Laryngopharyngeal Reflux: 38 News To Protect Your Health

There are so many people who suffer from acid reflux all around the world and, because of wrong diets and lifestyle habits, the number is increasing.

However, there is also another type of reflux that deserves the greatest attention.

This happens when the stomach content goes up to the upper respiratory tract: this condition is called “silent reflux” or “LPR”, meaning laryngopharyngeal reflux.

As you can imagine from its name, there are some specific symptoms of the disease, when it involves the larynx and the pharynx.

The most important fact is that the acidic content of the stomach can seriously endanger the throat.

Furthermore, it’s possible for affected people to report milder symptoms, however, this fact can lead to a greater risk of underestimating the disease.

Another important preliminary consideration is that when it comes to treatments, natural remedies and homemade solutions are the best options.

Dietary habits and lifestyle changes are even more important in the case of LPR, just because symptoms may not be so felt and apparently serious for a long time.

That’s why we want to deepen more about that.

Laryngopharyngeal Reflux

Laryngopharyngeal Reflux

There are no differences between LPR and the more “common” acid reflux when we consider the mechanism underlying the disease.

In both cases, the stomach content goes up to the esophagus.

In LPR, however, the throat is involved.

This thing does not happen always.

In other words, people who suffer from LPR also have acid reflux, while people who have acid reflux may not have LPR. This thing alone makes you aware of the extreme importance of working on dietary habits and proper lifestyle changes, as a solution to avoid the throat to be involved.

The specific connection between acid reflux and LPR has been investigated and proved by several important studies.

The conclusion is the growing prevalence of laryngopharyngeal symptoms in patients with gastroesophageal reflux disease.

But there’s another thing to consider: in fact, although they are so closely related, LPR is a multifactorial syndrome and gastroesophageal reflux disease is not the only cause involved.

This means that we can possibly expect other factors and promoting conditions in people who suffer from LPR.

Causes of LPR

There is a variety of factors that can lead to developing LPR.

However, there’s a common factor, that’s always the same for everything that has to do with acid reflux.

The lower esophageal sphincter (LES) results weaker, and it’s no longer able to prevent that stomach acid flows back in the esophagus.

Not in all cases, the refluxate can reach the throat, but this is exactly the case of people who suffer from LPR.

The condition is more frequent in infants and children (and normal up to 6-7 months) just because the LES is not well-formed yet.

In adults, all factors that can able to promote reflux are a potential cause of LPR as well.

We can group them in two equally important categories.

Physical Characteristics
In this group of factors, there are conditions like all problems with the lower food pipe valve, problems with food pipe contractions, slow-emptying stomach, and the hiatal hernia, that’s the likely most relevant factor among all.
Lifestyle Risks
In this group of factors, there are conditions like overweight and obesity, the frequent consumption of alcohol, spicy and fatty food, and sodas, as well as other bad habits such as tobacco smoking and drinking alcohol.

There are two final considerations to add:

  • the people who use their voices frequently, such as teachers and singers, have a higher risk of developing LPR
  • adult people often have a cold or the flu before developing LPR (infections can make the throat more sensitive to the aggression of acid)

This is the reason why it is so important to work on dietary habits and lifestyle changes to get rid of LPR (or, at least, to control it in the best possible way).

Silent Acid Reflux: Why It’s Called Like That

LPR is also called “silent reflux” because in many cases symptoms are mild and they may not even be warned.

However, there are some things to point out.

First of all, people who suffer from acid reflux may not be affected by LPR or silent reflux.

That’s why the most important thing to do is to work on dietary habits and lifestyle in order for you to prevent the condition.

People who suffer from silent reflux in many cases are now aware of that, and this is the thing that makes the whole picture worse.

Diagnosis is not always easy, and this delays proper treatment.

That’s why this condition is called “silent”.

And it may affect, with similar but at the same time different consequences, both infants and adult people.

Silent reflux in children

LPR is frequent in infants and children.

Even if it can be considered normal in the first 6-7 months, there are some cases when this condition does not disappear naturally.

Silent reflux in children is important also because it may determine the narrowing of the area below the vocal cords, and/or the occurrence of some contact ulcers (because of the acidic aggression to the mucosa).

