Introduction
Laryngopharyngeal reflux (LPR) is the upward movement of stomach contents into the throat. It is common in adults and children. Patients are usually unaware of LPR and often do not complain of heartburn - unlike gastro-oesophageal reflux disease (GORD).
Causes
It is usually caused by a leaky valve between the oesophagus (food pipe) and stomach. Certain foods (below) can exacerbate reflux.
Symptoms
Patients with LPR are more prone to excessive throat-clearing, a persistent dry cough, sore throats not associated with a cold, a hoarse voice or a feeling of something stuck in the throat.
Diagnosis
The diagnosis is made by assessing your voice box with a small camera that is passed through the nose after local anaesthetic spray. The area of the voice box just above the food pipe often looks red and inflamed in patients with LPR.
Treatment
The treatment of LPR involves medication, dietary modifications and behavioural changes. Medications called proton pump inhibitors taken twice daily before meals and Gaviscon taken after meals are very effective.
The following foods may worsen LPR: caffeine (e.g. coffee and tea), alcohol, chocolate, peppermints, citrus fruits (e.g. oranges and mandarins), kiwi, pineapples, tomatoes, spicy foods (e.g. hot mustard, curry, hot peppers or chilli), fatty foods (e.g. burgers and chips) and carbonated drinks (e.g. soda).
Bending over or exercising within 2 hours of eating a big meal can worsen LPR. Eating smaller meals throughout the day, instead of 3 larger meals, may improve LPR. Do not lie down within 3 hours after eating a large meal. Avoiding snacks just before bed is recommended. Sleeping with your head elevated (an extra pillow or raising the head of the bed) is very helpful at preventing stomach contents reaching your throat.
Frequent throat clearing can worsen LPR symptoms and negatively affect your voice. If you sense a build-up of secretions in the throat, try swallowing or taking a sip of water instead of clearing your throat.
Dr Levin can assess whether you are likely suffering from reflux and initiate a treatment regime involving medicines, dietary advice and behavioral changes.