Laryngopharyngeal Reflux (LPR)

What is it?

Laryngopharyngeal Reflux (LPR), sometimes known as Persistent Throat Symptoms or Silent Reflux, is backflow of gastric juice and enzymes from the stomach into the oesophagus (food pipe) which reaches the larynx (voice box).

The lining of the stomach is able to cope with the acid, but the throat cannot. In LPR it is the enzyme Pepsin, when combined with acid from the stomach or from food/drink, can damage the lining of the throat.

Symptoms of LPR may include:

• Sore throat.
• Excess mucous in the throat.
• The feeling of a lump or tightness in the throat (globus sensation).
• Regular coughing or throat clearing.
• Dryness in the mouth and throat.
• Hoarseness of the voice.

It is different to Gastro-oesophageal Reflux Disease (GORD) where the common symptoms are heartburn and/or indigestion.

You can also have both LPR and GORD together.

How is it diagnosed?

Your Speech and Language Therapist or other health professional will ask you about your symptoms and work with you to develop a treatment plan.

You may need an examination by an Ear, Nose Throat (ENT) doctor using a small, flexible camera. You may also need further assessment from a Speech and Language Therapist specialising in voice disorders.

You may need further tests to measure the level of Pepsin in your throat. You may also need further assessment from a gastroenterologist (a doctor specialising in stomach and digestion).

What can I do to help?

There are a number of things you can do to reduce the symptoms. These will involve changes to your lifestyle and diet.

Avoid eating foods which can make reflux worse

These include high fat foods, chocolate, spicy foods, citrus foods such as grapes, carbonated (fizzy) drinks, caffeine, acidic foods such as tomatoes or tomato based products.

Eat smaller, more frequent meals

Try having smaller meals, rather than a big meal, this will help the physical load on the stomach. Sipping water between meals rather than drinking and eating together. Sit and relax after you have eaten.

Reduce alcohol intake

Alcohol can increase reflux symptoms, especially white wine and spirits.

Avoid eating late at night

Reflux is aggravated by bending, lifting, lying flat. Leave 3 hours after eating before going to bed.

Try raising the head of the bed

Using blocks or wedges under the head of the bed to raise it about 6 inches, will alter the angle you sleep at. Try sleeping on your left side to reduce reflux.

Weight management

Being overweight can also make reflux worse. Eat a healthy diet and drink plenty of fluids (avoiding caffeine) – alkaline mineral water can help.

Avoid tight clothing around the waist.

Smoking

Smoking can also increase reflux symptoms. If you need support seek a referral to Smoking Cessation.

Chewing gum

Gum containing bicarbonate of soda may help relieve symptoms.

Medication

An over the counter antacid containing alginates such as Gaviscon Advanced is sometimes recommended. This forms a raft over the contents of the stomach to reduce contents rising up the oesophagus. It also treats damage already caused in the oesophagus and throat.

Take Gaviscon Advanced 30 minutes after eating and before bedtime.

Simple antacids without alginates are less effective and not recommended to treat LPR/silent reflux.

If you are already taking medication for other conditions, please consult your doctor before trying over-the-counter reflux medications.

Your GP may also prescribe you medication to reduce the acidity of the stomach juices. A Proton Pump Inhibitor (PPI) such as lansoprazole or omeprazole may be prescribed and these should be taken 30mins before food. Your GP will discuss suitable medication with you.