In addition, the disease may involve the eustachian tube, resulting in recurrent ear infections.

Another thing that can scare parents is when the infants are turning blue and/or vomit a lot (especially in the presence of projectile vomiting or vomit that contains blood).

They are both possibly occurring manifestations for silent reflux in infants and children, although not always referred to this specific condition.

Finally, there may also be a consistent buildup of middle ear fluid.

It’s very important to monitor the situation in children and infants, to avoid the progression of the condition towards more serious complications.

Silent reflux in adults

In adult people, silent reflux can scar the voice box and the whole throat.

These are two important facts because can lead to serious issues, when untreated.

That’s why it’s essential to recognize symptoms, even if this is not an easy task.

Any effort is worth if we think about the complications that can occur.

First of all, people who suffer from untreated silent reflux have a higher chance of developing cancer.

Moreover, the disease can affect the lungs, with pneumonia.

Finally, there are additional complications that involve asthma, emphysema, and bronchitis.

The first step to take is to recognize symptoms.

Symptoms Of LPR

One of the most important things about LPR is the occurrence of nonspecific laryngeal symptoms and signs.

This often makes the diagnosis more difficult than expected.

When the diagnosis is late or wrong, treatment is delayed and the disease can become more serious.

That’s why is extremely important to recognize symptoms (in the image posted above, a list of the most common symptoms from Md Edge).

In people who also have GERD or acid reflux, things may be easier, because these people are supposed to adopt lifestyles and eating habits that prevent the direct involvement of the throat.

In other cases, things are much more complicated.

To date, one of the most used approaches to identify if a person is affected by LPR or not is the “exclusion” diagnosis.

To make things simple, this approach is based on the administration of PPIs, but many patients with suspected laryngopharyngeal reflux have persistent symptoms despite maximal acid suppression therapy.

There are at least 3 distinct levels of symptoms for people who have LPR. They appear as follows.

1st Level Symptoms
In the 1st level symptoms, we find more common manifestations of acid reflux, starting from heartburn. In addition, a metallic taste in the mouth is often present. There are also throat clearing, cough, hoarseness, and the typical “globus” sensation, meaning a “lump” in the throat that doesn’t go away with repeated swallowing. This level of symptoms can be easily confused with other problems, just because they are so vague and non-specific.
2nd Level Symptoms
In the 2nd level symptoms, we find something that makes an idea of something more specific, but still difficult to recognize. More precisely, there may be a sensation of postnasal drip, mucus, troubles in swallowing and breathing, and one of the most typical symptoms, namely a sore throat.
3rd Level Symptoms
In the 3rd level symptoms, we find symptoms that are more likely related to LPR and can make the diagnosis more specific. Among them, there are chronic cough and asthma, in many cases also apnea (defined as noisy breathing or pauses in breathing), many troubles in feeding, spitting up, or inhaling food, and the difficulty in gaining weight (particularly important for children).

As you can see, it’s not easy to identify the disease with certainty.

That’s why prevention is the key.

LPR cough

This is one of the most typical symptoms of LPR.

With more details, the cough of people who suffer from LPR has some specific features, as follows:

  • it’s dry and often chronic
  • it’s responsible for hoarse voice, especially in the morning

Chronic cough is a cough that lasts for 8 weeks or more.

There is a connection between GERD and chronic cough: it has been demonstrated that approx. 25% of people with GERD also develop a chronic cough.

Some studies revealed that GERD can be a factor for chronic cough in more than 40% of cases.

This symptom is highly relevant to the final diagnosis, even if it may not be present in all cases.

Sore throat from LPR

This is another frequently occurring symptom of LPR.

The symptom should not be confused with throat pain, that is a not so common symptom of LPR, instead.

Sore throat is due to the irritating action of an acid to the mucosa, and this happens when stomach content goes up and reaches vocal cords and the upper digestive tract.

Depending on the specific case, varying levels of irritation can be possible.

What’s common to almost all people who suffer from LPR is the presence of hoarseness, frequent throat clearing, coughing, or the sensation that something is stuck in the throat.

Like any other symptom of LPR, this may go unnoticed, and that’s a serious issue because of delayed treatments.

How to recognize LPR

As we’ve seen, there are many possibly occurring symptoms in a person affected by silent reflux (LPR).

