Laryngopharyngeal Reflux Disease & Recommendations to Prevent Acid Reflux
What is Reflux?
When we eat, chew and swallow, food reaches our stomach by going down a muscular gullet or esophagus that connects the back of our throat to the stomach. Food in the stomach is then mixed with acid and digestive enzymes, produced by the lining of our stomach.
The gullet or esophagus has 2 sphincters -bands of muscle fibers that close off the muscular tube. These sphincters keep the contents of the stomach within the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the back of your throat) and one is at the bottom of the esophagus (at the junction with the stomach).
The term "reflux" means the backward or return flow of contents up through sphincters and into the lower esophagus from the stomach or into the throat from the esophagus.
What is GERD and what is LPRD?
Some patents have abnormal amount of reflux of stomach contents up thru the lower sphincter and into the esophagus. This is referred to as GERD or Gastro esophageal Reflux Disease.
If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or laryngopharyngeal Reflux Disease.
The structures in the throat or connected to the throat (pharynx, larynx, trachea and lungs) are much more sensitive to stomach acid and digestive enzymes, and so very small amounts of reflux here can result in damage.
Why don't I have heart burn or stomach problems?
This is a question that is often asked by patents with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated from acid reflux. Most of the reflux events that can damage the throat happens without the patient ever knowing that it is occurring.
What are the common symptoms of LPRD?
The common symptoms of acid reflux are hoarseness of voice, chronic ( ingoing) cough, frequent throat clearing, pain or sensation of discomfort in the throat, the feeling of a lump in the throat, problems while swallowing, bad or bitter taste in the mornings on waking up, shortness of breathing , refereed ear pin and phlegm in the throat.
If you have some or all of the above symptoms then reflux could be an issue.
How do we make a Diagnosis of LPRD?
The following signs during the laryngeal (voice-box) examination of a patient with the fore mentioned symptoms are further proof of a diagnosis of LPRD.
  1. Red irritated arytenoid (structure at the back of the vocal fold)
  2. Red, irritated larynx (voice box)
  3. Small laryngeal ulcers.
  4. Swelling of the vocal folds
  5. Granuloma in the larynx
  6. Thick mucus from with the voice box.
What can I do to reduce my LPRD?
  1. Stress: take significant steps to reduce stress! Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount.
  2. Foods. You should pay close attention to how your body system reacts to various foods. You can discover which foods cause an increase in reflux symptoms. Foods that have been shown to cause reflux in many persons are:
    - Spicy, acidic & tomato based: Curries, Mexican or Italian food.
    - Acidic fruits & juices such as orange juice, lemon juice, etc.
    - Fast foods and other fatty foods
    - caffeinated beverages (coffee, tea, soft drinks) and chocolate
    - Peppermint
  3. Mealtime
    - Don't gorge yourself at mealtime
    - Eat sensibly (moderate amounts of food)
    - Eat meals several hours (at least 3) before bedtime
    - Avoid bedtime snacks
    - Don't exercise immediately after eating
  4. Bodyweight: Try to maintain a healthy body weight. Being overweight can dramatically increase reflux.
  5. Nighttime Reflux: Elevate the head of your bed 4-6 inches with books, bricks or a block of wood to achieve a 10 degree slant.
  6. Avoid tight belts and other restrictive clothing.
  7. Smoking: if you smoke, -STOP. Smoking causes reflux.
What are the medications for LPRD?
  1. Take one dose (or as recommended on the label) at meals and bedtime of an over the counter antacid such as Gavison or Mylanta.
  2. Medications such as H2 blocker ( Zantac or Tagamet), Proton Pump Inhibitors( Nexium, Controloc or Pariet)may be prescribed by your doctor