Laryngopharyngeal Reflux (LPR), often called “silent reflux,” occurs when stomach contents travel up the esophagus and irritate the tissues of the throat and larynx. This condition is distinct from classic heartburn because many people with LPR do not experience a burning sensation in the chest. Instead, symptoms manifest as a chronic cough, persistent throat clearing, hoarseness, or the sensation of a lump in the throat. The lining of the larynx and pharynx lacks the protective mechanisms of the esophagus, meaning even a small amount of refluxed material, including acid and the digestive enzyme pepsin, can cause irritation. Healing LPR requires a comprehensive approach through changes in diet, adjustments to daily lifestyle habits, and physician-supervised medical treatments.
Dietary Strategies for Reducing Reflux
Dietary modifications are the foundation of LPR management because what a person eats directly influences the volume and acidity of stomach contents. Eliminating common trigger foods is the initial step in reducing reflux episodes and allowing the throat tissue to heal. Highly acidic foods and beverages irritate the already sensitive larynx and include citrus fruits, tomatoes, tomato-based products, and vinegar.
Fatty or fried foods should be avoided because they slow down gastric emptying, keeping food in the stomach longer and increasing pressure against the lower esophageal sphincter (LES). These high-fat meals can also cause the LES to relax, making it easier for stomach contents to flow back up. Other known triggers, such as chocolate and mint, contain compounds that chemically relax the muscle valves that guard the entrance to the esophagus.
Carbonated drinks, even sparkling water, introduce gas into the stomach, which increases pressure and forces gastric contents upward. Caffeine and alcohol should also be limited as they both stimulate stomach acid production and relax the esophageal sphincters. Incorporating alkaline foods can help neutralize stomach acid and pepsin.
Foods with a pH level of 5 or higher are generally well-tolerated and should be favored, such as melons, bananas, oatmeal, and most green vegetables. Lean proteins, including skinless chicken, fish, and egg whites, are also recommended as they are low in fat and less likely to trigger reflux.
Shifting eating patterns to include smaller, more frequent meals, instead of three large ones, prevents the stomach from becoming over-distended. This habit reduces pressure on the LES. Avoiding eating within two to three hours of going to bed gives the stomach sufficient time to empty before lying down.
Lifestyle Modifications
Adjusting daily activities and habits is important for managing LPR symptoms, focusing on physical positioning and avoiding behaviors that compromise the esophageal sphincters. Positional therapy uses gravity to help keep stomach contents where they belong, especially during sleep. Elevating the head of the bed by six to eight inches is recommended, achieved by placing blocks under the bedposts or using a specialized foam wedge beneath the mattress.
It is important to use this full torso elevation rather than simply propping the head up with extra pillows, as pillows can bend the body and increase pressure on the abdomen. Similarly, avoid lying down or reclining immediately after eating. Allowing a gap of at least two to three hours after a meal ensures the stomach is not full when horizontal.
Maintaining a healthy weight is a significant factor in reducing reflux episodes. Excess weight, particularly around the midsection, increases intra-abdominal pressure. This heightened pressure pushes stomach contents up against the LES, increasing the likelihood of reflux into the throat.
Certain habits directly contribute to the relaxation of the upper esophageal sphincter (UES). Smoking introduces nicotine, which relaxes the UES and delays the emptying of the stomach. Reducing or eliminating alcohol consumption is also advised, as alcohol relaxes the muscle barrier and stimulates acid production.
Stress management techniques can help control LPR, as stress can worsen digestive function. Incorporating practices like deep breathing exercises or meditation can mitigate the body’s physical response to stress.
Medical and Pharmaceutical Interventions
Medical treatment focuses on reducing stomach acid production or creating a physical barrier against reflux. The most common class of medications prescribed are Proton Pump Inhibitors (PPIs), which work by deactivating the acid-producing pumps in the stomach lining. Since LPR involves damage to sensitive tissue, treatment regimens often require a higher dosage and a longer duration than for typical heartburn.
An initial treatment trial may last for a minimum of six months because the throat tissues take considerably longer to heal than the esophagus. Histamine-2 Receptor Blockers (H2 Blockers) block the signals that tell the stomach to produce acid. These are less potent than PPIs but are sometimes used in combination, often taken at bedtime, to control nocturnal acid breakthrough.
Alginates offer a non-acid-suppressing approach by creating a protective physical barrier in the stomach. The compound reacts with stomach acid to form a gel-like “raft” that floats on top of the stomach contents. This physically prevents the upward flow of acid and the damaging enzyme pepsin into the throat.
For people whose LPR symptoms persist despite rigorous adherence to dietary changes, lifestyle modifications, and high-dose medical therapy, surgical intervention may be considered. A procedure called fundoplication involves wrapping the upper part of the stomach around the lower esophagus to reinforce the LES. This option is reserved as a last resort for severe, refractory cases.