/backflow of acid into your oesophagus. This is called gastro-oesophageal reflux. Sometimes the acid can reflux past the upper oesophageal sphincter into your throat or voice box. This is called laryngopharyngeal reflux (LPR).
Why don’t I have heartburn?
Many people with LPR do not suffer from heartburn. Acid that passes quickly through the food pipe does not have a chance to irritate the area that produces the symptom of heartburn. However that same acid also pools in the throat and voice box. Compared to the oesophagus, the voicebox and the back of the throat are more sensitive to the affects of the acid and will cause prolonged irritation, resulting in the symptoms of LPR.
What are the symptoms?
As above the following are the symptoms:
Chronic throat clearing
Chronic sore throat
Difficulty in swallowing
Foreign body sensation (something stuck in the throat)
A bad taste in the mouth or bad breath
Hoarseness or loss of voice
What to expect at the ENT’s examination?
A history is taken and a head and neck examination is performed. The doctor will use a Nasendolaryngoscope. This is a thin flexible fibre-optic lens that allows the doctor to look at your voice box and throat. If there is inflammation, you might have LPR.
What other tests can be done?
1. Sometimes if the symptoms are very severe or if the symptoms do not resolve with medical treatment your ENT may order a test called Ambulatory 24hour pH monitoring to verify the diagnosis. This test involves inserting a tiny tube through the nose into your oesophagus. The tube has sensors which measures the amount of acid that refluxes into your oesophagus and throat. The sensors are connected to a small pocket size computer which records the activity in a 24 hour period. (use in the throat is controversial)
2. Measurements of the oesophageal muscle tension can be done in a way very similar to pH testing.
3. X-rays that view the swallowing mechanism and anatomy. This is called a barium swallow.
4. Gastroscopy and oesophagoscopy.
What is a hiatus hernia?
The stomach is continuous with the oesophagus through an opening in a sheet of muscle between the chest and the abdomen called the diaphragm. A small part of the top of the stomach can rise up through the opening in the diaphragm into the chest, which is called a hiatus hernia. Patients with a hiatus hernia may have symptoms of reflux of acid, but not all people with acid reflux have a hiatus hernia. It is usually diagnosed on gastroscopy or barium swallow
What is the treatment?
There are four general treatments for LPR
• Posture changes and weight reduction
• Diet modifications
• Medications to reduce stomach acid or to promote stomach motility
What are the medications?
The first type of medications either reduce or completely shut off the amount of acid.
The second type promotes stomach emptying by increeasing the motility of the stomach.
How long do I need medication?
Patients should begin to experience relief in their symptoms in about two weeks. However treatment is generally recommended for 4 months. If the symptoms resolve, the medication can then begin to be reduced. Some patients will be symptom free without the medication while other people may have relapses which require treatment again.
I have been treated for LPR by my ENT. I still have symptoms. Is this possible?
It is possible to fail medical therapy (even high dose or 4 times a day dosing regimes) in spite of a correct diagnosis. Unlike symptoms of gastro-oesophageal reflux disease, LPR symptoms do not resolve quickly, often taking several months to resolve.However, please follow up with your ENT as failure on therapy does need to be investigated for other diagnosis or other treatment options.
When is surgery necessary?
Surgery is necessary in individuals who have severe resistant LPR. This is however rare. Surgery is used to tighten the lower oesophageal sphincter. This is called a Nissan Funduplication.
What can we do to prevent reflux?
• Avoid smoking as it aggravates reflux.
• Avoid tight fitting clothes.
• Avoid eating less than two hours prior to bedtime.
• Avoid eating a large meal at night.
• Weight loss.
• Foods to avoid: caffeine, carbonated beverages, citrus beverages and mints, alcoholic beverages, cheese, fried foods, eggs and chocolate.
• For patients with more severe symptoms it is helpful to sleep with the head of the bed elevated. Six inches of bed elevation will decrease reflux significantly. Do not use pillows as this causes the stomach to bend and can aggravate the problem.