What is Laryngopharyngeal reflux?
Laryngo-pharyngeal Reflux (LPR) is when stomach acid comes up your food pipe (oesophagus) all the way to your throat and into your voice box (larynx).
This is different from the reflux and heartburn you may be familiar with (Gastro-Oesophageal Reflux / GORD), which usually stays within your food pipe and does not reach your throat.
Reflux does not always cause heartburn or indigestion so you may not know that you have it. This is called silent reflux. Your throat and voice box are very delicate and contact with stomach acid can cause irritation, discomfort and sometimes pain. It can damage the delicate structures inside your voice box, making them red or swollen.
Images courtesy of Lucian Sulica, MD, www.voicemedicine.com
What are the symptoms of silent reflux?
- Hoarse voice
- Irritating Cough – more so after eating or when lying down
- Mucous or phlegm in the throat
- Trouble swallowing
- Feeling a ‘lump’ in your throat
- Sore or dry throat
- Choking or coughing particularly at night
- Burning sensation
- Bitter taste in your mouth
What are the causes of reflux?
Reflux happens when the two bands of muscle at the top and bottom of your oesophagus weaken or relax and allow acid from the stomach to shoot upwards towards your throat.
In silent reflux, the stomach acid can come up in a spray form which you cannot always feel. It is very normal to experience heartburn/indigestion, perhaps after eating a large meal or lying down too soon after eating. It is not normal for the contents of your stomach to reach your throat regularly.
It is unclear what causes reflux, however things which cause high pressure in the stomach can make it worse. For example:
- eating a large meal, spicy or fatty foods
- bending over from the waist or wearing tight clothing
- being pregnant
- lying down
- being overweight.
You should also avoid:
- alcohol and caffeine
- extreme exercise.
How is reflux treated?
Your Doctor and Speech Pathologist will recommend the right treatment for you. There are several things that can help:
- Changing your diet and lifestyle habits
- Using medications which reduce stomach acid
- Having surgery, although this is rarely recommended.
Diet and lifestyle advice
The following suggestions can help reduce your symptoms of reflux:
- Stop smoking. Smoking can cause reflux, likely following every cigarette. Ask your doctor about your local stop smoking clinics.
- Wear clothing that is loose around your waist and avoid belts, tight stockings and corsets.
- Bend down from the knees, not the waist. Bending from the waist can trigger reflux as you are squeezing your stomach.
- Avoid lifting heavy objects.
- Avoid straining due to constipation.
- Do not eat within three hours of bedtime and avoid lying down or reclining just after eating.
- Maintain a healthy weight as being overweight can put pressure on your stomach.
- Avoid foods that can trigger reflux e.g. spicy foods, chocolate, acidic foods such as tomatoes and citrus fruits.
- Avoid acidic and fizzy drinks such as coffee, citrus juices and soft drinks, particularly Coca Cola and Pepsi.
- Avoid excessive or extreme exercise – be mindful of your technique when lifting heavy weights.
- Limit alcohol, particularly spirits and white wine.
- Raise the head of your bed – place a brick under each foot at the head-end of your bed so the whole bed is at an angle downwards. This does not mean just adding extra pillows or propping up the mattress.
- Sleep on your left side as the stomach contents cannot escape as easily.
In discussion with your doctor, you may be advised to take the following:
- Antacid medications which also contain alginate (e.g. Gaviscon Dual Action). This reacts with the acid in your stomach and forms a barrier over the stomach contents to stop it from coming up towards your throat. Gaviscon can be taken after eating or last thing at night. It is important not to eat or drink anything after taking it.
- Acid blocking tablets called Proton Pump Inhibitors (PPIs) or H2 Blockers to reduce the production of stomach acid (e.g. Nexium / Zantac).
- These can be recommended once or twice daily. It is often advised to take these for several months.
- Please follow advice from your doctor as to when to take tablets. Often tablets work better if taken half an hour before breakfast and/or dinner.
- Keep taking the tablets until your doctor says stop. If you stop taking them suddenly, reflux can come back, often worse than it was before.
If you have any concerns about your symptoms, please discuss with your doctor or specialist.