How to Manage Throat Reflux (LPR)

What is throat reflux?

Reflux happens when the muscle between the stomach and the food pipe (esophagus) relaxes at the wrong time and stomach contents flow back up. When it stays in the esophagus, it usually causes heartburn (GERD). When it reaches the throat and voice box, it is called laryngopharyngeal reflux (LPR). The lining of the throat is more sensitive than the esophagus, and most people with LPR do not have heartburn, which is why it is called silent reflux. You can have one type or both.

These throat symptoms can also have other causes, such as post-nasal drip or a sensitive throat. If they do not improve with treatment, we may recommend further testing.

Common symptoms of LPR:

• Frequent throat clearing, extra mucus or a feeling of post-nasal drip
• Hoarseness
• A feeling of a lump in the throat
• A long-lasting cough, or choking spells that can wake you at night
• A sore or burning throat, or a sour taste
• Trouble swallowing

What daily habits help?

What should I eat?

Fatty and fried foods, caffeine, alcohol, carbonated drinks, chocolate, mint, citrus and tomatoes are the most common triggers. A mostly plant-based, Mediterranean-style diet is a good pattern to follow, and for some people it helps about as much as a reflux medicine. In practice, that means about 9 of every 10 foods you eat are plant foods: vegetables, fruit, whole grains, beans and nuts, with fish, chicken or lean meat as a small side rather than the main part of the meal.

Caffeine and alcohol: for the first 8 weeks, have no caffeine, or no more than 1 cup of coffee or tea a day and none in the evening, and no alcohol. Water is the best drink. If you usually have 2 or more cups a day, cut back over 1 to 2 weeks to avoid caffeine headaches. Once your throat is better, add caffeine back 1 cup at a time and stop again if symptoms return. After that, if you drink, have no more than 1 drink a day and none within 3 hours of bedtime.

What are Gaviscon Advance and Reflux Gourmet?

We often recommend one of these alginate products. Alginate is a natural substance from seaweed. After you swallow it, it forms a soft layer that floats on top of the stomach contents and helps keep them from coming back up, which can ease throat reflux symptoms.

• Take it after each meal and at bedtime, so 4 times a day. For Gaviscon Advance liquid, that is 10 mL (2 teaspoons) each time; for tablets, follow the package. It works quickly and has few side effects. It comes as chewable tablets and as a liquid.
• Buy the right one. Gaviscon Advance is the UK formula, which you can order online. The Gaviscon products sold in US stores, including Extra Strength and Maximum Strength, are a different formula.
• Reflux Gourmet is another alginate product, sold in the US. It is a good alternative; use it as the label directs.
• Mint flavor: some versions are peppermint flavored. Natural peppermint can trigger reflux, but the flavoring in these products is not thought to.
• Ask us first if you have kidney disease or have been told to limit salt or potassium.

What about acid-reducing medicines?

We often prescribe a proton pump inhibitor (PPI), usually for 2 to 3 months, to help throat symptoms settle, whether or not you have heartburn. As the diet and habit changes take hold, we wean you off it. Take it the way we told you.

• Proton pump inhibitors (PPIs) such as omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and dexlansoprazole (Dexilant) lower the amount of acid the stomach makes.
• H2 blockers such as famotidine (Pepcid) also lower acid, more mildly. Some people take one at bedtime.
• Antacids such as Tums or Rolaids work quickly but briefly. They help mild, occasional reflux but are not meant for everyday use.

Are PPIs safe?

For most people, yes, especially for the weeks to months we usually prescribe them. Many people have no side effects. The most common are headache, nausea, diarrhea, constipation, stomach pain and gas.

People who take a PPI for a long time, usually more than a year or two, have been found to have higher rates of:

• Low vitamin B12
• Low magnesium, which can cause muscle cramps, twitching or an irregular heartbeat
• Bone fractures
• Some gut infections, such as C. difficile diarrhea
• Kidney problems

Most of these links come from studies that cannot show whether the PPI caused the problem. In a large trial where people took a PPI or a placebo for 3 years, the only possible difference was a small rise in gut infections. The risk seems to grow the longer you take a PPI and the higher the dose, so we use the lowest dose that works, for the shortest time, and check regularly whether you still need it.

How long until I feel better?

Stick with the changes. Irritation from reflux takes time to heal: most people notice a difference in throat symptoms within about 8 weeks, and full improvement can take several months. Do not stop a medicine or go back to old habits without talking with us, even if you feel better.

When should I call?