Laryngopharyngeal Reflux (LPR) aka “Silent Reflux”
LPR Can Cause:
Too Much Throat Mucus
A Lump in the Throat
What Is Reflux and What Is LPR?
The term REFLUX comes from a Greek word that means “backflow.” It refers to “the back flow of stomach contents.” Normally, once the things that we eat reach the stomach, digestion should begin without the contents of the stomach coming back up again, i.e., refluxing. Some people have reflux just into the esophagus (the swallowing tube that joins the throat to the stomach). If this happens frequently, a person may develop heartburn, (a painful, burning sensation in the chest). This condition is called gastroesophageal reflux disease (GERD). In some people, the backflow from the stomach goes all the way up to the throat. That is LPR.
The term LARYNGOPHARYNGEAL REFLUX (LPR) refers to the backflow of stomach contents into the larynx and pharynx (the voice box and throat). LPR can occur during the day or night, and many people who have LPR will not have heartburn; so LPR is sometimes called silent reflux.
Many People with LPR Don’t Have Heartburn, Why Is That?
Some people with LPR have a lot of heartburn, but usually, people who have LPR don’t have heartburn very often. In fact, more than half of people who have LPR never have heartburn. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus. However, if even small amounts — the refluxate comes all of the way up into the throat – throat problems can occur. This is because, compared to the esophagus, the voice box and throat are much more sensitive to injury and irritation from reflux compared to the esophagus. This is the explanation for “silent reflux.”
How Do I Know If I Have LPR?
Chronic hoarseness, throat clearing, and cough, as well as a feeling of a lump in the throat or difficulty swallowing may be signs that you have LPR. Some people have intermittent hoarseness, and others have problems with too much nose and throat drainage, that is, too much mucus or phlegm. That causes chronic throat clearing. If you have any of these symptoms, and especially if you smoke, you should ask your doctor about LPR.
The specialists who most often treat people with LPR are Laryngologists (throat/voice doctor) or Otolaryngologists (ear, nose, and throat physicians). If your doctor thinks that you could have LPR, he/she will probably perform a throat examination and look at the voice box and the lower throat. If this area is swollen and/or red, you may have LPR. At that point, your doctor may order some tests or recommend specific treatment.
What Tests Might My Doctor Order?
If your doctor orders tests, it is to be certain about your diagnosis, to help pick the best type of treatment for you, and to make sure that you don’t have any complications. The three most common tests for LPR are high-definition manometry, pH monitoring (pH-metry), and transnasal esophagoscopy (TNE). These tests each give different information, and it is common to have more than one test done. Manometry takes about 30 minutes to complete, and it evaluates the swallowing mechanism, especially function and the esophagus and stomach valves. An overnight test, pH monitoring measures acid in the esophagus and throat throughout the day and night; see below. TNE is a quick and easy way for your doctor to examine your esophagus for signs of damage from reflux and to make sure that you don’t have pre-cancer or other growths in the esophagus. This is a relatively new kind of minimally-invasive endoscopy that is done so that you can return to normal activity right after the test.
What Is It Like to Have pH-Monitoring (pH-Metry)?
Double-probe (simultaneous pharyngeal and esophageal) pH-metry is a special test that takes about 24-hours to complete. People are not admitted to the hospital for pH-metry, which is used to measure acid in your esophagus and throat. Some people say this test is annoying, but it is not painful. It is extremely useful in evaluating the severity and pattern of LPR. To do this test, you will have a small, soft, flexible tube placed through your nose and down into your throat, where it will stay over night. The tube, called a “pH probe,” is connected to a small computer (a box that you wear around your waist) that measures acid in your esophagus and in your throat. At the Voice Institute, we employ advanced diagnostic technology that is well-ahead of the state of the art, and which will provide answers. Click here to see the Voice Institute Reflux-Testing Info Sheet.
How Is LPR Treated?
Treatment for LPR should be individualized, and your doctor will suggest the best treatment for you. Generally, there are several treatments for LPR but diet is very important, and reflux treatment should be customized for each patient based upon his/her symptoms and findings. There is no one size fits all.
(1) Changing habits and diet to reduce gastric reflux
(2) Medications to reduce acid and the effects of LPR
(3) Surgery to restore the stomach valve and prevent reflux
Most people with LPR need to modify how and when they eat, as well as take some medication to get well. Sometimes, nonprescription liquid antacids, such as Gaviscon, are recommended. When used, these antacids should be taken one-half-hour after meals, before exercising, and bedtime.
Your doctor also may give you a prescription. LPR is usually treated with medicines called PPIs that reduce stomach acid. These medicines are usually taken twice-a-day, 30-60 minutes before breakfast and 30-60 minutes before the evening meal. In addition to PPIs, sometimes a second type of medication (like Zantac, ranitidine, or Pepcid) is recommended before bedtime. For people who have symptoms after meals, chewing gum can help, too. Finally, a low-acid low-fat diet helps as much as anything; there will be further posts on this soon; see also the Reflux Diet, Cookbook & Cure website.
Will I Need LPR Treatment Forever?
Most patients with LPR require some treatment most of the time, and some people need life-long medicine. But some people do recover completely or at least have LPR-free intervals of many years. Having LPR is a little like having high blood pressure in that with treatment, it doesn’t usually cause serious medical problems; but without treatment, LPR can be serious, even dangerous. For people with LPR who don’t improve with medication or who are allergic to reflux medicines, stomach surgery called lap fundoplication, that restores function of the main esophageal valve, may be recommended. It now appears that diet is very important; see The Reflux Diet, Cookbook & Cure.
What Kind of Problems Can LPR Cause and Are They Serious?
LPR can cause serious problems: Breathing problems (such as asthma or bronchitis), choking episodes, sleep apnea, and relatively uncommonly, cancer of the esophagus, lung, throat, or voice box. For cancer to develop as a result of LPR, it must be very severe and go untreated for many years. People with reflux should be checked by a doctor.