Laryngopharyngeal Reflux

What is silent reflux? What is LPR?

The term REFLUX comes from a Greek word that means "backflow" and it usually refers to "the back flow of stomach contents."  Normally, once the things that we eat reach (the stomach, digestion should begin without the contents of the stomach coming back up again or refluxing.  

The term Laryngopharyngeal Reflux (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or the pharynx (the throat). LPR can occur during the day or night, even if a person who has LPR hasn't eaten a thing.

Not everyone with reflux has a lot of heartburn or indigestion, in fact, many people with LPR never have heartburn. This is why LPR is called SILENT REFLUX, and the terms "Silent reflux"  and  "LPR"  are  often  used interchangeably. Because LPR is silent, it is sometime difficult to diagnose.

Many people with LPR don't have heartburn . . . Why is that?
Some people with LPR do have heartburn. Some people with LPR don't have heartburn very often, but actually about half of people who have LPR never any have heartburn at all. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus and cause heartburn.

However, if even small amounts of refluxed material come all of the way up into the throat, other problems can occur. This is because compared to' the esophagus, the voice box and throat are much more sensitive to injury and Irritation from stomach acid. Also, LPR can sometimes affect a person’s breathing and lungs.

How do I know if I have LPR?
Chronic hoarseness, throat clearing, and cough, as well as a feeling of a lump in the throat or difficulty swallowing may be signs that you have LPR. Some people do have heartburn, too. Some people have hoarseness that comes and goes, and others have a problem with too much nose and throat drainage, that is, too much mucus or phlegm. If you have any of these symptoms, and especially if you smoke, you should ask your doctor about LPR.  The specialist who treats people with LPR is the Otolaryngologist (Ear, Nose and Throat Specialists).

If your doctor thinks that you could have LPR, he or she will probably perform a throat exam first and look at the voice box and the lower throat, If this area looks swollen and/or red, you probably have LPR. At that point, your doctor may order some, tests or recommend specific treatment.

How is LPR treated?
Treatment for LPR should be individualized, and your doctor will suggest the best treatment, for you. Generally, there are several treatments for LPR:

• Changing habits and diet  to reduce  reflux medications to reduce stomach acid
• Dietary and lifestyle changes alone, are not often enough to control LPR — medications that reduce stomach acid are also usually needed. These must be prescribed by your doctor.

Tips for reducing reflux and LPR

• Control your LIFESTYLE and your DIET
• If you use tobacco, QUIT.    
• Smoking makes you reflux. After every cigarette you have some LPR.
• Don't wear clothing that is too tight, especially around the waist (trousers, corsets, belts)
• Do not lie down, just after eating in fact do not eat within three hours of bedtime
• You should be on a low-fat diet     
• Limit your Intake of red meat 
• Limit your intake of butter
• Avoid fried foods
• Avoid chocolate
• Avoid cheese
• Avoid eggs
• Specifically avoid caffeine (especially coffee, arid tea), soda pop (especially cola), and mints
• Avoid alcoholic beverages, particularly in the evening.

Will I need LPR treatment forever?
Most patients with LPR require some treatment, most of the time, and some people need medicine all of the time. Some people recover completely for months or years, and then may have a relapse.

In one way, having LPR is a little like having high blood pressure — with treatment, LPR does not usually cause, serious medical problems, but, without treatment, LPR can be serious, even dangerous.

For people with severe LPR, or people who cannot take reflux medicine, "antireflux" surgery (to restore a new and better stomach valve) may be recommended.    In people who have this surgery, most get good relief from LPR for many years.

What kind of problems can LPR cause and are these serious?
LPR can cause serious problems.  LPR can cause noisy breathing, choking episodes, breathing problems (such as asthma or bronchitis), and very uncommonly, cancer of the esophagus, lung, throat, or voice box. (For cancer to develop as a result of LPR, the LPR must be very severe and, go untreated for many years.)

Can children get LPR?
LPR is more difficult to diagnose in children, so that infants and children who may have LPR should be taken to specialists for pH-metry and other tests.

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

How can The Medical City help you?
At The Medical City we have a complete roster of competent otolaryngologist / ENT specialist who may assess or treat people with sore throat.

For further inquiries or if you want to seek consult, please call:

CENTER FOR VOICE AND SWALLOWING DISORDERS
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6251

EAR NOSE AND THROAT CENTER

Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6251 / 689-8201 (direct line)

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444