Laryngopharyngeal Reflux Disease
and Recommendations to Prevent Acid Reflux
What is Reflux?
When we eat something, the food reaches the stomach by traveling down the muscular tube called the esophagus. 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 fiber 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 (the junction with the stomach). The term REFLUX means “a backward return of flow”, and refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.
What is GERD and what is LPRD?
Some people have an abnormal amount of reflux of stomach acid up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal 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 (pharynx, larynx, and trachea) are much more sensitive to stomach acid and digestive enzymes, so small amounts of reflux into the area can result in more damage.
Why Don’t I have heartburn of stomach problems?
This is a question that is often asked by people with LPRD. The fact is that only one third of patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. Most of the reflux events that can cause damage happen without the patient ever knowing that they are occurring, and is called ‘silent’ reflux.
Common Symptoms of LPRD:
- Chronic (ongoing) cough
- Frequent throat clearing
- Burning, pain or sensation in the throat
- Lump in the throat feeling
- Problems while swallowing
- Bad/bitter taste in mouth
- Dry throat
- Asthma-like symptoms
- Referred ear pain
- Post nasal drip
- Singing: Difficulty with high notes, difficulty with soft notes, delayed onsets or decreased clarity.
Diagnosis of LPRD:
The following signs seen by the patient are strong indicators of LPRD
- Swollen, red, irritated arytenoids (structures at the back of the vocal cords)
- Red, irritated vocal cords
- Small laryngeal ulcers
- Swelling of the vocal cords
- Granulomas in the voice box
- Evidence of hiatal hernia (may or may not be associated with reflux).
- Significant laryngeal pathology of any type.
Testing for LPRD:
Esophageal endoscopy, Barium Esophagram, and a 24 hour pH probe monitoring are some of the tests that may be used to evaluate for LPRD. However, the reflux does not always show up in these tests, but is present enough to irritate the voice or throat. Often, a 3-6 month trial of a reflux medication, along with the following behavioral strategies, is the best test for LPRD.
- Stress: Take significant steps to reduce your stress! Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount of reflux.
- Smoking: If you smoke, STOP! This dramatically causes reflux and many other damaging effects to your body.
- Tight Clothing: Avoid tight belts and other restrictive clothing.
- Body Weight: Being over weight can dramatically increase reflux. Try to maintain a healthy body weight.
- Exercise: Exercise regularly. However, avoid exercising immediately after eating. Do not lift heavy things after eating. Sit-ups and abdominal crunches can put pressure on your lower esophageal sphincter and worsen reflux.
- Nighttime Reflux: Recent studies have shown that LPRD often occurs during the day. However, if you experience some of your symptoms more in the morning, you may be having some reflux at night. Do not prop the body up with extra pillows. This may increase the reflux by kinking the stomach. Do elevate the head of your bed 4-6 inches with books, bricks, or boards to achieve a 10 degree slant. Or, purchase a foam wedge that is made specifically for this purpose. Your entire torso must be elevated from the hips up.
- 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 of minimize some of the following foods.
- Spicy, acidic and tomato-based foods like Mexican or Italian food.
- Acidic fruit juices such as orange juice, grapefruit juice, cranberry juice etc..
- Fast foods and other high fat foods, especially fried foods.
- Caffeinated beverages (coffee, tea, soft drinks) and chocolate.
- Alcohol, peppermint, nuts.
- Carbonated beverages.
- Limit dairy product consumption, especially late at night. Dairy products digest slowly, which encourages acid reflux.
- Don’t gorge yourself at mealtime.
- Eat sensibly (moderate amount of foods)
- Eat meals three hours before bedtime
- Avoid bedtime snacks
- Drink at least 8 ounces of water each day, but do not drink too much before bedtime
- If you do eat a spicy meal, don’t have alcohol or caffeine with it. Instead, drink water.
- Learn to moderate the foods that may cause reflux. You don’t have to give up ice cream forever, but if you have heartburn when you eat it, don’t have a bowl of ice cream just before you go to bed. Learn what your body can and cannot handle.
Medications for LDRP:
- Take one dose (as recommended on the label) at meals and at bedtime of and over the counter antacid such as Tums or Mylanta. Tums has the added benefit of containing calcium.
- Medications such as H2 Blockers (Axid, Pepcid, Tagamet, Zantac), and Proton pump inhibitors (Prilosec [omeprazole], Prevacid, Aciphex, Protonix, or Nexium) may be prescribed or recommended by your physician. These medicines are usually taken for at least several weeks at a time, and often several months. If you need to take these medicines for longer periods of time, you will be referred to a Gastroenterologist. Prolonged use of reflux medicines has been linked to pneumonia, diarrhea with C. difficile bacteria, increased risks of fractures, and low levels of calcium, Vit B12, and magnesium.