THROAT DISCOMFORT AND LARYNGOPHARYNGEAL REFLUX 

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WHAT IS LARYNGOPHARYNGEAL REFLUX?

Laryngopharyngeal reflux (LPR) is a common condition in which acid made in the stomach travels up the oesophagus (gullet) and gets into the throat. Stomach acid production is a natural process and helps us digest food as well as kill harmful bacteria amongst other function. However, acid contained within the stomach can travel back up towards the throat causing pain and discomfort.

WHAT ARE THE SYMPTOMS?

Symptoms may include one or more of the following: sore throat, an irritated larynx (voice box), burning sensation in the throat, bad taste in the mouth (particularly in the morning), excessive catarrh, hoarseness, globus sensation (feeling of something stuck in the throat), change in voice quality, persistent cough, and sometimes heartburn and indigestion.

HOW IS IT DIAGNOSED?

A description of your symptoms to your doctor or consultant may be sufficient evidence for a diagnosis of laryngopharyngeal reflux. For confirmation or to see the extent of the condition an examination of your throat with a nasoendoscope (a long thin tube with a camera on the end) can be carried out in the Ear Nose and Throat (ENT) clinic. This may reveal inflammation and redness that is typical of laryngopharyngeal reflux.

WHAT IS THE TREATMENT?

First line treatment to alleviate the symptoms of laryngopharyngeal reflux is to make lifestyle and dietary changes. Stopping smoking and reducing alcohol intake has obvious health benefits in addition to improving LPR symptoms.
There are many foods that typically worsen reflux and these should be avoided. Eating small, regular meals is advisable as large meals prompt the stomach to producing larger quantities of acid. Food and drink that typically aggravate LPR are as follows:

Spicy foods
Caffeine
Fatty and fried foods
Cheese
Acidic drinks; orange, grapefruit, cranberry juice Spirits, red and white wine

In addition to dietary changes, lifestyle changes can also be made to alleviate symptoms, including avoiding eating at least 3 to 4 hours before bedtime, elevating the head when sleeping by using at least two pillows or raising the head of the bed with blocks (this helps to stop the flow of acid from the stomach back up the oesophagus), not wearing tight clothes around the stomach, losing weight if necessary, and regular exercise.

MEDICATION

A simple, effective treatment is regular Gaviscon, an antacid that works quickly to neutralise stomach acidity. It is readily available in chemists and supermarkets and should be taken after meals and before bedtime. Your doctor or consultant may prescribe a proton pump inhibitor (PPI) such as Omeprazole or Lansoprazole to neutralise the stomach acid and therefore alleviate your symptoms.

If your symptoms have not improved after a 3 to 4-week diagnostic trial of Gaviscon and proton pump inhibitor treatment prescribed by your doctor, you must return to your GP or Consultant for further assessment to exclude a more serious underlying disease process as the cause of your symptoms.

SUMMARY

Laryngopharyngeal reflux is a common cause of throat related symptoms. Simple lifestyle and dietary modifications in addition to Gaviscon and anti-acid medication described above, should provide symptomatic relief in the majority of cases. Thorough assessment by an ENT surgeon is vital for those patients whose throat symptoms are not getting better after 3 to 4 weeks of therapy, especially if there is a history of smoking and alcohol consumption.