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Broad and learned
clinical background

Gut Reaction #19: Laryngopharyngeal Reflux (LPR)

During episodes of gastro-oesophageal reflux, the stomach’s contents (containing hydrochloric acid) may rise to the upper oesophagus, beyond the upper oesophageal sphincter (a ring of muscle at the top of the oesophagus) and into the back of the throat. This is known as laryngopharyngeal reflux (LPR) and is a condition that can affect anyone.

While Gastro-Oesophageal Reflux disease (GORD), a similar condition, presents with the classical symptom of heartburn (a burning sensation in the lower chest), there is no such predominant symptom for LPR. For this reason, it is sometimes referred to as ‘silent reflux’.

Possible symptoms include excessive throat clearing, a persistent cough, hoarseness or trouble swallowing and/or breathing. A diagnosis of LPR is often made by ENT surgeons who may examine the larynx using a small endoscope. Usually, patients will be referred onto a gastroenterologist for further assessment and treatment.

LPR is predominantly treated with acid-lowering medication such as proton pump inhibitors (PPIs) that reduce the production of acid by the stomach. If patients with a hiatus hernia (predisposes to GORD) surgical repair may be considered.

However, a paper recently published in JAMA Otolaryngology (October 2017) has suggested that a plant-based diet and consumption of alkaline water might be as effective as treatment with a PPI. The main outcome of the study was a change in Reflux Symptom Index (RSI) – the 1st group were treated with PPI and standard anti-reflux precautions (PS) and the 2nd group with alkaline water, a plant-based Mediterranean-style diet and standard anti-reflux precautions (AMS). Results from the study showed that the percentage of patients achieving a clinically meaningful reduction in RSI was 54% in PS-treated patients and 63% in AMS-treated patients. While there is still more work to be done, this study shows promising and intriguing results.

For more information about LPR or GORD please do not hesitate to contact Dr. Adam Harris