Overview
LPR is different from Gastroesophageal reflux disease (GERD). With GERD, stomach acids flow back only as far as the esophagus (the swallowing tube that joins the throat to the stomach). This acid flow to the esophagus often causes heartburn, a painful, burning sensation in the chest. More than half the patients with LPR do not experience heartburn because the stomach acid does not stay in the esophagus long enough to irritate the esophagus and cause heartburn symptoms. Many patients with LPR often have throat symptoms but do not experience heartburn.
Diagnosis Patients with LPR may have one or more of the following symptoms:
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Risk Factors
Risk factors that may increase your chance of LPR include:
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alcohol use
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drinking caffeinated beverages
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eating before bedtime
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eating foods that are high in fat, tomato-based, or spicy
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lying down after eating
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obesity
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smoking
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wearing tight clothing
If your doctor thinks that you may have LPR, he or she will perform a throat examination using a small mirror or a special camera. If your throat and/or voice box (larynx) is swollen and/or red, you may have LPR that requires treatment.
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Treatment Options Treatment for LPR should be individualized. Your doctor will determine the best treatment for you. Generally, treatment for LPR may include lifestyle changes, medication, or surgery.
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Lifestyle changes
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If you use tobacco, quit. Smoking can cause reflux.
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Maintain your ideal weight.
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Don't wear tight clothing.
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Do not lie down three hours after eating.
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Do not eat three hours before bedtime.
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Limit your intake of caffeinated beverages, mints, citrus fruits and juices, tomato-based products, spicy and fatty foods, and alcohol, including wine.
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Medication
Most individuals with LPR require medication to control the acid that causes the throat irritation associated with LPR. The need for medication will vary, and your doctor will determine which of the following medications is best for you:
Brand name |
Generic name |
| |
|
Aciphex |
Rabeprazole sodium |
Nexium |
Esomeprazole Magnesium |
Prevacid |
Lansoprazole |
Prilosec |
Omeprazole |
Protonix |
Pantoprazole Sodium |
They work best when taken 30 to 60 minutes before eating a meal that contains protein, such as meat, cheese, or fish. If you take the medicine once a day, it is important to take it 30 to 60 minutes before you eat dinner. If you take the medicine twice a day, take 1 dose 60 minutes before breakfast and 1 dose 60 minutes before dinner. If you do not eat dinner, take the medicine 60 minutes before lunch.
Brand name |
Generic name |
| |
|
Axid |
Nizatidine |
Pepcid |
Famotidine |
Tagamet |
Cimetidine |
Zantac |
Ranitidine |
H2 blockers are often prescribed in addition to PPIs. Because both types of medications are used to reduce acid secretion in the stomach, they are not effective once you begin experiencing the symptoms of LPR. To be effective, they must be taken regularly.
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Antacids
Antacids - Tums, Rolaids, and Maalox - neutralize acid that is already in the stomach. They are effective for treating the acute symptoms of LPR. Different brands may have different active ingredients such as calcium, aluminum, or magnesium. In general, magnesium neutralizes stomach acid faster, but also may cause loose stools or diarrhea. Antacids that contain aluminum may cause constipation.
Avoid or minimize high-risk behaviors that trigger the reflux, such as eating tomato-based foods, fatty foods, and spicy foods, or drinking alcohol or caffeinated beverages. It is best to take antacids after the meal, especially if you drank alcohol with the meal or if you plan to go to sleep less than 3 hours after eating.
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Surgery
If your reflux problem is severe, or the excess acid cannot be controlled by medication, your doctor may recommend surgery. This surgery will create a new and better valve between the esophagus and stomach to prevent the acid from backing into your throat or voice box. A multidisciplinary team, comprised of gastroenterologists, general surgeons, thoracic, surgeons, and speech-language pathologists, in addition to your otolaryngologist will help determine the best treatment for you.
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