Silent or Laryngopharyngeal Reflux

What is Laryngopharyngeal reflux?

The term REFLUX comes from a Greek word that means "backflow". Laryngopharyngeal Reflux (LPR) refers to the backflow of stomach contents (food, stomach juices/acid) all of the way back up into the larynx (the voice box) or the pharynx (the throat).

What symptoms can LPR give rise to?

LPR may be responsible for:

•The sensation of a lump in the throat

•Irritable chronic cough, and “the need to constantly clear the throat”

•Altered voice

•Choking sensation, or “too much mucus at the back of the throat”

•Burning sensation at the back of the throat

•Trouble swallowing

•Heartburn &/or indigestion

Significant proportion of people with LPR may not have heartburn or indigestion. This is thought to be because that the reflux contents do not stay in the oesophagus long enough to cause irritation of its lining, and hence cause heartburn.The larynx and the throat, however, have a very sensitive lining and only a small amount of reflux is necessary to irritate their linings and give rise to the above symptoms.

What should I do if I have symptoms of LPR?

The symptoms of LPR are the same symptoms that are associated with other disease processes. It is important that you consult your doctor to exclude other conditions that may be causing your symptoms. It is usually necessary for the doctor to examine your throat, and your larynx. Less commonly, it may be necessary to order some other tests to exclude other pathologies, and to confirm the diagnosis.

What is the treatment for LPR?

The treatment options for isolated LPR are:

•Changing life style and dietary habits to reduce reflux,

•medications to reduce stomach acid

Changing life style and dietary habits

•Stop smoking.

•Reduce weight & avoid tight fitting clothing.

•Avoid bending down, and lifting heavy objects. Bend down by bending your knees to pick things up, rather than flexing at the hip.

•Eat small regular meals, and avoid eating late at night.

•Reduce alcohol intake & avoid fizzy drinks, and caffeine (coffee & tea)

•Avoid spicy food and citrus fruits and juices

•Limit your intake of fatty foods & butter.

•Avoid fried foods, chocolate, cheese & pastry.

Most people with LPR need to modify their lifestyle, as well as take some medication, to get well.

Medication

Your doctor may prescribe you medication to dilute the acid from the stomach (antacids), and/or medication to reduce the acid secretion from your stomach (ranitidine, proton pump inhibitors e.g. lansaprazole).

Surgery

A form of key hole surgery called Endoscopic Fundoplication may be used to the repair the leaky sphincter, between the stomach and the oesophagus. As an alternative to medical treatment surgery in this form has been reported to be an effective therapy for LPR, but is rarely indicated.

Will I need treatment for ever?

Within 2 to 3 months of treatment, most patients report improvement in their symptoms. However some require prolonged or chronic treatment.