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Acid Reflux & LPR

Laryngopharyngeal Reflux Definition: What Is Laryngopharyngeal Reflux?

Laryngopharyngeal reflux (LPR) occurs when contents (acid and enzymes) from the stomach enter the throat and is not associated with heartburn or a “burning” sensation in the chest, earning it the nickname “silent reflux.”

Patients may complain of a recurrent cough or throat and swallowing problems, but assume it is not acid reflux because they don’t have heartburn.

Gastroesophageal reflux disease (GERD), on the other hand, is acid reflux that enters into the esophagus and is often associated with heartburn.

Causes of LPR and GERD

Valves are located above the stomach in the lower esophageal sphincter (LES) and below the throat in the upper esophageal sphincter (UES) that allow food and liquids to flow downward to the stomach. If these valves malfunction, stomach contents may flow backward, with LES weakness causing GERD and UES weakness causing LPR.

Common Symptoms of LPR

Common symptoms of laryngopharyngeal reflux include:

  • Throat clearing or scratchy throat: Frequent throat clearing occurs as the acid may overstimulate the nerve endings in the throat.
  • Recurrent cough: A reflux cough is a common chronic condition that is different from many other types of cough. Almost like a choking spell or gagging cough, it is often annoying and even embarrassing for patients. Reflux coughing may occur throughout the day (worse in the morning) for months and may produce a clear or thick phlegm. A post-viral cough (cough after an upper respiratory infection) is also associated with LPR and may last for months after the infection resolves. The cause is essentially from a hyper-reflexive cough reflex from hyper-sensitized nerves injured from the stomach acid.
  • Globus sensation or a “lump in the throat”: When the acid injures the lining of the throat, the throat will feel like there is “something stuck.” This foreign body sensation may cause you to frequently clear your throat.
  • Hoarseness: The vocal cords are susceptible to injury from stomach content that causes them to swell or aggravates vocal cord nodules and polyps.
  • Recurrent choking or laryngospasm: When the acid strongly irritates the nerves in the throat, it can trigger a throat spasm that feels like choking. For the most part, it is very temporary, although it can be quite scary when it occurs. In children and in more extreme conditions, laryngospasms may cause cyanosis (turning blue) until they subside.
  • Difficulty swallowing: Swelling from the acid burning the entrance to the esophagus can cause a sensation that food is getting stuck in the throat.
  • Recurrent sore throat: The recurrent acidity in the throat may irritate the lining of the back of the throat, causing a noninfectious irritation or a burning pain.
  • Sour or acid taste in the mouth: If the acidity reaches the mouth, one may actually taste the bitterness.
  • Bad breath: Occasionally, LPR can cause halitosis or bad breath.

Diagnosing LPR

Diagnosing LPR is not easy! Unlike GERD, which often causes characteristic changes that can be visualized on endoscopy or by acid testing, LPR does not have a single hallmark test.

Dr. Pasha may suspect LPR after reviewing your health history and completing a physical examination.

Physical examination may include placing a flexible viewing tube through the nose and into the voice box (larynx). Signs of reflux include redness or ulceration of the vocal folds (cords) or swelling in the area around the entrance to the esophagus. Occasionally, we may order a pH probe, a barium swallow, or a scope carried out by a gastroenterologist:

  • A PH probe is a sensitive test especially for GERD that measures acid by placing a probe through the nose and into the esophagus. The probe measures the frequency, severity, and duration of acid reflux by detecting changes in the acid content of the esophagus. However, stomach acid isn’t the only potential cause of LPR, which can also be brought on by stomach enzymes and other content. Therefore, LPR may have a normal pH probe.
  • A barium swallow or upper gastrointestinal study is completed by drinking a chalky substance (barium). Barium can be seen with an X-ray when refluxing from the stomach back into the esophagus. However, this test is not very specific for acid reflux.

Schedule an Appointment

Schedule an appointment with Pasha Snoring & Sinus Center today to find relief to your acid reflux & LPR (silent reflux).

FAQs about Acid Reflux & LPR

How Can I Have Acid Reflux Without Heartburn?

