Laryngopharyngeal Reflux (LPR) is a condition where stomach contents flow back into the throat and voice box, leading to irritation. Often called “silent reflux,” LPR typically lacks the classic heartburn symptom of Gastroesophageal Reflux Disease (GERD). Instead, it commonly manifests through upper airway symptoms like chronic cough, hoarseness, frequent throat clearing, a lump sensation (globus), and post-nasal drip.
Lifestyle Adjustments
Dietary modifications are a key component of LPR treatment. Avoiding trigger foods can significantly reduce reflux episodes. Foods that are highly acidic, such as citrus fruits (lemons, limes, pineapples), tomatoes, and vinegar, can activate pepsin, an enzyme that damages throat tissue. Spicy and fatty foods, including fried items, full-fat dairy, and fatty meats, can also worsen symptoms by relaxing the lower esophageal sphincter, which normally prevents stomach contents from flowing upward.
Certain beverages should also be limited or avoided. Carbonated drinks, even sparkling water, can carry acid upward with their bubbles. Caffeine, alcohol, chocolate, and mint (including peppermint tea) are known to relax the esophageal sphincter, contributing to reflux. Instead, focusing on a diet rich in whole grains, lean proteins like fish and eggs, low-fat dairy, and non-citrus fruits such as bananas and melons can be beneficial.
Beyond food choices, adopting specific eating habits and behavioral changes can help manage LPR. Eating smaller, more frequent meals reduces pressure on the stomach. Also, avoid eating within 2-3 hours of bedtime and lying down for at least three hours after meals; gravity helps keep stomach contents in place.
Elevating the head of the bed by 6-8 inches can physically help prevent stomach acid from flowing back into the throat during sleep. This can be achieved by placing wooden blocks, bricks, or specialized bed risers under the legs at the head of the bed, or by using a wedge pillow placed under the mattress or on top of it. Additionally, avoiding tight clothing around the waist can reduce abdominal pressure that might contribute to reflux. Weight management also plays a role in reducing pressure on the stomach and alleviating LPR symptoms.
Medication Approaches
Proton Pump Inhibitors (PPIs) are a primary medication for LPR. These medications, such as omeprazole, lansoprazole, and esomeprazole, significantly reduce stomach acid. For LPR, PPIs are often prescribed at higher doses and for 2-6 months, longer than for GERD, as the throat and voice box are more sensitive to acid damage. PPIs are generally taken on an empty stomach, 30 to 60 minutes before a meal, with a twice-daily dosage often more effective.
H2 Blockers like famotidine, reduce stomach acid production by blocking histamine receptors. While not as potent as PPIs, H2 blockers can be used for milder symptoms or in conjunction with PPIs, particularly to control nighttime reflux. They are often taken at bedtime to help manage symptoms that may occur during sleep.
Antacids, such as Tums or Rolaids, offer immediate but temporary relief by neutralizing existing stomach acid. These are typically used for symptomatic relief after meals or as needed. Alginates, derived from kelp, provide another form of relief by forming a physical barrier, or “raft,” on top of stomach contents. This raft helps to prevent reflux of both acidic and non-acidic material, and can bind to pepsin and bile, removing them from refluxed material. Alginates can be used as an adjunct to PPI therapy or as an alternative, and can significantly improve LPR symptoms.
Considering Advanced Treatments and Professional Consultation
Seeking professional medical guidance becomes important if LPR symptoms persist despite consistent lifestyle modifications and medication use. Worsening symptoms, or the presence of severe indicators such as difficulty swallowing (dysphagia), unexplained weight loss, or a chronic cough that wakes you up at night, warrant a medical evaluation. These signs may indicate complications or suggest that the current treatment approach is not effective.
A doctor, often an otolaryngologist (ENT specialist) or a gastroenterologist, may perform diagnostic tests to confirm LPR and rule out other conditions. A flexible laryngoscopy involves inserting a small, lighted camera through the nose to examine the throat and vocal cords for signs of inflammation or tissue damage. Esophageal pH monitoring measures acid levels in the throat and/or esophagus over a 24-hour period, helping to determine the extent and frequency of reflux. Impedance testing can also be used to detect both acidic and non-acidic reflux episodes.
In severe cases where conservative measures have not provided sufficient relief, surgical options may be considered. Fundoplication, such as the Nissen fundoplication, is a procedure where the upper part of the stomach is wrapped around the lower esophagus to strengthen the lower esophageal sphincter and prevent reflux. Another option is the LINX Reflux Management System, which involves implanting a flexible ring of magnetic titanium beads around the lower esophageal sphincter. This device allows food to pass while maintaining sufficient pressure to prevent reflux. These surgical interventions are reserved for individuals with severe, refractory LPR symptoms and are considered after thorough diagnostic evaluation.