Laryngopharyngeal Reflux (LPR), often called “silent reflux,” occurs when stomach contents flow back into the throat and voice box. Unlike typical acid reflux, LPR frequently does not cause classic heartburn. Instead, individuals may experience persistent throat clearing, hoarseness, a chronic cough, or a sensation of a lump in the throat. This reflux can irritate upper airway tissues, leading to uncomfortable symptoms.
Lifestyle Adjustments for Relief
Lifestyle changes can significantly alleviate LPR symptoms. Elevating the head of your bed by four to six inches prevents stomach contents from flowing back during sleep, achievable with blocks or a wedge pillow. Avoid lying down immediately after eating, waiting at least two to three hours. Eating smaller, more frequent meals reduces pressure on the lower esophageal sphincter.
Wearing loose-fitting clothing around the abdomen helps prevent increased stomach pressure that can promote reflux. Maintaining a healthy weight is important, as excess weight can contribute to reflux.
Reducing or eliminating smoking and alcohol consumption is crucial. Both substances relax esophageal sphincter muscles, making reflux easier. Managing stress through relaxation techniques like yoga or meditation can also reduce LPR flare-ups.
Dietary Strategies to Manage LPR
Diet plays a significant role in managing LPR symptoms, and identifying personal trigger foods is key. Certain foods and beverages increase acid production or relax esophageal sphincters, allowing reflux.
High-fat foods, such as fried dishes and fatty meats, can slow stomach emptying and relax the lower esophageal sphincter, exacerbating symptoms. Acidic foods like citrus fruits, tomatoes, and tomato-based products can directly irritate throat and voice box tissues. Spicy foods, chocolate, and mint are common triggers, as they can cause irritation or weaken the esophageal sphincter. Caffeinated beverages and carbonated drinks may also stimulate acid production and relax the esophageal sphincter, contributing to reflux.
Conversely, bland, low-acid foods can help soothe the digestive system. Lean proteins, non-citrus fruits like bananas and melons, vegetables, and whole grains are generally well-tolerated. Keeping a food diary can be a useful tool to pinpoint dietary triggers.
Medical Approaches to LPR
When lifestyle and dietary changes are insufficient, medical treatments can help manage LPR symptoms. Over-the-counter (OTC) options are a first line of defense. Antacids, for instance, provide immediate but temporary relief by neutralizing stomach acid.
Another class of OTC medications, H2 blockers, such as famotidine, reduce stomach acid production. These can offer more sustained relief than antacids. For stronger acid suppression, proton pump inhibitors (PPIs) are frequently prescribed.
PPIs, including omeprazole, lansoprazole, and esomeprazole, block proton pumps in the stomach lining, significantly reducing acid secretion. These medications are taken once or twice daily, 30 to 60 minutes before a meal, for several weeks or months. While these medications can effectively manage symptoms, they primarily address acid production and may not fully resolve the underlying causes of LPR. Their use should be guided by a healthcare professional.
When Professional Medical Care is Needed
If LPR symptoms persist despite lifestyle and dietary adjustments, seek professional medical care. A doctor’s evaluation is also necessary if you experience “red flag” symptoms, such as difficulty swallowing, unexplained weight loss, or vomiting blood, as these could indicate more serious conditions.
A healthcare provider, such as an otolaryngologist or gastroenterologist, can perform diagnostic tests to confirm LPR or rule out other issues. These tests may include flexible laryngoscopy, pH testing, esophageal manometry, and upper endoscopy.
In severe cases where other treatments have been unsuccessful, surgical options might be considered. Fundoplication, for example, is a procedure that reinforces the lower esophageal sphincter to prevent reflux. This surgery is a last resort and aims to strengthen the muscular barrier between the esophagus and stomach. A proper diagnosis and a personalized treatment plan developed with a healthcare professional are important for effective, long-term management of LPR.