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LPR: The "Silent" Version of Reflux

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Posted by Nausheen Jamal, MD

head neck

What Is LPR?

LPR stands for Laryngopharyngeal Reflux. LPR is sometimes called “silent reflux” because it does not cause the traditional reflux symptoms of heartburn or indigestion. However, don’t let the name fool you – it still causes symptoms! Typical symptoms of LPR include sensation of post nasal drip, frequent throat clearing, hoarseness, issues with swallowing, a sensation of a lump in the throat, dry cough, and mucous in the throat.

What Causes LPR?

LPR is a condition in which stomach contents (such as the food you eat, or the acid produced by the stomach) travel from your stomach, up your food pipe, and into your throat. Although we have muscle valves at the top and bottom of our food pipes that are supposed to prevent this from happening, they are not effective 100% of the time. Even when they work pretty well, you can still get symptoms of LPR.

How Is It Diagnosed?

LPR is usually diagnosed using a combination of patient symptoms and examination of the throat. A clinician may examine your throat with a scope, which is passed either through your nose or your mouth. If your doctor notes findings of redness, swelling, or mucous, she or he may diagnose you with LPR.

Sometimes, further testing is needed. You may need to have an upper endoscopy, for example. You may need other testing performed by a GI doctor (gastroenterologist), such as manometry (checking pressure levels in your food pipe) or a pH probe test (to check for acidity levels in your food pipe).

How Is It Treated?

LPR is treated in pretty much the same way that traditional reflux, or GERD (gastroesophageal reflux disease), is treated. Interestingly, although smaller amounts of reflux can cause LPR symptoms without causing GERD symptoms, we often need to treat LPR with higher doses of reflux medications than are needed for GERD.

Your doctor will ask you to follow a low acid diet. Many of the foods and drinks that we consume contain high levels of acid, and it is important to eliminate these. Processed foods may be highly acidic. Other problematic foods include fatty/greasy foods, tomatoes and tomato-based products, citrus fruits and juices, caffeine, and carbonated beverages.

Aren’t GERD & LPR the Same Thing?

"My GI doctor (gastroenterologist) tells me that I don’t have reflux. Why are you still treating me with reflux medicines?"

As surprising as it may sound, GERD and LPR are not quite the same thing. Although they are both related to refluxing stomach acid, they can be caused by different amounts and types of reflux, and they cause different symptoms. It is possible to have LPR without having GERD, and it is also possible to have GERD without LPR. That is why your otolaryngologist (ENT doctor) may recommend treatment with reflux medications even though a gastroenterologist may have told you that it is not necessary.

If you are experiencing the symptoms of LPR, you should consider an evaluation at the Temple Voice, Airway & Swallowing Center. For more information or to schedule an appoitnment, call 844-570-1767.

Betty Craig

Nausheen Jamal, MD

Nausheen Jamal, MD, Assistant Professor of Otolaryngology/Head and Neck Surgery at the Lewis Katz School of Medicine at Temple University, was recently featured in the publication ENT Today.

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