Laryngopharyngeal Reflux, LPR, Silent Reflux
Do you have a sensation of a lump in your throat? Does it feel like you have constant post nasal drip, but rarely are able to cough it up and out? You may be experiencing symptoms of laryngopharyngeal reflux. Other names include LPR and silent reflux. Read on below to learn more!
What is Laryngopharyngeal Reflux/LPR/Silent Reflux exactly?
Laryngopharyngeal reflux (LPR) is a type of reflux that affects the throat (pharynx) and voice box (larynx). LPR is sometimes called “silent reflux.” It is caused by reflux (even gaseous reflux) from the stomach/food pipe (esophagus) coming up into the pharynx and larynx. The concern when reflux comes up this high is not just about acid. It’s primarily worrisome due to an enzyme called pepsin. Pepsin is an enzyme in our stomachs that helps digest protein – which is a great thing in our stomachs because we eat protein! But… when the acid comes up the pepsin comes too.
What’s so bad about Pepsin?
The pepsin recognizes our throat muscles as protein and begins to digest them. Acid activates pepsin. Now that it’s in the throat, it no longer matters if acid comes up from the stomach, or if we eat something acidic. To add insult to injury, pepsin can lay dormant on those muscle fibers for up to 90 days. If it’s re-activated by any type of acid, it has another 90 days. The acid will activate the pepsin, which will then begin to eat away at our muscle tissues making them red, puffy, and/or irritated.
This irritation can lead to a “globus” sensation (lump in the throat, or sensation of mucus/post-nasal drip), and may even cause frequent throat clearing and/or coughing. Voice changes may occur if the laryngeal tissue is also affected. Increased muscle tension in our throats, possibly related to this irritation, can then cause us to “feel” our mucus more too. Plus, irritation at the vocal fold level causes the folds to excrete thicker mucus to protect themselves. What a mess, right?!
What Can I Do About It?
The good news: LPR is treatable. Your best bet is to get a correct diagnosis by a fellowship-trained laryngologist (an Ear, Nose, and Throat doctor that specializes in the throat). They will take a peek at your larynx/pharynx through some type of endoscopy and ascertain that you have signs of reflux in your throat. They may discuss dietary/lifestyle changes to improve the reflux, and may even prescribe some acid reducing medications (e.g., proton pump inhibitors or H2 blockers) if deemed beneficial. If you have voice, cough, or throat clearing problems, they may also recommend treatment with a speech-language pathologist (SLP) to provide further education/monitoring of dietary/lifestyle changes and work on exercises/replacement strategies, as appropriate.
Aside from medications, the following dietary and lifestyle changes can be helpful:
Avoid eating 3-4 hours before bedtime
Sleep on an incline
Do not recline for at least 30 minutes after meals
Try drinking some alkaline water (pH 8.8 or above) – shown to turn off Pepsin in test tubes.
Start with 8 oz after each meal for a week. If it works continue, if it doesn’t don’t spend all the extra money on water
Reduce the acidity of your diet
Looking to read more about LPR and a low-acid diet? Check out the book Dropping Acid: The Reflux Diet, Cookbook, and Cure. This is where I got my first description of reflux.
You could also learn more about reflux and self-care in my vocal wellness course!
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