What is Laryngopharyngeal Reflux Disease (LPRD)?

When we eat something, the food reaches the stomach by traveling down a muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) that help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). The term REFLUX means backward or return flow and it usually refers to the backward flow of the stomach contents up through the sphincters and into the esophagus or throat.

What is the difference between GERD and LPRD?

Some people have an abnormal amount of reflux of stomach acid up through the lower sphincters and into the esophagus. This is referred to as GERD, or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD, or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx and lungs) are much more sensitive to stomach acid and digestive enzymes, so smaller amounts of the reflux into this area can result in more damage.

Why don’tI have heartburn or stomach problems?

This question is often asked by patients with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. Most of the reflux events that can damage the throat happen without the patient ever
knowing that they are occurring.

Common Symptoms of LPRD:

Hoarseness, chronic (ongoing) cough, frequent throat clearing, fain or sensation in throat, feeling of lump in throat, problems while swallowing, bad/bitter taste in mouth(especially in morning), asthma-like symptoms, referred ear pain, post-nasal drip, singing: Difficulty with high notes

Diagnosis of LPRD:

The following signs seen by the physician during endoscopy are strong indicators of LPRD:

1. Red, irritated arytenoids (structures at the back of the vocal folds)
2. Red, irritated larynx
3. Small laryngeal ulcers
4. Swelling of the vocal folds
5. Granulomas in the larynx
6. Evidence of hiatal hernia (May or may not be associated with reflux)
7. Significant laryngeal pathology of any type

Treatment for LPRD:                                                                                                 

1. Stress: Take significant steps to reduce stress. Make time in yourschedule to do activities that lower your stress level. Even moderatestress can dramatically increase the amount of reflux.

2. Foods: The following foods have been shown to cause reflux in many
people. It may be necessary to avoid or minimize some of the following
foods:
- Spicy, acidic and tomato-based foods like Mexican or Italian food.
- Acidic fruit juices such as orange juice, grapefruit juice, cranberryjuice, etc..
- Fast foods and other fatty foods.
- Caffeinated beverages (coffee, tea, soft drinks) and chocolate.

3. Mealtime:
- Do not gorge yourself at mealtime
- Eat meals a few hours before bedtime
- Avoid bedtime snacks
- Do not exercise immediately after eating4. Body Weight: Try to maintain a healthy body weight. Being overweight can dramatically increase reflux.
5. Nighttime Reflux: If the 24-hour pH monitoring demonstrates nocturnal reflux, elevate the head of your bed 4-6 inches with books, bricks or a block of wood to achieve a 10 degree slant.
6. Tight Clothing: Avoid tight belts and other restrictive clothing.
7. Smoking: IF YOU SMOKE, STOP!! This dramatically causes reflux and many other evils to your body.

Medications for LPRD:

Medications such as H2Blockers (Axid, Pepcid, Tagament, Zantac)
Proton pump inhibitors (Prilosec,  Prevacid, Nexium, Aciphex, Protonix) or motility agents
(Reglan) may be prescribed by your physician. 

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