Laryngopharyngeal Reflux (Silent Reflux)

Laryngopharyngeal Reflux (LPR) refers to the backflow of stomach acid up the esophagus and into the larynx (voice box) or the pharynx (throat). It is sometimes called silent reflux because, unlike typical gastroesophageal reflux, LPR can occur without heartburn or indigestion. This is because the stomach acid does not stay in the esophagus long enough to irritate the esophagus and cause heartburn. What causes LPR? Stomach acid that is produced to help with digestion of food is prevented from backing up into the esophagus by a ring of muscle at the entrance of the stomach known as the lower esophageal sphincter. If this sphincter is not functioning well, stomach acid can backflow into the esophagus. LPR occurs when stomach acid backs up the entire length of the esophagus and enters the throat and voice box. How would you suspect that you could have LPR? The predominant symptoms of LPR affect the throat and voice box. These symptoms include: Hoarseness A "lump" in the throat Trouble swallowing Chronic cough Thick or excessive throat mucous Chronic throat clearing In addition to these symptoms, some people with LPR also have the typical gastroesophageal reflux symptoms of heartburn and indigestion. How is LPR diagnosed? Because LPR is often silent, it can be difficult to diagnose. If your doctor suspects that you have LPR, he/she will probably perform a throat exam first and look at the voice box and the lower throat. Redness and swelling in this area is highly suggestive of LPR. In order to confirm the diagnosis, endoscopy and/or pH monitoring may be performed. Endoscopy involves the use of a viewing instrument called a laryngoscope to look at the voice box and throat. pH monitoring is a procedure in which a small, flexible tube is placed through the nose and into the throat and esophagus. This tube is left in place for a 24-hour period, measuring the amount of acid that enters the throat. How is LPR treated? The three general methods for treating LPR are 1) changing habits and diet to reduce reflux, 2) taking medications to reduce stomach acid, and 3) undergoing surgery to prevent reflux. Of these treatment options, addressing lifestyle habits that may be contributing to acid reflux is the simplest, safest, and least expensive method. Tips for reducing reflux and LPR: If you use tobacco, quit. Don't eat at least 3 hours before going to bed. Lying down shortly after eating is especially bad for someone who has reflux. Minimize fried, fatty and spicy foods in your diet. Certain foods including chocolate, peppermint, onions, acidic fruit juices, and garlic are notorious for causing reflux. Avoid tight clothing, especially around the waist. If needed, lose weight. Cut out caffeine, specifically coffee, tea, and caffeinated soft drinks. Avoid alcoholic beverages, particularly in the evening. In addition to these measures, many people with LPR benefit from elevation of the head of the bed by 4 to 6 inches by placing wood or cinder blocks under the headboard. This keeps acid in the stomach where it belongs through "gravity". Placing several pillows under your head does not substitute for raising the head of the bed; in fact, this maneuver can make the problem worse. Many people with LPR will require a medication to reduce reflux or to neutralize stomach acid. These include proton pump inhibitors (Prilosec, Prevacid, Protonix), H2 blockers, (Pepcid, Tagamet, Zantac), and Antacids (Maalox, Mylanta). Surgery is reserved for the most severe cases of reflux. The most commonly performed procedure for this is called a "fundoplication", in which the lower esophageal sphincter is tightened to prevent stomach acid from entering the esophagus. How long is treatment usually necessary? LPR is somewhat like high blood pressure in that it is a condition that is usually "managed" rather than "cured". In other words, most people with LPR will need to pay attention to lifestyle measures or take medications indefinitely.