Acid Reflux & LPR

Some Metairie Snoring & Sinus patients complain of recurrent throat problems like sore throats, bad breath, coughing, itchiness, foreign body sensation, throat clearing, and swallowing difficulties, which may be caused by acid reflux. Sometimes patients who suffer from these symptoms rule out acid reflux because they do not have heartburn, but Laryngopharyngeal Reflux (LPR) is not associated with a heartburn sensation; rather Gastroesophageal Reflux Disease (“GERD”) is a type of acid reflux that causes heartburn. LPR and GERD are two separate entities that are a result of stomach acid entering into the esophagus or throat.

GERD is caused in most patients when the stomach “valve” that prevents stomach content from entering the esophagus, malfunctions, or becomes loose, making it incompetent. The stomach acid that refluxes into the esophagus may be damaging.

Similar to GERD, LPR occurs when the lower esophageal sphincter is too leaky and does not prevent acid from leaving the stomach. If the acid travels into the throat (pharynx) or voice box (larynx), it can cause multiple damaging symptoms. One may experience regurgitation of gastric contents into the mouth, sore throat (recurrent pharyngitis), hoarseness (recurrent laryngitis), coughing, gagging, or difficulty swallowing. One may also feel that something is stuck in the throat (globus sensation).

After a visit to Metairie Sinus & Snoring, our physicians may suspect GERD or LPR based on your health history and results of a physical examination. Our physicians may ask you about your voice, chronic cough, or throat clearing, and examine your throat and mouth for evidence of any reflux. Additional tests may be required to establish a diagnosis, such as a pH probe, barium swallow, or a direct laryngoscopy in the office.

The pH probe test involves placing a thin pH probe through the nose and into the esophagus, which will measure the frequency, severity and duration of acid reflux by detecting changes in the acid content of the esophagus. A barium swallow or upper gastrointestinal study involves drinking a chalky substance (barium), which can be seen with x-ray when refluxing from the stomach back into the esophagus. An in-office laryngoscopy involves placing a flexible viewing tube through the nose and into the voice box (larynx).

If any of these tests suggest acid reflux, Metairie Snoring & Sinus will help you manage your reflux to reduce your symptoms and possible complications. We may also refer patients to a gastroenterologist (GI) doctor for a scope of the esophagus and stomach.

There are essentially three methods for managing GERD and LPR:

  1. Behavior modification
  2. Medical therapy
  3. Surgical intervention

Most patients benefit from a combination of behavior modifications and medication to reduce symptoms and lessen the risk of significant complications of GERD. After proper diagnosis, Metairie Sinus & Snoring will prescribe medication and also recommend some steps to manage your reflux.

  • Stop smoking, because smoking causes reflux.
  • Weight loss. Shedding a few pounds may be all that is required to prevent reflux.
  • Avoid eating late at night or lying down after meals. It is best to eat more than three hours prior to bedtime and to avoid large meals at night.
  • Over-the-counter antacids
  • If symptoms occur at night, sleeping with your head and upper torso elevated may help.
  • Avoid tight-fitting clothing around the waist.
  • Eat five small meals per day rather than three larger meals.
  • Keep a food diary to help you identify those foods that trigger symptoms. Common “trigger foods” include caffeine, citrus juices, tea, alcohol, mint, chocolate, fatty foods, cheese, fried foods and eggs.
  • Proton pump inhibitors (PPIs)
  • Promotility agents
  • H2-blockers

PPIs are the most common treatment for LPR, often administered at high doses two to three times per day.

Promotility agents, such as cisapride and metoclopramide, work by speeding up the process of moving food out of the stomach and into the small intestine. These are not commonly prescribed because they are associated with heart problems and side effects.

H2-Blockers like Zantac™, Pepcid™, Tagament™ block the receptors that causes acid production and are available over the counter in low doses.

General ENT

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