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Laryngopharyngeal Reflux (LPR)

Laryngopharngeal reflux (LPR) occurs when stomach acid and enzymes travel back up the esophagus from the stomach to the lower throat, causing symptoms such as a persistent cough and chronic throat irritation.

LPR affects some people who may also have gastroesophageal reflux (GERD), though about a third of people with LPR do not complain of the heartburn symptoms usually associated with GERD.

Instead of causing heartburn, the reflux acid irritates the lining of your throat, as well as the voice box and surrounding tissue. This causes extra mucus to form, resulting in frequent throat-clearing and a chronic cough. Left untreated, LPR can cause long-standing problems with swallowing, speaking and breathing.

LPR symptoms

  • Chronic cough, including cough that wakes you up
  • Frequent throat-clearing, especially during or after a meal
  • Mild hoarseness
  • Chronic throat irritation
  • Difficulty swallowing (dysphagia)
  • Frequent sore throats not associated with colds
  • Feeling of a lump in your throat

How can I get help for LPR?

See your primary care doctor or an ear, nose and throat (ENT) specialist if you are experiencing any of the symptoms of LPR. At Rush, adults with issues like chronic cough, difficulty swallowing and frequent sore throats can get specialized care through the Voice, Airway and Swallowing Program.   

LPR care at Rush

If you have been diagnosed with LPR or have symptoms of LPR, experts from Rush's Voice, Airway and Swallowing Program can help.

Diagnosis

The following may be used to provide an accurate diagnosis:

  • A special scope to look at your voice box
  • A swallowing study

If needed, a gastrointestinal (GI) specialist will provide additional tests, including the following:

  • A special scope to look at your esophagus and stomach
  • A pH test to determine the level of acid in your throat

Many of these tests are performed in the office. This helps keep you out of the hospital and allows for real-time assessment of issues —including LPR — that may be affecting your breathing, swallowing and/or voice.

Treatment

The most effective treatment for LPR includes changes in diet and lifestyle, as well as medications. LPR can usually be relieved and controlled with this three-tiered process.

Diet:

  • Try to avoid or limit caffeine, alcohol, peppermint and chocolate, which weaken the lower sphincter muscle leading from the stomach to the esophagus.
  • Reducing your intake of citrus, pineapple, tomatoes and spicy foods will help prevent irritation of the throat lining.
  • Carbonated beverages, such as soda, sparkling water or beer, can bring acid from your stomach to your throat and should be avoided.

Behavior:

  • Relax and wear loose clothes after eating. Bending over or putting pressure on your abdomen can force acid into your esophagus.
  • Eat smaller meals so your stomach doesn't distend.
  • Stay up for three hours after eating a meal.
  • Avoid bedtime snacks or beverages.
  • Prop the head of your bed up so that you sleep on a slight downward slant.

Medications:

  • Your doctor may prescribe medications to control your acid such as a protein pump inhibitor (PPI).
  • Over-the-counter antacids may also help relieve the symptoms of acid reflux.

The experts at Rush's Voice, Airway and Swallowing Disorders Program will work with you so that you have the support you need to make the necessary diet and lifestyle changes.

Surgery:

If your LPR is severe and symptoms persist after taking medication and making diet and lifestyle changes, your doctor may recommend a laparoscopic surgery called Nissen fundoplication.

During this procedure, a general surgeon will expand your lower sphincter — the bundle of muscles located at the low end of your esophagus, where it meets the stomach. This helps to prevent acid from moving up your esophagus.

Why choose Rush for LPR care

  • Specialized care: The highly qualified experts in Rush's Voice, Airway and Swallowing Disorders Program specialize in diagnosing and treating issues that affect your breathing, swallowing and/or ability to use your voice, including LPR.
  • A team approach: Physicians with the program collaborate with colleagues in other departments, including gastroenterology and nutrition, and general surgery to provide the multidisciplinary treatment you need to relieve your LPR symptoms and help you feel better.

Departments and programs that treat this condition