Heartburn is an uncomfortable burning sensation in the chest caused by irritation in the lining of the swallowing tube (esophagus) from back-flowing acid from the stomach. If reflux becomes frequent (two or more times a week) or severe, resulting in significant problems, it is called gastroesophageal disease or GERD. Almost everyone experiences gastroesophageal reflux at some time.

LPR is not associated with heartburn because the acid and stomach contents travel past the esophagus and up to the upper throat area, which is why it’s sometimes called “silent reflux.”

What Can I Do to Reduce Acid Reflux Naturally?

Treating acid reflux, especially LPR, begins with behavior changes. Dr. Pasha feels that most cases of LPR can be treated with behavior changes alone, avoiding the potential complications of medications.

To reduce acid reflux naturally, try to:

  • Quit smoking: Easier said than done, but smoking is a risk factor for acid reflux.
  • Lose weight: For patients with recent weight gain, shedding a few pounds may be all that is required to prevent reflux. In many cases, LPR may be the first symptom of a poor diet. Dr. Pasha is focused on wellness and has a weight loss program and an in-house nutritionist if you need guidance.
  • Avoid late-night meals: Avoid eating three hours prior to bedtime or a large meal at night. LPR is particularly sensitive to gravity when you lie flat.
  • Keep your head elevated at night: This method alone has been known to be successful in treating LPR. You can purchase a “wedge” in order to protect the neck from being too angled, or simply place risers at the front of your bed.
    Avoid big meals: Several small meals are much safer than a single large meal in reducing reflux.
What Foods Should I Avoid with LPR?

Consider keeping a food diary to identify what worsens your symptoms. Here are the most common culprits that are known to weaken the valve above the stomach (LES):

  • Alcohol, caffeine, tea, and citrus drinks (consider noncaffeinated drinks)
  • Chocolate and mints (peppermint and spearmint)
  • Tomatoes, garlic, and onions
  • Fried food
  • Fatty foods
  • Citric fruits (orange, grapefruit, etc.) and bananas

These foods should be avoided or at least only consumed during the first half of the day; avoiding them before sleep is especially important.

Should I See a Gastroenterologist to Have My Esophagus “Scoped”?

That depends. If you have difficulty controlling your reflux, a gastroenterologist may suggest more advanced therapeutic options. Additionally, a gastroenterologist may suggest undergoing a “scope” of the esophagus, called an EGD.

An EGD may reveal changes in the esophagus, stomach, or duodenum, including ulcers, inflammation, bacteria, or (rarely) cancer or pre-cancer (Barrett’s esophagitis). Typical LPR is associated with a normal EGD.

What Can Happen If You Don’t Treat Acid Reflux?

GERD or LPR only cause serious complications occasionally. These complications include injury or breaks of the lining of the esophagus (esophageal erosions or ulcer) or narrowing of the esophagus (esophageal stricture).

The normal esophageal lining may be replaced with abnormal (Barrett’s) lining. This condition is called Barrett’s esophagus and has been associated with an increased risk of esophageal cancer.

Other possible complications of untreated GERD/LPR include chronic or recurrent laryngitis (hoarseness) or pharyngitis (sore throats). If stomach acid continues to “leak” or aspirate into the lungs, GERD may cause asthma or lung irritation (bronchitis or tracheitis).

What Is a Hiatal Hernia?

Hiatal hernia occurs when the upper portion of the stomach pushes through a small opening in the diaphragm (diaphragmatic hiatus) and into the chest. The diaphragm is the muscle that separates the stomach from the chest. Studies have demonstrated a correlation with the presence of a hiatal hernia and a weak esophageal “valve” (sphincter) that may result in reflux, especially GERD.

 

How Effective Is Surgery for LPR?

For persistent problems, Dr. Pasha may send you to a surgeon that performs surgery for acid reflux. One such procedure is called a fundoplication, which involves wrapping the upper part of the stomach around the lower esophagus to create a stronger valve between the esophagus and stomach. It can be done laparoscopically (with small surgical incisions) or as a traditional open operation with a larger incision.

What About LPR in Babies and Kids?

LPR in neonates is quite common and typically resolves as the child matures. The symptoms in children can be more serious, especially laryngospasm, which in severe cases can cause babies to turn “blue.” LPR in children is also associated with recurrent ear infections, bronchitis, and narrowing of the area below the vocal cords.

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