Laryngopharyngeal Reflux Disease (LPR)

Symptoms

Your doctor has diagnosed you as having laryngopharyngeal reflux disease or LPR. This condition develops when stomach acid travels up into your throat. Although you may experience heartburn or indigestion, many of our patients do not have these complaints.

Some of the more common symptoms seen in our patients include:

• Sensation of drainage down the back of the throat or excessive mucus
• Feeling of something caught in the throat, sometimes a tickling or burning sensation
• Throat clearing
• Chronic cough
• Post-nasal drip
• Sore throat
• Hoarseness
• Difficulty swallowing
• Prolonged vocal warm-up for singers
• Loss of the high end of the vocal range

Diagnosis

Most often, your physician can diagnose LPR by examining your throat and vocal cords with a rigid or flexible telescope. The voice box is typically red, irritated and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months. At other times, you may have to undergo a dual-channel pH probe test to diagnose your condition. This involves placing a small tube (catheter) through your nose and down into your swallowing passage (esophagus). The catheter is worn for a 24-hour period and measures the amount of acid that refluxes into your throat. This test is not often necessary, but can provide critical information in certain cases.

Treatment

Most of the time, LPR is well controlled with medications such as proton pump inhibitors (PPIs). Occasionally, surgery is needed in severe cases or those that do not resolve with the use of medication. The recommended surgery is called a laparoscopic nissen fundoplication and is performed by a general surgeon. Positive proof of reflux disease is needed first, generally by a pH probe study. With some patients, the esophagus must also be examined for pre-malignant changes. Your ENT physician can perform a screening test called transnasal esophagoscopy (TNE). This test will require you to be placed under local anesthesia.

Lifestyle changes can also help in the treatment of LPR. Many foods and drinks can make your symptoms worse and it is important that these be eliminated. In addition, being overweight, smoking and drinking alcohol are all factors that worsen reflux disease. It is important to work on the following areas as well:

• Cut out caffeine. Specifically, avoid coffee, tea and caffeinated soft drinks. Soft drinks, such as Coke and Pepsi, are particularly bad because they are very acidic and the carbonation leads to belching and further reflux of acid into the throat. Acidic juices, like orange, grapefruit, cranberry, can worsen reflux.
• Avoid chocolate and mints.
• Avoid alcohol, especially in the late evening and before bedtime.
• Quit smoking.
• Eliminate fried, fatty and spicy foods from your diet. A low-fat diet is the best way to avoid reflux. Onions and garlic are notorious for causing reflux.
• Maintain a healthy weight. Avoid tight-fitting clothing.
• Stop eating at least three hours before going to bed. Eating a heavy meal just before going to sleep is especially bad for your reflux condition.
• Take medications your doctor has prescribed for you. In most cases, your physician will prescribe a proton pump inhibitor drug (PPI) such as Nexium, Prevacid, Protonix, Prilosec or Aciphex. These drugs may be prescribed twice a day, which is double the usual dose for routine reflux disease. Please see below for more details on your medication.
• Elevate the head of your bed four to six inches by placing wood or cinder blocks under the headboard. Most of our patients have daytime reflux disease,and this step is not necessary in two-thirds of our patients. This step is important if your symptoms are worse in the morning. This indicates active reflux at night. Placing several pillows under your head does not substitute for raising the head of the bed. In fact, this maneuver can make the problem worse.

Important information about your medications

If you are taking a PPI such as Nexium, Protonix, Prevacid, Aciphex, Prilosec (omeprazole) or Zegerid, it is important to take your medicines 30 minutes to one hour before meals. These medicines may be given twice a day, so that will mean taking a pill before breakfast and dinner. The medicine is absorbed better if taken this way. You should know that your insurance company/pharmacy program usually prefers a certain PPI. We are happy to change your prescription to the “preferred” PPI. For more information, please contact your health care provider. Insurance companies commonly deny twice daily dosing of these medications. This can be appealed. Please ask for handout describing how to appeal to your insurer.