These days, almost every one is familiar with GERD, or gastroesophogeal reflux. GERD is persistent heartburn that is very much “in your face.” It’s hard to ignore GERD, as the reflux and resulting heartburn can make life miserable. Thankfully, for those who suffer from GERD, a host of medications are available to treat the problem, such as Prevacid, Pepcid, Prilosec, and Xantac. Many of these medications are now sold over the counter, so you need only wander down the antacid aisle at the drug store to find relief for your GERD. Gone are the days of gobbling Tums by the handful to ward off the heartburn caused by those nasty stomach acids going places where they do not belong.
However, now along comes LPR, or laryngopharengeal reflux. LPR is GERD’s little know evil twin and for all the havoc that GERD can wreak, LPR can cause much more damage because in most cases, the reflux is silent and no heartburn is felt. But while heartburn is often not felt, those nasty stomach acids are irritating your vocal cords and this is simply no good.
LPR Symptoms
If LPR is silent then how do you know if you have it, you may ask. It turns out that LRP is not as silent as it is made out to be. While you may not feel any actual heartburn, there are a cluster of symptoms that accompany LPR that are not only annoying, but can be downright scary for some.
I found this out for myself this fall when I began to have odd symptoms that started to cause problems in my day to day life. These symptoms were more than annoying, they were frightening because they mimic some of the symptoms of lung cancer and as a former smoker, that always scares me. I have read people who liken LPR to a cold, but for me it was nothing like a cold, as I did not feel sick. I felt fine, overall.
At first, I thought I had a sinus infection because I was having huge amounts of post nasal drip. This post nasal drip resulted in me needing to clear my throat almost constantly. I also had an irksome cough, and as I was needing to clear my throat so often, I became quite hoarse, to the point where I didn’t want to talk on the phone as it was difficult, and invariably, whoever I was talking to would ask me what if I was sick. Along with all of this came a persistent sore throat that was more than a little tiresome. Still, I didn’t feel sick.
And so I Googled and I didn’t like much of what I read. However, finally I put in the right key word combination and I came across articles and discussions about LPR, or laryngopharengeal reflux, and it fit. It was an “Aha moment” that brought some relief in and of itself. During that time, I needed to have a chest x-ray for something and I didn’t have lung cancer, so I stopped fretting over that. I forgot about the LPR for a little bit until it returned with a vengeance. Then one day I bent over to pick something up off of the floor and felt that burning back wash of stomach acid in the back of my throat. My diagnosis was complete. I had LPR and as soon as I began to take over the counter Xantac, my symptoms disappeared.
GERD Versus LPR
Why do some develop GERD and other LPR? The stomach as two important sphincters, or valves, the upper esophageal sphincter, and the lower esophageal sphincter. When either, or both of these fail to contain the stomach acids to the stomach reflux of some sort is the result. In people who have GERD, it is the lower esophageal sphincter that is not functioning properly, allowing stomach acids to move up high enough to cause the sensation that is heartburn. When both sphincters fail to work properly, the stomach acids move high into the throat, and even up to the mouth, and LPR is the result.
I have never had traditional heartburn which is felt as a burning sensation under the breastbone. Whenever I had what I called heartburn, usually during my pregnancies, my burning was always at the back of my throat, so LPR has always been my form of reflux, thought it was rarely troublesome when I was not pregnant. If you are experiencing constant post nasal drip, or a lot of mucus in your throat, the need to clear your throat often, a sore throat, hoarseness, and even the feeling of a lump in the back of your throat, you may have LPR and should be evaluated by a physician as the continual irritation caused by the stomach acids to the vocal cords can cause damage.
Diagnosing LPR
LPR is usually definitively diagnosed by the use of a small scope that is inserted into your mouth and down into your throat to look for inflammation of the vocal cords and the throat. If swelling, redness, and irritation are seen then treatment is begun for LPR. Some people with LPR symptoms may need to have a 24 hour acid pH teat done in which a thin catheter is inserted into the throat and kept there for 24 hours to see if stomach acids are reaching the throat.
Once treatment is begun for LPR the symptoms usually disappear quickly, though complete healing of the throat may take months. LPR is treated the same way as GERD is with the use of acid reducing medications such as Prevacid, or Prilosec and the like. For me, the use of an acid blocking medication is very effective and if I stay on top of it, I have no problems. Once I begin to clear my throat a lot again, I know that I have forgotten to take my acid blocking medication and my symptoms return in no time flat.
LPR and Lifestyle Changes
There are some things that you can do that may lessen your problems with LPR. These include losing weight–I had just lost a ton of weight before my symptoms began–a great irony, avoiding caffeine, which I rarely drink anymore, wearing loose clothing, and quitting smoking. Also, avoid alcohol, which I never drink, and avoid fatty foods–another thing I avoid regularly. Spicy foods and chocolate may increase problems with LPR and those are my downfalls. I love spicy food and need a bit of 90% cacao dark chocolate every day. As long as I take my medications, I am okay. It is also recommended that you do not eat for three hours prior to bedtime and this is a hard one for me, too. Elevating the head of your bed by about 6″ may help, also.
LPR is literally a pain in the neck—or throat, but it can be managed effectively with medication and lifestyle changes. Once you have been diagnosed and have begun treatment with acid reducing medications you can then begin to look at what lifestyle changes to may need to make to lower your chances of recurrent LPR and to allow your vocal cords to heal properly. While your kids may enjoy your inability to yell at them, there are few perks to you when you are hoarse all of the time and LPR treatment is simple and painless.
C. Blake Simpson M.D.
Laryngopharengeal Reflux Disease
http://www.uthscsa.edu
Laryngopharengeal Reflux
http://homepage.mac.com
