Laryngopharyngeal reflux (LRP) is a condition in which acidic stomach contents pass through the sphincter at the top of the esophagus, splashing the vocal cords, tissues at the back of the throat or the back of the nasal cavity. The result of this process can be long-term inflammation, hoarseness and abnormal narrowing near the vocal cords. Treatment for LRP typically combines lifestyle modifications and medication.
Cause and Symptoms
LRP is essentially an extension of gastroesophageal reflux disease (GERD). GERD occurs when acidic stomach contents flow back into the esophagus. It is caused by weakening of the lower esophageal sphincter, a muscular band at the bottom of the esophagus that usually blocks the re-entry (reflux) of stomach contents. LRP occurs when the sphincter at the top of the esophagus also fails, allowing stomach contents to rise even higher.
Symptoms of LRP include sore throat, hoarseness, difficulty swallowing, chronic cough, post-nasal drip, mucus in the back of the throat and sensations that may be similar to having something caught in your throat. If you experience these symptoms, see your doctor. Strangely enough, LRP sufferers frequently do not have heartburn, since acids may pass through quickly enough to avoid irritating the esophagus itself.
Treatment Through Lifestyle Change
Treatment for LRP typically begins with a number of lifestyle modifications. Begin by making certain changes to your diet. Eliminate the use of caffeine, including coffee, tea and caffeinated drinks and sodas. These acidic products can worsen the effects of LRP, and the carbonation from soda can cause belching, which may lead to the reflux of more stomach contents. Caffeinated colas are particularly acidic, and should be specifically avoided. Be aware that high acid juices like orange, cranberry or grapefruit can also worsen your condition.
Try to eliminate certain foods, as well. Onions and garlic are main offenders in creating the conditions for reflux, but other culprits include fatty, spicy and fried foods, as well as chocolate and mint. Avoid eating anything within 3 hours of your bedtime. Additional relief from LRP can be gained from losing weight, quitting smoking and avoiding alcohol. Like food, alcohol should be specifically off-limits in the hours before bedtime. Elevate the head of your bed several inches to further discourage nighttime reflux.
Medications may also be used for LRP. If they are needed, your doctor will likely prescribe a proton pump inhibitor (PPI). These medications block enzymes in the stomach that produce acid. Examples include esomeprazole (Nexium), lansoprazole (Prevacid) and rabeprazole (Aciphex). Your doctor may also use prescription H2 blockers, another class of drugs that lower the production of stomach acid. Examples include famotidine (Pepcid), ranitidine (Zantac) and lansoprazole (Prevacid).
Be aware that both PPIs and H2 blockers can interfere with your body’s ability to absorb calcium. The effect can be especially prominent since these compounds are often given at relatively high doses. Consult your doctor for a complete explanation of the potential side effects of your medication.
Stubborn cases of LRP may require surgery to physically tighten the lower esophageal sphincter. Your doctor will inform you if this option is necessary.