LINDA J.
DINDZANS, MD Office: 414-536-7000
JODI M.
KORNAK, MD Fax: 414-536-7001
LARYNGOPHARYNGEAL
REFLUX (LPR)
Gastroesophageal reflux (GERD) is the term for
frequent abnormal back flow of lots of stomach acid and irritating digestive
juices up into the esophagus (the food passage between the throat and
stomach). Many people experience GERD as
a simple occasional heartburn, but some people suffer more severe indigestion,
with erosive inflammation of the esophageal lining. Nighttime is often worse than during the day.
A type
of silent reflux, called laryngopharyngeal reflux
(LPR), causes different symptoms. This
kind of reflux happens less frequently and more quickly, but goes much higher
into the throat, where the lining is much more sensitive. It usually involves little bits of acid, just
a few drops at a time. It can happen day
or night, but more typically during the day.
Some people experience sore throat, hoarseness, chronic cough, and even
asthma. A lump sensation in the throat, or feeling of post nasal drip, phlegm or sour taste
in the throat is typical with LPR. There
is often a frustrating feeling of needing to constantly clear the throat. Heartburn symptoms are often absent in LPR,
because the reflux happens too quickly for the esophagus to feel it. (Thus the term “silent.”) LPR is difficult to diagnose. The only reliable test for LPR is a somewhat
invasive and cumbersome 24 hour monitor, involving a long flexible tube placed
in the nose and swallowed into the stomach.
Even this nest might not detect LPR in 20 percent of patients.
If you
have reflux, you can sometimes control the problem by controlling lifestyle and
diet. Use as many of the following
suggestions as needed to get relief:
1. AVOID fatty foods, chocolate, mints and
alcohol, especially in the evening. All
of these have been shown to increase reflux in many people.
2. AVOID cola, beer, and milk. They may increase acid production.
3. AVOID eating within three hours of bedtime,
and do not lie down just after eating.
Nighttime refluxers often benefit by sleeping
with the head elevated on several extra pillows. This uses gravity to help make reflux less
likely at night.
4. IF YOU SMOKE, QUIT. Tobacco irritates the throat and can also
cause more reflux.
5. IF YOU ARE OVERWEIGHT, LOSE WEIGHT. Clothing that fits tightly across the mid
section of the body should also be avoided.
If
possible, AVOID CERTAIN MEDICATIONS, which can increase reflux: 1. birth control pills, 2. heart and blood
pressure medication containing nitrate or calcium channel blockers, 3. Asthma medication containing theophylliine (rarely used nowadays). DO NOT stop prescription medication without
the consent of your primary physician.
Taking
over the counter medication which blocks stomach acid production can be
helpful. The best one available is Prilosec OTC. Laryngopharyngeal reflux is treated with twice a day
dosing, unlike GERD which is typically only treated once a day. The two doses are best taken on an empty
stomach, one hour before the morning and evening meals. Prescription medications similar to Prilosec are also available. Keep in mind that it might take 2 or 3 months
using medication daily to get good relief of throat symptoms. Other, less potent but somewhat helpful over
the counter medications include Zantac (two 75 mg tablets twich
daily, or one 150 mg tablet twice daily), and Pepcid
AC (two tablets twice daily). All these medications are generally safe, but if
you have questions or concerns regarding interaction with other medications you
now take, ask your primary physician and pharmacist. If medication is helpful incontrolling
reflux, consider using it daily for up to six months, then taper off the
medication, and start taking it again in the future if reflux symptoms recur.
SURGERY,
called Nissen fundoplication,
can be a very effective treatment to control reflux. It is a last resort for the most severe
cases.