Reflux is when acid stomach contents, including food and pepsin (a digestive enzyme) flow back up the oesophagus. In some people, small amounts of stomach acid can ‘reflux’ back into the throat (larynx and pharynx), this is known as laryngopharyngeal reflux (‘LPR’). It may also be referred to as ‘silent reflux’ as many people do not experience any of the classic symptoms of heartburn or indigestion

The lining of the throat is designed to cope with stomach acid but the structures in the throat are sensitive to acid stomach contents so small amounts of reflux into this area can result in irritation or damage.

Symptoms of Silent Reflux include

  • Feeling of ‘lump or tightness in the throat’
  • Hoarseness and vocal fatigue
  • Frequent throat clearing
  • Difficulty swallowing
  • Sore, dry throat
  • Chronic cough
  • Tickly, scratchy or burning sensations in the throat
  • Excess mucus
  • Heartburn or indigestion

Image of Larynx, throat, windpipe, stomach

 

 

How is LPR treated?

  • Making lifestyle and dietary changes
  • Medication to reduce stomach acid.

What can you do to help yourself?

  • Weight loss – Losing weight and eating healthier can be the best way to reduce reflux. In addition, weight loss has a number of other health benefits, including a decreased risk of type 2 diabetes and heart disease.
  • Quit smoking – (saliva is needed to keep heartburn at bay and smoking keeps your body from producing enough of it. Smoking increases the amount of acid that is produced by the stomach and weakens the lower oesophageal sphincter causing it to be less effective at keeping acid in the stomach).
  • Avoid problem food – Some foods cause relaxation of the lower oesophageal sphincter, promoting acid reflux. Foods to avoid include:
  • Hot, spicy food, tomato-based foods, onions, citrus fruits, juices, anything with vinegar.
  • Fried, fatty or greasy foods.
  • coffee and tea (both caffeinated and decaffeinated) 
  • Chocolate.
  • Fizzy drinks.
  • Alcohol (Spirits and white wine are the worst offenders).
  • very salty, crispy or crumbly food

These may increase the irritation already caused by the reflux

●    Avoid large and late meals – Lying down with a full stomach may increase the risk of acid reflux. By eating three or more hours before bedtime, reflux may be reduced. In addition, eating smaller meals may prevent the stomach from becoming over distended, which can cause acid reflux.

  • Raise the head end of your bed.
  • Avoid wearing tight clothing around your middle.
  • Avoid stressful situations if you can and do things to help you to relax.
  • Improve your posture, avoid bending just after meals, and eat meals in an upright position at the table rather than in front of the TV.

Treatment

You may be prescribed medication to reduce stomach acid production.

Acid reducing medications called Proton Pump Inhibitors (PPI) are often used to reduce acid production in the stomach. These should be taken half an hour before your breakfast and evening meals, approximately 12 hours apart. (Often prescribed twice daily however please use as directed by your doctor)

Antacid medications containing alginate (such as Gaviscon Advance) are also very helpful. This should be taken 15 minutes after every meal and every night before going to bed. This helps to keep the acid, pepsin and stomach contents in your stomach by forming a floating raft. This may be used in combination with an acid reducing medication.

Initial treatment will usually be for more than one month. It often takes up to 3 months for the full effect of treatment and lifestyle changes to be felt.

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Information.Governance@ncic.nhs.uk | 01228 603961

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