We’ve also considered that a diagnosis can be made with an “exclusion” principle, based on the administration of PPIs.

However, there are two additional opportunities, and they use to work better than the PPIs administration.

We post below an image directly from the Rush University Medical Center, one of the top centers for the diagnosis of LPR.

The suggested procedures are related to the deep observation of the voice box, and a careful study of how a person swallows.

Only for some cases, it may be possible to rely on additional tests like esophagus/stomach endoscopy and/or a pH test to investigate the acidity level in the throat (this is particularly important for people who are at risk of acidic aggression).

Once you have gone through all these steps, the diagnosis of LPR (silent reflux) can be considered certain.

This is important because still many people are mistakenly diagnosed with LPR.

In the image posted below (from MD Edge), you can find the pros and cons of each possible diagnostic test for LPR).

In many cases, investigation of other causes of laryngeal symptoms (allergy, sinus, or pulmonary disease) should be considered.

This is particularly valid for patients who don’t respond to the administration of PPIs.

LPR Treatment

The best treatment for LPR is made of dietary changes and the adoption of a proper lifestyle.

However, this may not be enough, that’s why we strongly recommend integrating some highly useful homemade remedies in your diet.

We’ll deepen more about this specific aspect later, for the moment let us present the 4 progressive levels of treatment protocols for LPR that are currently in use.

Level 1: Diet
There are some foods to avoid, and others to prefer, in order for you to conquer a normal quality of life.
Level 2: Lifestyle
You should relax and wear loose clothes after eating, because tight clothes makes pressure on the abdomen and this is very similar to what happens for pregnant women. In addition, you should eat smaller meals so your stomach doesn’t distend, and don’t lie down for at least three hours after eating a meal. Sleeping habits are also important, that’s why you want to avoid bedtime snacks or beverages and sleep on the left side (if you wish, you could raise your pillow for lowering the chance of reflux).

Level 3: Medications
There are some prescription medications can work, such as PPIs, however, their effectiveness is not guaranteed. Moreover, they do not act on the root cause of this disease. Some doctors may suggest taking over-the-counter antacids, but also, in this case, you can’t expect to cure the root cause of LPR.
Level 4: Surgery
This is the last level of currently suggested treatments for LPR. No need to say that you have to do everything you can to prevent arriving at this point. The “surgical solution” is called Nissen fundoplication. We’ll present a bit more of that in a moment.

Just like any other reflux-related condition and/or complication, you have to work on the first two levels to avoid the need for the 3rd and the 4th.

This is very important because in the 1st and 2nd level you have the chance of getting a normal quality of life for years to come.

Gaviscon for LPR

Nowadays, Gaviscon Advance is considered one of the best if not the best medication for treating LPR.

This is due to the content in alginates, that are always more gaining attention.

There are two important mechanisms of action:

  • first of all, Gaviscon creates a barrier (foam) to prevent acid material to go back in the esophagus
  • in addition, because of part of refluxate can still pass through the barrier, Gaviscon has the capability to filter the refluxate

This second action is interesting because reflux is full of different “ingredients” (like pepsin) that can make things much worse than usual.

However, there still are side-effects and, as you imagine, this does not work on the root cause of the disease.

The question is: does Gavison work for increasing the pressure of the LES? The answer is not.

It creates a barrier, it filters the acidic content, however, it works on consequences of reflux, so nothing to do with avoiding/preventing the reflux.

That’s why dietary habits and lifestyle changes are the keys.

There is a very relevant study released in 2019 that clearly states things as they are.

The therapeutic effect of PPIs for extraesophageal symptoms (including LPR) is not satisfactory compared to that of typical GERD, and the treatment of the extraesophageal manifestations of GERD remains a challenge.

And when it comes to the next level of suggested treatments, things are not better.

LPR surgery

Before to present the surgical option for LPR, there’s a crucial thing to consider.

People whose symptoms do not respond to a proton pump inhibitor are unlikely to benefit from surgery.

This is extremely important because still many doctors are forcing patients to surgery when there are no chances of solving the issue.

This once again demonstrates the importance of working on the first 2 levels we presented before.

