Do you also have a constant sore throat? Is your voice hoarse? This could be LPR (Laryngopharyngeal Reflux)!

Do you also have a constant need to clear your throat? Does it feel like there's a lump in your throat? Does your voice sound a little different and hoarse? Most of us dismiss these things as just a common cold or an allergy. But it could be something different than you think. This is what we call LPR, or "Silent Reflux" in medical terms. Let's talk about it simply today.

What exactly is this LPR?

Simply put, LPR is a special type of gastritis. Acid reflux is when stomach acid and digestive juices flow back up into the throat. This is usually felt in the chest, in the lower part of the esophagus. We call it heartburn.

But in LPR, these stomach acids come up even higher and reach our larynx, the voice box, and the pharynx. Because it comes up past the esophagus, the symptoms are very different from regular gastritis. That's why many people don't even realize it's a type of gastritis. Instead of heartburn and stomach pain, LPR mainly affects the parts of your voice, throat, and nose. It's also called "Silent Reflux" because it doesn't show the usual gastritis symptoms.

What is the difference between LPR and GERD?

You may have heard the term GERD. GERD stands for Gastroesophageal Reflux Disease. It refers to a condition of persistent gastritis. Although both conditions involve stomach acid coming up, there are some slight differences between the two.

Let's understand this difference a little more clearly.

What are the symptoms of LPR?

Because the symptoms of LPR are a bit different, it can sometimes be mistaken for asthma, allergies, or a bad cold. The main symptoms are:

• Hoarseness or lowering of the voice.
• A feeling like something like a ball is stuck in the throat.
• Constant need to clear your throat .
• Chronic cough that lasts for a long time.
• Excessive mucus in the throat and nose.
• Difficulty swallowing food.
• Persistent sore throat .
• Loss of voice or laryngitis.
• Wheezing is a whistling sound when breathing.
• Postnasal drip.
• Frequent upper respiratory tract infections such as colds and flu.
• New onset of asthma or worsening of existing asthma .

Why does this LPR occur? Let's look at some reasons.

Imagine that there are two important gates on the road from our stomach to our throat. These are the muscular rings at the top and bottom of our esophagus. They're like valves. We call these `(esophageal sphincters)`.

1. Lower Esophageal Sphincter (LES): This is located between the esophagus and the stomach. Its main function is to prevent stomach acid from flowing back up into the esophagus.

2. Upper Esophageal Sphincter (UES): This is located between the esophagus and the throat. It prevents anything that has entered the esophagus from going up into the throat.

For LPR to occur, both of these valves must not close properly. Normal gastritis occurs when the lower esophageal sphincter (LES) becomes weak. However, for LPR to occur, the upper esophageal sphincter (UES) must also not close properly and become loose. This is when stomach acid can leak up into the esophagus.

So why are these gates weak?

There can be many reasons for this. Some are temporary, while others develop over time.

1. Things that weaken the lower esophageal sphincter (LES)

• Certain medications: Certain medications such as calcium channel blockers for high blood pressure, benzodiazepines for mental calm, and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Certain foods and drinks: coffee, chocolate, alcohol, mint, garlic, and onions.
• Lifestyle habits:
• Lying down for at least 3 hours after eating.
• Eating a lot at one time.
• Wearing tight clothing or belts that constrict the abdomen.
• Other situations:
• Hiatal hernia: Part of the stomach protrudes into the chest.
• Pregnancy: Due to hormonal changes and increased pressure on the abdomen.
• Obesity: Increased pressure in the abdomen.
• Smoking: The chemicals in tobacco relax this muscle ring.

2. Things that weaken the upper gate (UES)

After the acids have entered through the lower entrance and come up, they need to be stopped from reaching the throat through this upper entrance. But these things can also weaken it.

• Lying down: When we lie down at night, both of these gates relax a little.
• Burping: When you burp, both of these valves open, allowing a small amount of acid to enter your throat along with air bubbles.
• Bending forward, exercising, singing: These activities can increase pressure in the abdomen and put pressure on the upper part of the uterus.
• Smoking and alcohol use: Both of these open up both doors.

What are the possible complications of LPR?

If LPR is not treated properly, certain complications can occur over time.

• Excessive mucus and frequent infections: Stomach acid refluxing into the throat disrupts the normal process of clearing mucus from the throat and nose. When mucus builds up, germs can accumulate, leading to frequent infections.
• Chronic voice and throat problems: This long-term swelling of the throat and vocal cords can make it difficult to speak and swallow. Over time, small lumps (vocal cord lesions) may also develop on the vocal cords.
• Respiratory system complications: Acids that enter the throat can sometimes be inhaled into the lungs without us realizing it, especially during sleep at night. This can lead to lung infections and other respiratory problems.

How do I know for sure if this is LPR?

If you have the symptoms we discussed earlier, especially if you can't find a cause, it's best to see an ear, nose, and throat specialist (ENT Surgeon). The doctor will listen to your symptoms and examine your throat.

There are several main tests performed for this:

• Flexible Laryngoscopy: A procedure in which a small camera attached to a flexible, thin tube is passed through the nose and into the throat to examine the inside of the larynx and throat. This is a simple test that can usually be done in the doctor's office.
• Upper Endoscopy: This involves inserting a tube with a camera through your mouth to examine your esophagus and stomach. This can help determine the cause of your LPR.
• Esophageal pH test: A test that measures the acid levels in your throat and esophagus over a 24-hour period.
• Esophageal Manometry: A test that measures the function and strength of the muscles in the esophagus.

What are the treatments for LPR?

The main focus in treating LPR is on changing our lifestyle and eating habits.

Changing lifestyle and eating habits

There are many things you can do yourself to control LPR. These are the most important things.

Drug treatment

While you make lifestyle changes, your doctor may prescribe certain medications to help heal the damage to your throat and larynx.

• Proton Pump Inhibitors (PPIs): These work by reducing the production of acid in the stomach. These may need to be used for several months.
• H2 Blockers: These are another type of medication that reduces acid production.
• Alginates: These medications create a protective layer over the stomach lining, preventing acids from coming up.

Surgery

Surgery is rarely necessary for LPR. Surgery is only considered if there is a specific cause, such as a hiatal hernia, or if other treatments have failed.

LPR, Laryngopharyngeal Reflux, Silent Reflux, Gastritis, Mucus in the throat, Chronic cough, Hoarse voice, Chest inflammation