Laryngeal Reflux: Patient Information Sheet

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

Laryngopharyngeal Reflux Disease or LPR develops when stomach acid travels up into your throat. Although you may experience "heartburn" or "indigestion", many of our patients do not have these complaints. You need to have an laryngoscope to exclude any other reasons for your symptoms.

SYMPTOMS OF LPR

• sensation of drainage down the back of the throat or excessive mucus
• feeling of something caught in the throat (sometimes a tickling or burning sensation)
• throat clearing
• chronic cough
• post-nasal drip
• sore throat
• hoarseness
• difficulty swallowing
• prolonged vocal warm-up (for singers)
• loss of the high end of the vocal range

DIAGNOSIS OF LPR:

Most often, your doctor can diagnose LPR by examining your throat and vocal cords with a rigid or flexible telescope. The voice box is typically red, irritated, and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months.

At other times, you may have to undergo a dual-channel pH probe test to diagnose your condition. This involves placing a small tube (catheter) through your nose and down into your swallowing passage (esophagus). The catheter is worn for a 24-hour period and measures the amount of acid that refluxes into your throat. This test is not often necessary, but can provide critical information in certain cases.

TREATMENT OF LPR:

Most of the time, LPR is well controlled with medications (Proton Pump Inhibitors, or PPI's), as described on the back of this sheet. Occasionally, surgery is needed in severe cases or those that don't resolve with medications. The recommended surgery is called a Laparoscopic Nissen Fundoplication, and is performed by a General Surgeon. Positive proof of reflux disease is needed first, generally by a pH probe study. With some patients, the esophagus (swallowing tube) must also be examined for pre-malignant changes.

One of the first things you must do is make some changes in your lifestyle. Many foods and drinks can make your symptoms worse, and it is important that these be eliminated. In addition, being overweight, smoking, and drinking alcohol are all factors that worsen reflux disease. It is important to work on the following areas as well:

1) AVOID CAFFEINE: 

Specifically, avoid coffee (highest caffeine content), tea, and caffeinated soft drinks. Soft drinks such as Coke and Pepsi are particularly bad, because they are very acidic (pH of 2.3), and the carbonation leads to belching and further reflux of acid into the throat. Other acidic juices (orange, grapefruit, cranberry) can worsen reflux.

2) AVOID CHOCOLATE AND MINTS.

3) AVOID ALCOHOL: 

Especially in the late evening and before bedtime.

4) QUIT SMOKING.

Smoking adds to the laryngeal irritation and increases the risk of cancer.

5) ELIMINATE FRIED, FATTY, AND SPICY FOODS FROM YOUR DIET (within reason): 

A low-fat diet is the best way to avoid reflux. Onions and garlic are notorious for causing reflux.

6) LOSE WEIGHT: If you're overweight. Avoid tight-fitting clothing.

7) STOP EATING AT LEAST 3 HOURS BEFORE GOING TO BED: 

Eating a heavy meal just before going to sleep is especially bad for your reflux condition

8) TAKE THE MEDICINES YOUR DOCTOR HAS PRESCRIBED FOR YOU:

In most cases, your doctor will prescribe a "proton pump inhibitor" drug (PPI) such as Nexium, typically prescribed for TWICE A DAY for 2-3 months  which is double the usual dose for routine reflux disease. Please see below for more details on your medication and discuss risks with the doctor prior to use. These medications should not be suddenly stopped but slowly weaned off to prevent rebound reflux. You may also take some Gaviscon before bedtime. 

9) RELAXATION: 

Some of the symptoms may also be due to spasm o a muscle called Crico Pharyngeus. Meditation/ relaxation will be an excellent adjunct to the treatment

10) WHEN AND HOW TO TAKE YOUR MEDICATIONS

IMPORTANT INFORMATION ABOUT YOUR MEDICATION

If you are taking a Proton Pump Inhibitor (PPI) such as  Nexium, it is important to take your medicines 30 minutes - 1 hour before meals. Most of these medicines are given 40mg twice-a-day, so that will mean taking a pill before breakfast and dinner. The medicine is absorbed better if taken this way. After two months you may take only the night time dose.

RISK: 
Studies have shown an increased risk of hip fractures on those who take this medication longer term. 

It is best that you do everything else outlined above including losing weight. You may gradually taper off the medications and see how you fare.

If you continue to be affected by this problem you will need to make a decision on longer term medications vs surgery to treat reflux.  Surgery also caries significant risks. 

SURGICAL METHODS

Those who fail medical treatment will need a full gastroscope and with PH and Pressure monitoring of your oesophagus. 

After a patient has been diagnosed with reflux, indications for a surgery - Nissen procedure includes:

1. Failed medical management
2. Patient request for surgery over medical management
3. Complications of GER including peptic stricture and Barrett’s esophagus

4. Extraesophageal manifestations of reflux resistant to therapy