LPR can cause hoarseness, coughing, a burning sensation and mucous in the throat, difficulty swallowing, brief spasms of the vocal cords and a bad taste in the mouth upon awakening.
Nicknamed “silent reflux” because it doesn’t always come with the traditional symptoms of the better-known gastroesophageal reflux disease (GERD), LPR can go undiagnosed. If left untreated, LPR can cause frequent throat and sinus infections, chronic voice and throat irritation, and vocal cord lesions.
Common, but less well known than GERD
It’s estimated that 10 percent of people who see a throat specialist have LPR.
In people with the condition, acid and digestive enzymes back up into the larynx and pharynx — the cavity between the nose and mouth — through the esophagus; by contrast, with GERD, stomach contents travel to the lower esophagus instead. People with GERD often have heartburn, indigestion and upper abdominal or chest pain. The symptoms of the two conditions can overlap, but they don’t always.
Both are treated with acid-blockers and a low-acid diet, as well as lifestyle changes. (See a list of diet and lifestyle changes below.)
Studies have found a connection between LPR and asthma, pneumonia and bronchiectasis, which cause the tubes carrying air in and out of the lungs to become widened and loose. One of the more vexing but rare effects of LPR can be its effect on the voice.
“If the voice gets very hoarse, it can affect [the patient’s] ability to work sometimes,” said Claudio Milstein, director of the Voice Center at Cleveland Clinic’s Head and Neck Institute, who usually recommends voice therapy for patients with hoarseness. And, frequent throat-clearing can be “annoying” for the LPR sufferer and those around them.
Milstein said one of the more frightening LPR symptoms is laryngospasm, in which a drop of acid gets into the throat and the throat closes up in response.
“Patients cannot breathe, and it’s really scary. … It’s usually short-lived, but patients feel like it’s hours and go into panic mode,” said Milstein, who is also an otolaryngology-head and neck surgery professor at Cleveland Clinic Lerner and Case Western Reserve University School of Medicine. He said he sees patients three or four times a month with the symptom. Milstein uses behavior modification, diet and medication to treat LPR, and he said his patients usually improve within a few months.
Why diagnosis can be difficult
LPR symptoms can mimic other diseases, making diagnosis a challenge. If you suspect you have it, contact your primary care doctor or an ear, nose and throat specialist.
Gastroenterologists and ENTs typically diagnose LPR based on symptoms, and ENTs often also use laryngoscopies (a process in which a thin tube with a camera is inserted through the nose to look at the larynx or voice box), mainly to rule out polyps, tumors and vocal fold paralysis.
Oral salivary pepsin testing, which measures the amount of the digestive enzyme pepsin in one’s saliva, can help diagnose LPR but is not yet widely available. In addition, pH monitoring can measure the amount of acid entering the esophagus, which is helpful in diagnosing both GERD and LPR.
Doctors are still searching for reliable LPR diagnostic tests.
Lee Akst, an associate professor of otolaryngology-head and neck surgery at Johns Hopkins University School of Medicine, said he thinks reflux is overdiagnosed.
“The mistake I think our field has made is that we’ve relied on reflux as some magic diagnosis to explain every throat complaint,” he said.
Ault’s doctor prescribed a strict low-acid diet, as well as Prilosec twice daily and a natural alginate product. He also suggested nasal rinses with a mild steroid mixed in with the saline. About two months after making the changes, her reflux symptoms largely disappeared.
“Pretty much his recommendation was to stop eating and drinking almost anything and everything I cared about — coffee, wine, tomatoes, berries, you’d be surprised what has acid in it,” said Ault, 59.
Megha Ramani, a private wealth lawyer and student of Hindustani classical music, made major lifestyle changes after her diagnosis by a doctor in London. Although medication helped, Ramani, 39, still had trouble with hoarseness. “I literally almost lost my voice,” she said.
She consulted an Ayurvedic doctor, who suggested limiting her sour and spicy foods for a while, eating seasonal and locally grown fresh fruits and vegetables, and taking herbal remedies. The book “The Acid Watcher Diet” by Jonathan Aviv, an ENT surgeon in New York, also helped, and she found support from the International Foundation for Gastrointestinal Disorders.
She also started doing yoga, Pilates and breathing exercises, as well as walking, and lost weight. “I removed a lot of processed food from my diet, exercised regularly, and because my voice was affected, I was recommended speech therapy,” Ramani said. “I was told I was not breathing the correct way, so was taught how to do breathing exercises.”
Ruth E. Thaler-Carter, a freelance writer and editor in St. Louis cut down on the chili, spaghetti sauce and pizza her husband loved, as well as citrus fruits. She also lost about 40 pounds and used a special pillow to raise her head at night. As a frequent public speaker, she had to get rid of the nagging cough and hoarseness.
The two things she couldn’t give up entirely were coffee and chocolate. But she found ways to cut back by switching to a smaller coffee pot as a way of tricking herself into thinking she was getting as much coffee as she had before and cutting up her chocolate, to keep her from eating a whole candy bar.
“It’s a combination, I think, of creativity and some self-control,” said Thaler, 70. LPR “was affecting my sleep and general comfort, so anything I could do to make it better was worth it, even if it meant a little sacrifice.”
Recommended diet and lifestyle changes
LPR is frequently treated with acid blockers, a low-acid diet and lifestyle changes including:
- Quitting smoking.
- Limiting alcohol intake.
- Losing weight and increasing exercise.
- Avoiding eating less than three hours before bedtime.
- Raising the head of one’s bed or using an inclined pillow.
- Doctors also recommend taking Gaviscon or alginates from brown seaweed and, in some cases, Baclofen, a muscle relaxant.
