Is your throat always sore? This could be LPR (Laryngopharyngeal Reflux)!

Do you often feel like there's a lump in your throat, like something is stuck in it? Do you often feel like clearing your throat and saying "Mm... Mm..."? You might think it's a cold or an allergy to dust. But if it hasn't subsided for months, the cause may be something a little different and deeper than you think. Today we're talking about a "hidden" problem that many people don't know about, but that many people have. We call this LPR, or Laryngopharyngeal Reflux.

What is LPR? Is this also called 'silent reflux'?

Okay, let's keep this simple. You may have heard of "gastritis" or "acid reflux." This is when the stomach juices that help digest food flow back up into the esophagus. Usually, when this happens, we feel a burning sensation in our chest or stomach. We call this condition GERD (Gastroesophageal Reflux Disease).

But LPR is a slightly different, special case. What happens here is that the acid coming up from the stomach doesn't stop at the chest, but rather travels further up into your throat (pharynx) and the box where your vocal cords are (larynx).

Simply put, GERD is a problem that starts in the chest. LPR is a problem that goes further up and affects the throat. Some people can have both. Some people can have just LPR.

What are the symptoms that suggest LPR?

If you have had one or more of these symptoms for a long time, be concerned. Let's take a look at the main ones.

Why does the stuff in the stomach come up into the throat like this?

To understand this, we need to know a little about our esophagus. Think of it as a tube with two valves at the top and bottom. We call these valves sphincters .

1. The Lower Esophageal Sphincter (LES): This is located between the esophagus and the stomach. When we swallow, it opens to let food pass into the stomach, and then closes tightly again. This stops stomach acid from coming back up.

2. The Upper Esophageal Sphincter (UES): This valve is located between the esophagus and the throat. Its function is to stop anything that has entered the esophagus from going back up into the throat.

For LPR to occur, both of these valves must not work properly. First, the lower valve (LES) must weaken, allowing stomach acid to flow back into the esophagus. Then, the upper valve (UES) must weaken, allowing the acid to flow back into the esophagus.

So, why are these valves weak?

There can be many reasons for this. Some are temporary, some are long-term.

1. Things that weaken the LES

In most cases, the same causes that affect normal gastritis also affect this.

• Some medications: Painkillers (NSAIDs), some medications for high blood pressure (Calcium channel blockers), and medications for mental health problems (Tricyclic antidepressants) can cause this valve to loosen.
• This can also be caused by certain foods and drinks: coffee, chocolate, mint, garlic, onions, and alcohol.
• Bad habits:
• Lying down 2-3 hours after eating.
• Eating a lot at one time can cause stomach bloating. This increases the pressure inside the stomach and pushes acid up.
• Wearing clothes that are tight on the stomach, especially around the waist.
• Long-term causes:
• Hiatal Hernia: This is when a small portion of the stomach protrudes into the chest. This weakens the function of the LES valve.
• Obesity: As weight increases, pressure inside the abdomen increases. This is also a major cause.
• Pregnancy: Hormonal changes and increased pressure inside the abdomen during this time can temporarily cause gastritis and LPR.
• Smoking: Smoking is a major enemy that loosens this valve.

2. Things that weaken the upper esophageal sphincter (UES)

After the acid comes up through the lower valve, the upper valve is the last guardrail protecting the throat. Our throats are not designed to withstand acid like the esophagus. So even a very small amount of acid can cause great damage.

• Lying down: When we lie down, both of these valves become slightly looser. This makes LPR more likely to occur at night while we sleep.
• Burping: When you burp, both valves open, allowing a small amount of acid to enter your throat along with the air.
• Bending forward, exercising, singing: Activities like these can increase the pressure under the upper valve, weakening it.
• Smoking and alcohol: Both are equally harmful to both valves.

Is it dangerous to ignore LPR status?

Yes, if this condition persists for a long time, some complications may occur.

• Frequent infections: Acid in the throat interferes with the natural cleansing process in the throat and sinuses. This can lead to mucus buildup and frequent throat and respiratory tract infections.
• Long-term voice and throat problems: Continuous exposure to acid can damage the vocal cords, causing things like vocal cord lesions. Long-term exposure to this condition may slightly increase the risk of laryngeal cancer.
• Respiratory complications: A small amount of acid that enters the throat can travel up the trachea into the lungs without us even realizing it, especially during sleep. This is called silent aspiration . This can lead to lung infections and conditions like bronchitis.

How do I know exactly what LPR is?

If you have been experiencing the symptoms we discussed earlier for a long time, the best thing to do is to see an ear, nose, and throat specialist (ENT Surgeon) . He or she will listen to your symptoms and examine your throat.

The main test usually performed for this is a flexible laryngoscopy . This involves passing a very thin, camera-equipped tube through your nose and down your throat to examine the inside of your vocal cords and throat. This is a painless procedure that can be done in a few minutes.

This test can check for redness and swelling in the throat. Sometimes, further tests may be needed to confirm the diagnosis or to rule out other causes.

• Upper Endoscopy: This involves inserting a camera through the mouth to examine the esophagus and stomach. It can check for problems with the lower esophageal sphincter (LES) and hiatal hernia.
• Esophageal pH test: This measures the acid levels in the throat and esophagus over a 24-hour period.
• Esophageal Manometry: A test that measures the function and strength of the muscles of the esophagus and its valves.

Okay, what do we do about this now? What are the treatments?

The most important thing in treating LPR is to make changes in lifestyle and dietary habits . Medication comes in second place.

1. Changing lifestyle and eating habits (this is the most important)

If you follow these habits exactly, you can often control this condition without medication.

2. Drug treatment

While making lifestyle changes, your doctor may prescribe medication to help damaged throat tissue heal.

• Proton Pump Inhibitors (PPIs): Drugs such as Omeprazole and Pantoprazole work by reducing the production of acid in the stomach. These are usually prescribed for several months.
• H2 Blockers: Medications like Famotidine also help control acid.
• Alginates: These create a protective layer on the stomach, preventing acid from coming up.

3. Surgery

This is rarely necessary. Surgery is only considered if there is a specific physical problem, such as a hiatal hernia, or if no other treatment has helped.

In conclusion, LPR is a somewhat annoying condition, but it can be managed well if managed properly. The most important thing is not to ignore the symptoms, get an accurate diagnosis, and especially be patient with the necessary lifestyle changes.

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