Avoid bending or stooping as much as you can. Dietary factors often contribute to acid reflux. Certain foods are acids or irritants themselves; others will bring out stomach acid in large amounts.
Physical causes can include weak or abnormal muscles at the lower end of the esophagus where it meets the stomach, normally acting as a barrier for stomach contents re-entering the esophagus. Other physical causes include hiatal hernia, abnormal esophageal spasms, and slow stomach emptying. Changes like pregnancy and choices we all make daily can cause reflux as well. These choices include eating foods like chocolate, citrus, fatty foods, spicy foods or habits like overeating, eating late, lying down right after eating, and alcohol/tobacco use (see below).
Some may have difficulty breathing if the voice box is affected. Many patients with LPR do not experience heartburn. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat.
If appropriate, your physician will discuss this option with you. Most people do not know that acid reflux can also cause voice problems or symptoms in the pharynx (back of throat). This can happen to someone even if they are not aware of any heartburn and is sometimes called silent reflux, atypical reflux or laryngopharyngeal reflux. GERD and LPR can be diagnosed or evaluated by a physical examination and the patientâ€™s response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the esophagus, 24 hour pH probe with or without impedance testing, esophageal motility testing (manometry), and emptying studies of the stomach.
However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin.
Chronic Cough and LPR: What You Need to Know
3. Altman K W, Stephens R M, Lyttle C S, Weiss K B. Changing impact of gastroesophageal reflux in medical and otolaryngology practice. There is no specific test for LPR.
- Also, refluxed acid is more likely to pool in the larynx and pharynx, resulting in prolonged exposure.
- This is why GERD is often characterized by the burning sensation known as heartburn.
- The most common symptom of acid reflux is heartburn, a burning sensation in the lower chest and middle abdomen.
- However, current diagnostic tests for reflux and LPR have many shortcomings and can lead to misdiagnosis of this disease (Table 2).
- Estimates of the economic burden of extraesophageal reflux have shown that expenditures for extraesophageal manifestations of reflux could surpass $50 billion, 86% of which could be attributable to pharmaceutical costs [2, 3].
While horizontal, the stomach contents can more easily pass backwards up the esophagus. Other individuals may simply not experience heartburn even though reflux is present. Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention.
This problem is further magnified by the fact that pharyngolaryngeal lesions may have multiple etiologies with similar appearance and presentation. The combination of direct injury by refluxate and symptoms such as chronic laryngospasm and throat clearing can lead to vocal cord edema, contact ulcers, and granulomas that cause other LPR-associated symptoms such as hoarseness, globus pharyngeus, and sore throat. The delicate ciliated epithelium of the respiratory tract is sensitive to damage when these mechanisms fail. Dysfunction in the cilia leads to mucus stasis.
Other diagnoses should be entertained, while the drug is tapered to prevent rebound acid reflux. GERD has also been implicated in the development of leukoplakia and squamous cell carcinoma of the true vocal cords.3, 10, 11 Leukoplakia, defined as the presence of a whitish plaque on a mucosal surface, in itself does not carry any diagnostic implications. However, in the presence of GERD, leukoplakia is considered to be precancerous.
However, it should be pointed out that, in a well-performed prospective study, laryngoscopy revealed one or more signs of laryngeal irritation in over 80% of healthy controls [Milstein et al. 2005]. Moreover, it has been demonstrated that accurate clinical assessment of LPR is likely to be difficult because laryngeal physical findings cannot be reliably determined from clinician to clinician, and such variability makes the precise laryngoscopic diagnosis of LPR highly subjective [Branski et al. 2002]. The sensitivity and specificity of ambulatory pH monitoring as a means for diagnosing GERD in patients with extraesophageal reflux symptoms have been challenged [Vakil et al. 2006].
Complications of LPR
Consultation with a gastroenterologist might also be needed confirm the diagnosis or determine if there are other potential causes for the LPR symptoms. Testing needed to diagnose LPR include upper GI endoscopy (EGD), (acid) pH testing, and esophageal manometry. In persistent or severe cases of reflux laryngitis, the patient may be asked to undergo a procedure called a pH probe monitoring.