Talking about surgery, the Nissen fundoplication (image above, from the Medical College of Wisconsin)envisages that a general surgeon will expand your lower sphincter (LES).

This maneuver is supposed to make things better because it should prevent acid from moving up your esophagus.

In other words, people who undergo surgery for LPR must know that the response of their laryngeal symptoms to surgery would still be uncertain.

The bottom line, a surgeon must carefully select patients before suggesting this therapy, and a specific follow-up is needed to prevent post-surgery complications.

Most effective treatment for LPR

It’s not so easy to precisely identify the “best” treatment for people who are dealing with LPR.

In short, you must be aware of what foods you should avoid and which ones are good.

In the case of LPR, it’s a bit harder to identify what is good for you, because symptoms may not be very well perceived.

That’s why we suggest to always work on diets and lifestyle.

This is valid for both LPR and common reflux.

To this end, we suggest considering what follows.

First of all, you could consider a holistic, more comprehensive 5-Step approach to getting rid of reflux in any case, whatever your symptoms.

This is the likely best way to take action, because of two reasons:

  • the first one, you can work on everything causes you to trouble at once
  • the second one, you can prevent the worsening of the situation and complications that can occur if you are not fully aware of your LPR

As an alternative, you can consider the second option, a quicker but similarly consistent way to work on root causes of reflux.

There is then the full kit for treating reflux with some “not conventional” (we might say “creative”) natural, homemade remedies.

This specific kit will help you figure out so many natural remedies that it’s nearly impossible for us to say what is best for your case.

Once again, personal experience will guide you through the process, especially when you are aware of the different levels of LPR symptoms (we considered them before).

What we said is closely related to the presence of some highly useful natural products and mixes that can really help people who suffer from reflux.

Natural remedies for LPR reflux

If you want to go for one of the best, if not the best, natural healers of LPR, try Manuka Honey.

We consider it as the likely better and faster solution to reflux when it reaches the upper digestive and respiratory tracts, together.

It works because of its ability to soothe the mucosa, even when the acidic aggression has already happened.

Similarly, you can use turmeric and turmeric tea, along with slippery elm and many other herbs you can even grow on your own.

It’s important that you figure out what’s best for your case (and for your taste) so that you’ll get the chance to work on the root causes of this condition for a long time.

LPR Diet

There are some things always to remember when you’re creating your personal dieting plan for LPR.

You should avoid or limit caffeine, alcohol, peppermint, and chocolate because they are able to weaken the LES.

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You should also limit the intake of citrus, pineapple, tomatoes, and spicy foods because they have a promoting action for the irritation.

Finally, you should also avoid (or at least strongly limit) drinking carbonated beverages, such as soda, sparkling water or beer.

What we presented above are just some general guidelines, you can do more by following a very-well designed dietary program to help people with reflux.

Best foods for LPR

There are many foods you can eat to make things better with your LPR.

In general, you must select foods that do not contain acid and cannot determine aggression on the mucosa.

Only to name a few, there are:

  • Whole grains
  • Bananas
  • Apples
  • Legumes
  • Lean Meats
  • Water
  • Vegetables (leafy greens)

Very interesting to note that (still) water is among the suggested foods/beverages.

At the same time, always remember to avoid other drinks, such as caffeine-rich beverages, even if coffee may not be as dangerous as it seems.

We suggest remembering the following principle.

When you have to select foods to eat with LPR (or silent reflux), refer to what you know about the common form of acid reflux. There are no significant differences, but in this case, you should prefer foods and natural products able to coat and soothe the throat because it’s highly sensitive to the acidic aggression of refluxate.

That’s why we recommend checking the resources we posted before, just because they give you the precise idea of what to eat, what to supplement your diet with, and how to monitor your condition on a daily basis.

Conclusions

Laryngopharyngeal reflux still remains a controversial topic, because many scientists and physicians have doubts about considering it as a separate disease when compared to common acid reflux.

Whatever the case, there are at least 38 takeaways to remember.

They are listed below.

Box Title
#1) There are no differences between LPR and the more “common” acid reflux when we consider the mechanism underlying the disease.

#2) The condition is more frequent in infants and children (and normal up to 6-7 months) just because the LES is not well-formed yet.

#3) In adults, all factors that can able to promote reflux are a potential cause of LPR as well.

