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Reflux (Laryngopharyngeal Reflux – LPR)

The term Reflux means “a backward or return flow,” and it usually refers to the backward flow of the stomach contents into the esophagus or throat. When eating, food reaches the stomach by traveling down a muscular tube called the esophagus, a passageway that leads from the throat to the stomach. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) that help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). These sphincters relax to allow the food to pass and tighten to keep the stomach contents from returning back into the esophagus or throat. In Gastroesophageal Reflux Disease (GERD), the lower sphincter, which is located between the esophagus and the stomach, fails to tighten sufficiently. This results in occasional Reflux of stomach contents into the esophagus and may cause heartburn, among other digestive symptoms.

In some individuals, the higher sphincter between the throat and the esophagus may also fail to tighten sufficiently. In this situation, the stomach acids and digestive enzymes may make it all the way into the throat. This is called Laryngopharyngeal Reflux (LPR). The structures in the throat are much more sensitive to stomach acid and digestive enzymes. Thus, smaller amounts of the Reflux into this area can result in more damage.

Very few patients with LPR experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. In fact, most of the Reflux events that can damage the throat happen without the patient ever knowing that they are occurring. The patient often experiences the symptoms of reflux without ever feeling the initial event that caused the irritation in the throat.

Symptoms:

Common symptoms may include:

  • Hoarseness or scratchy voice
  • Chronic (ongoing) cough
  • Heartburn after eating
  • A frequent need to clear the throat A “lump in the throat” sensation A “choking” sensation Sore throat or irritation A mistaken perception of post-nasal drip or allergy Excessive, thick phlegm
  • Problems while swallowing
  • Sour/bitter/acidic taste in mouth (Especially in morning)
  • Singing: Difficulty with high notes Voice fatigue Laryngospasm: (a sudden involuntary closure of the vocal folds that makes it impossible to breathe for a few seconds)

Treatment:

There are a number of tests to diagnose acid Reflux, and a number of effective ways to treat the condition. Anti-Reflux medications are often prescribed, but optimal treatment also involves some simple lifestyle and dietary changes as outlined below.

  • Stress: Take significant steps to reduce stress. Make time in your schedule to engage in activities that lower your stress level. Even moderate stress can dramatically increase the amount of Reflux.
  • Foods: You should pay close attention to how your system reacts to various foods. Each person will discover which foods cause an increase in Reflux. The following foods have been shown to cause Reflux in many people. It may be necessary to avoid or minimize some of the following foods to reduce Reflux:
    • Citrus fruits and juices (orange juice, grapefruit juice, cranberry juice, etc.)
    • Fried/fatty foods
    • Spicy and acidic foods (Mexican food, Tomatoes, etc.)
    • Sodas and/or carbonated beverages
    • Caffeinated beverages and chocolate
    • Alcoholic beverages
    • Onions
    • Peppermints
  • Mealtime: Controlling when and how much you eat is also very important in reducing Reflux.
    • Eat sensibly (moderate amount of food)
    • Eat meals several hours before bedtime or lying down
    • Avoid bedtime snacks
    • Do not exercise after eating
  • Habits: Other than eating habits, there are several additional things you can do to help control acid Reflux.
    • Try to maintain a healthy body weight. Being overweight can increase Reflux.
    • Elevate the head of your bed 4-6 inches with books, bricks or a block of wood to achieve a 10 degree slant.
    • Avoid tight belts and other restrictive clothing, especially around your waist.
    • Limit the intake of aspirin and ibuprofen.
  • IF YOU SMOKE, STOP!! Smoking dramatically increases Reflux and harms your body in many other ways.