{"id":45,"date":"2013-12-08T21:08:17","date_gmt":"2013-12-08T19:08:17","guid":{"rendered":"http:\/\/www.entent.co.za\/?page_id=45"},"modified":"2015-05-06T00:39:38","modified_gmt":"2015-05-05T22:39:38","slug":"reflux","status":"publish","type":"page","link":"https:\/\/www.entent.co.za\/?page_id=45","title":{"rendered":"Reflux"},"content":{"rendered":"

How do I know if I have Laryngopharyngeal reflux?
\n<\/span><\/span><\/strong>If you have any of the following symptoms, you may have Laryngopharyngeal Reflux.
\n<\/span>\u2022 Hoarseness
\n<\/span>\u2022 Thick or excessive mucous in throat
\n<\/span>\u2022 Chronic throat irritation
\n<\/span>\u2022 Throat clearing
\n<\/span>\u2022 Heartburn
\n<\/span>\u2022 Chronic cough or night time cough<\/span>\u00a0<\/span><\/p>\n

What is Laryngopharyngeal Reflux (LPR)?
\n<\/span><\/span><\/strong>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).<\/span><\/p>\n

Why don\u2019t I have heartburn?
\n<\/span><\/span><\/strong>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.<\/span><\/p>\n

What are the symptoms?
\n<\/span><\/span><\/strong>As above the following are the symptoms:
\n<\/span>Dry cough
\n<\/span>Wheezing
\n<\/span>Chronic throat clearing
\n<\/span>Chronic sore throat
\n<\/span>Difficulty in swallowing
\n<\/span>Foreign body sensation (something stuck in the throat)
\n<\/span>Heartburn
\n<\/span>A bad taste in the mouth or bad breath
\n<\/span>Hoarseness or loss of voice
\n<\/span>Postnasal drip<\/span><\/p>\n

What to expect at the ENT\u2019s examination?
\n<\/span><\/span><\/strong>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.<\/span><\/p>\n

What other tests can be done?
\n<\/span><\/span><\/strong>1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Sometimes 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)
\n<\/span>2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Measurements of the oesophageal muscle tension can be done in a way very similar to pH testing.
\n<\/span>3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0X-rays that view the swallowing mechanism and anatomy. This is called a barium swallow.
\n<\/span>4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Gastroscopy and oesophagoscopy.<\/span><\/p>\n

What is a hiatus hernia?<\/span><\/span><\/strong><\/em>
\n<\/em>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<\/span><\/span><\/p>\n

What is the treatment?
\n<\/span><\/strong><\/span>There are four general treatments for LPR
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Posture changes and weight reduction
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Diet modifications
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Medications to reduce stomach acid or to promote stomach motility
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Surgery\u00a0<\/span>\u00a0<\/span><\/p>\n

What are the medications?
\n<\/span><\/span><\/strong>The first type of medications\u00a0either reduce or completely shut off the amount of acid.
\n<\/span>The second type\u00a0promotes stomach emptying by increeasing the motility of the stomach.<\/span><\/p>\n

How long do I need medication?
\n<\/span><\/span><\/strong>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.<\/span>\u00a0<\/span><\/p>\n

I have been treated for LPR by my ENT. I still have symptoms. Is this possible?
\n<\/span><\/span><\/strong>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.<\/span>However, please follow up with your ENT as failure on therapy does need to be investigated for other diagnosis or other treatment options.<\/span>\u00a0<\/span><\/p>\n

When is surgery necessary?
\n<\/span><\/strong><\/span>Surgery is necessary\u00a0in\u00a0individuals who have severe resistant LPR. This is however rare. Surgery\u00a0is used to tighten the lower oesophageal sphincter. This is called a Nissan Funduplication.<\/span>\u00a0<\/span><\/span><\/p>\n

What can we do to prevent reflux?
\n<\/span><\/span><\/strong>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Avoid smoking as it aggravates reflux.
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Avoid tight fitting clothes.
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Avoid eating less than two hours prior to bedtime.
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Avoid eating a large meal at night.
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Weight loss.
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Foods to avoid: caffeine, carbonated beverages, citrus beverages and mints, alcoholic beverages, cheese, fried foods, eggs and chocolate.
\n<\/span>\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0For 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.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

How do I know if I have Laryngopharyngeal reflux? If you have any of the following symptoms, you may have Laryngopharyngeal Reflux. \u2022 Hoarseness \u2022 Thick or excessive mucous in throat \u2022 Chronic throat irritation \u2022 Throat clearing \u2022 Heartburn \u2022 Chronic cough or night time cough\u00a0 What is Laryngopharyngeal Reflux (LPR)? Acid is produced … Continue reading Reflux<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/pages\/45"}],"collection":[{"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.entent.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=45"}],"version-history":[{"count":1,"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/pages\/45\/revisions"}],"predecessor-version":[{"id":46,"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/pages\/45\/revisions\/46"}],"up":[{"embeddable":true,"href":"https:\/\/www.entent.co.za\/index.php?rest_route=\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/www.entent.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=45"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}