Laryngopharyngeal Reflux (LPR), often called “silent reflux,” occurs when stomach contents move up the esophagus, reaching the larynx (voice box) and pharynx (throat). Unlike typical acid reflux (GERD), LPR frequently occurs without the classic symptom of heartburn. Instead, it causes chronic cough, hoarseness, and a sensation of a lump in the throat. While immediate symptom management is possible, true healing of the sensitive laryngeal tissue requires consistent effort over several weeks to months.
Confirming LPR and Setting Expectations
The first step toward effective treatment is receiving a definitive diagnosis, as LPR symptoms can easily be mistaken for allergies or chronic upper respiratory infections. An Ear, Nose, and Throat (ENT) specialist typically performs a flexible laryngoscopy, using a small camera to examine the throat for signs of irritation, swelling, or redness. Other diagnostic tools, such as 24-hour pH-impedance monitoring, track the frequency of both acidic and non-acidic reflux events reaching the throat.
The throat and vocal cords lack the protective mucosal layer found in the lower esophagus, making them vulnerable to small amounts of gastric contents, including the digestive enzyme pepsin. Because of this vulnerability, tissue damage takes a significant amount of time to resolve, even after acid exposure is controlled. Patients should expect symptom improvement to take at least 4 to 6 weeks, with complete tissue healing often requiring three to six months or longer.
Rapid Lifestyle and Dietary Adjustments
The most immediate relief comes from aggressive, non-pharmaceutical changes that physically prevent reflux. Dietary modification begins with the elimination of common triggers, which can weaken the lower esophageal sphincter or increase acid production.
- Citrus fruits
- Tomatoes
- Caffeine
- Chocolate
- Mint
- Alcohol
High-fat and spicy foods should also be avoided, as they delay stomach emptying and increase the likelihood of reflux episodes.
Behavioral adjustments are equally important for quick symptom reduction. Patients should strictly avoid eating or drinking anything except water for at least three hours before lying down or going to sleep. Elevating the head of the bed by four to six inches using blocks or a foam wedge utilizes gravity to help keep stomach contents in place. Additionally, wearing loose-fitting clothing and eating smaller, more frequent meals can help reduce pressure on the abdomen and the lower esophageal sphincter.
Medical Interventions for Acid Suppression
When lifestyle changes alone are insufficient, medical intervention focuses on suppressing gastric acid production. The most common prescription involves Proton Pump Inhibitors (PPIs), which significantly reduce the amount of acid the stomach produces. Unlike the treatment protocol for GERD, LPR often requires a higher dose of a PPI taken twice daily, typically 30 to 60 minutes before breakfast and dinner, to ensure maximum acid suppression.
H2 blockers may be added to the regimen, often taken at bedtime, to help control nocturnal acid production, as PPIs are most effective during the day. An alternative or adjunct treatment is alginate therapy, which involves taking a seaweed-derived compound. This compound forms a physical, floating gel barrier, or “raft,” on top of the stomach contents. This barrier offers immediate, mechanical protection against reflux, blocking both acid and pepsin from reaching the throat, and provides quick, temporary relief.
Sustaining Relief and Long-Term Resolution
Achieving true resolution in LPR requires continuation of treatment far beyond the initial disappearance of symptoms. Because laryngeal tissue heals slowly, medical therapy must often be maintained for three to six months to ensure the structures are fully repaired and protected. Stopping treatment prematurely, even if symptoms are gone, risks recurrence and a return to the inflamed state.
Once symptoms are consistently controlled and the physician confirms healing, the process of tapering off medication begins. Abruptly discontinuing PPIs can trigger rebound acid hypersecretion, where the stomach temporarily overproduces acid, causing a sudden flare-up of symptoms. A gradual step-down approach is necessary to minimize this risk, sometimes involving alternating medication days or temporarily using alginates during the transition. Long-term success ultimately depends on the patient’s permanent integration of key lifestyle changes to prevent LPR from returning.