#4) In other words, people who suffer from LPR also have acid reflux, while people who have acid reflux may not have LPR.

#5) The people who use their voices frequently, such as teachers and singers, have a higher risk of developing LPR.

#6) Adult people, often have a cold or the flu before developing LPR.

#7) LPR is also called “silent reflux” because in many cases symptoms are mild and they may not even be warned.

#8) People who suffer from silent reflux in many cases are now aware of that, and this is the thing that makes the whole picture worse.

#9) Diagnosis is not always easy, and this delays proper treatment.

#10) Silent reflux in children is important also because it may determine the narrowing of the area below the vocal cords, and/or the occurrence of some contact ulcers.

#11) In adult people, silent reflux can scar the voice box and the whole throat.

#12) People who suffer from untreated silent reflux have a higher chance of developing cancer.

#13) One of the most important things about LPR is the occurrence of nonspecific laryngeal symptoms and signs.

#14) There are 3 different levels of symptoms for LPR: common manifestations of acid reflux, more typical symptoms, and symptoms that are more likely related to LPR and can make the diagnosis more specific.

#15) LPR cough is dry,  and often chronic, in addition, it’s also responsible for hoarse voice, especially in the morning.

#16) Sore throat should not be confused with throat pain, that is a not so common symptom of LPR, instead.

#17) Diagnosis can be made with an “exclusion” principle, based on the administration of PPIs.

#18)  There are two other diagnostic procedures: the deep observation of the voice box, and a careful study of how a person swallows.

#19) Still many people are mistakenly diagnosed with LPR.

#20) The best treatment for LPR is made of dietary changes and the adoption of a proper lifestyle.

#21) 4 progressive levels of treatment protocols for LPR are currently in use: diet, lifestyle, medications, and surgery.

#22) You have to work on the first two levels to avoid the need for the 3rd and the 4th.

#23) Gaviscon Advance is considered one of the best if not the best medication for treating LPR (but it does not work on the root cause).

#24) However, the therapeutic effect of PPIs for extraesophageal symptoms (including LPR) is not satisfactory compared to that of typical GERD.

#25) People whose symptoms do not respond to a proton pump inhibitor are unlikely to benefit from surgery.

#26) Talking about surgery, the Nissen fundoplication envisages that a general surgeon will expand your lower sphincter (LES).

#27) People who undergo surgery for LPR must know that the response of their laryngeal symptoms to surgery would still be uncertain.

#28) It’s not so easy to precisely identify the “best” treatment for people who are dealing with LPR.

#29) You could consider a holistic, more comprehensive 5-Step approach to getting rid of reflux in any case, whatever your symptoms.

#30) As an alternative, you can consider the second option, a quicker but similarly consistent way to work on root causes of reflux.

#31) There is then the full kit for treating reflux with some “not conventional” (we might say “creative”) natural, homemade remedies.

#32) If you want to go for one of the best, if not the best, natural healers of LPR, try Manuka Honey.

#33) Similarly, you can use turmeric and turmeric tea, along with slippery elm and many other herbs you can even grow on your own.

#34) You should avoid or limit caffeine, alcohol, peppermint, and chocolate because they are able to weaken the LES.

#35) You should also limit the intake of citrus, pineapple, tomatoes, and spicy foods because they have a promoting action for the irritation.

#36) Finally, you should also avoid (or at least strongly limit) drinking carbonated beverages, such as soda, sparkling water or beer.

#37) Talking about good foods for people who suffer from LPR, you must select foods that do not contain acid and cannot determine aggression on the mucosa.

#38) To sum up, you should prefer foods and natural products able to coat and soothe the throat because it’s highly sensitive to the acidic aggression of refluxate.

The “one thing” to remember for all the people who suffer from this condition, is that LPR can be more serious than other manifestations of reflux.

This because symptoms are not felt in many cases, and this can delay the treatment.

One more time, diet and lifestyle are the keys to open doors to better health.

What To Do Next

Now it’s time to take action.

Check the resources we suggested before and always remember that you are the only person who can decide what the best treatment for LPR really is.

Personal experience is essential, even if there are some general rules to apply.

Thanks for your patience and attention.

Stay tuned for more info to come!

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