Laryngopharyngeal Reflux Management and Lifestyle Changes
Laryngopharyngeal reflux (LPR) occurs when the liquid, food, and/or gas contents of the stomach leak back up through the esophagus into the voice box (larynx) and/or the back of throat (pharynx). When this happens often, the tissues of the throat and voice box can be irritated or damaged by acidic as well as non-acidic stomach content. This condition may also be called silent reflux, when damage occurs without symptoms, or atypical reflux, when symptoms like cough or throat clearing occur.
LPR is related to gastroesophageal reflux disease (GERD), but it is not the same condition. People with GERD typically have heartburn as their main symptom. Many people with LPR may or may not have heartburn because the esophagus has natural protection against small amounts of acid reflux. However, the larynx and pharynx do not have this protection and can be easily damaged by reflux that backs into the throat.
How Can I Tell If I Might Have LPR?
There are several symptoms of LPR that you may wish to discuss with your doctor or an ENT (ear, nose, and throat) specialist, or otolaryngologist, including:
- Voice changes or hoarseness
- Difficulty swallowing
- Frequent coughing or choking
- A feeling of something stuck in the throat
- Excessive mucus
- Postnasal drip
- A bad or bitter taste in the mouth
- Heartburn
Your doctor can diagnose LPR by evaluating your symptoms and examining your throat in the office. They may use a mirror, light, or a small camera to examine your throat. The tissue in your throat and voice box may look red, irritated, and swollen from the reflux damage. This may eventually go away with lifestyle changes and medicine (see below) but the healing may take several months. Sometimes, the throat can look normal even if LPR is present.
The gold standard diagnostic tool for LPR and/or GERD is a specialized test that examines the presence of acid in the esophagus. The best test to look for LPR is called a 24-hour dual probe pH-impedance study. This test looks for the presence of acidic and non-acidic reflux content in both the esophagus and the throat. Another common test uses a small probe during a scope of the esophagus (also called endoscopy). The probe attaches to the wall of the esophagus and records measurements for 24 hours before releasing and passing through the remainder of the gastrointestinal tract.
How Can I Reduce LPR?
There are a number of lifestyle changes you can make to reduce your chances of experiencing LPR, including:
- Limiting or eliminating tobacco
- Limiting or eliminating alcohol
- Controlling your weight
- Reducing stress
- Drinking eight 8-ounce glasses (64 ounces) of water daily
- Eating smaller meals at least three hours before bedtime
- Not lying down or exercising after eating
- Elevating your head four to six inches in bed
- Trying not to wear tight clothing
- Reducing carbonated, caffeinated and/or citrus-based beverages
- Limiting foods containing a high amount of fat, grease, and spices
- Limiting tomato-based products, citrus fruit, chocolate, licorice, and mint
What Medical Treatments Are Available?
Your doctor may suggest one or more medications for your condition. Be sure to take them as directed by your doctor. It is important to pay attention to the timing of some medications for LPR. These may work best if taken 30 to 60 minutes before a meal. There are several over-the-counter (OTC) medications your doctor may consider based on your needs, including:
- Histamine blockers that reduce acid production, such as famotidine (Pepcid®) and cimetidine (Tagamet®)
- Proton pump inhibitors that stop stomach acid from forming, such as rabeprazole (Aciphex®), esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®), and pantatoprazole (Protonix®)
- Alginates derived from kelp that physically block the reflux of stomach content into the esophagus without having to absorb a medication, such as sodium alginate (Reflux Gourmet®), sodium alginate (Gaviscon Advance®), and sodium alginate, aloe vera (Esophageal Guardian®)
Some of these medications are also available by prescription at a higher dose, which may be more effective if results are not adequate with OTC options.
Finally, certain medications may increase the acid levels in your stomach and aggravate LPR symptoms. It is important to review all your medications with your doctor, including OTC medications and dietary supplements. Do not stop any medications without speaking with the doctor who prescribed them.
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The information on ENThealth.org is provided solely for educational purposes and does not represent medical advice, nor is it a substitute for seeking professional medical care.
Copyright 2024. American Academy of Otolaryngology–Head and Neck Surgery Foundation