Understanding Laryngo-Pharyngeal Reflux (LPR) or Silent Reflux
What is Silent Reflux?
Laryngo-Pharyngeal Reflux, often referred to as LPR or Silent Reflux, is a condition that sparks ongoing debate among medical professionals. While some question its existence, the symptoms associated with LPR are as prevalent and debilitating as traditional heartburn or indigestion.
Diagnosing and treating LPR can be challenging due to the lack of a universally accepted scientific definition and limited access to definitive diagnostic tests. The symptoms, however, are very real. Let’s take a look at symptoms and causes of LPR.
Symptoms of Laryngo-Pharyngeal Reflux
LPR manifests through various symptoms, and individuals may experience one or several of the following:
Sore Throat and Difficulty Swallowing
Occasional or persistent sore throat, sometimes more pronounced in the morning.
Voice Problems or Hoarseness
Changes or weakness of the voice, as well as difficulty hitting the right notes (especially noticeable in singers).
Cough
Nocturnal or postprandial (after meals) cough, which may not always respond to anti-acids and could be caused by non-acidic reflux.
Throat Clearing/Mucus and Post-Nasal Drip
Persistent throat clearing, mucus sensation, and post-nasal drip leading to a sore throat.
Globus Sensation
A feeling of a lump or obstruction in the throat.
Sinus Problems
LPR has been linked to sinus problems or past sinus surgeries.
Bad Breath and Shortness of Breath
Unpleasant breath is often associated with LPR. Some people also experience difficulty breathing or “air hunger”.
Nasty Taste and/or Tingling Lips
Patients sometimes report a strange or sour taste in the mouth, or a tingling sensation on the lips.
Causes of Laryngo-Pharyngeal Reflux (LPR)
LPR is a complex condition with various potential causes, including:
Poorly Functioning Lower Esophageal Sphincter (LES)
LES failure, often linked to a hiatus hernia, allows stomach contents to reflux into the throat, causing irritation and triggering symptoms.
Gastroparesis/Poor Gastric Emptying
Inadequate stomach emptying due to motility issues or functional blockages can lead to increased stomach pressure, causing reflux symptoms.
Small Intestinal Bacterial Overgrowth (SIBO)
Overgrowth of gas-producing bacteria can cause belching and reflux of gaseous substances to the throat, with rapid onset symptoms.
Low Stomach Acid
Some theories link reflux to low stomach acid, even though scientific evidence is currently insufficient. This is partly because pharmaceutical companies (which have the funds to fund research) are proclaiming all reflux is due to high stomach acid - so that they can get their acid blockers drugs prescribed to the most people - however this is simply not true. You can read my article on how to distinguish high stomach acid from low stomach acid here.
Upper Esophageal Sphincter (UOS) Dysfunction
UOS overactivity, responding to LES dysfunction, might contribute to symptoms like Globus (lump feeling in the throat), though the exact role remains unclear.
Treatment Options
So you think you might have LPR. What can you do? There are a couple approaches you can take first to rebalance your body and digestive system and resolve LPR naturally.
Try the Silent Reflux Diet
Dietary modifications, such as adopting the LPR diet or losing weight, form the initial phase of treatment.
The Silent Reflux Diet eliminates foods that can aggravate reflux symptoms or relax muscles in your lower esophagus, such as high-fat foods including fried foods and fatty cuts of meat, sweets, alcohol, sodas and acidic foods and beverages. It is also recommended to avoid chocolate, mints, and spicy foods because they’re known to weaken the esophageal sphincter. Histamine foods can also trigger acid reflux, so keep that in mind when eating fermented foods or drinking alcohol.
SIBO Management
If SIBO is diagnosed, a low FODMAP diet may be recommended as part of an eradication program alongside specific antimicrobials or antibiotics, probiotics, and motility-enhancing supplements or prokinetics.
Laryngo-Pharyngeal Reflux poses challenges in both diagnosis and treatment, but with the right approach and accurate identification of the root cause, successful management is possible. If you are experiencing LPR symptoms, do not despair – there is hope, and personalized treatment plans can lead to positive outcome.