The “Silent Reflux”
It isn't just heartburn anymore. With individuals being mistakenly treated for other disorders in relation to symptoms caused by the backup of stomach acid into the throat and sinus area, the potential for dangerous problems is rising.
It is a confusing and highly misdiagnosed disease that can go on for years and if left untreated, can be dangerous. It is Laryngopharyngeal Reflux, or LPR, which loosely translates to acid from your stomach backing up into your throat, voice box and nasal cavity.
For ages, heartburn has been associated with pain in the chest area, excessive gas or a bloated feeling often related to multiple lifestyle habits such as excess weight, skipping meals, eating spicy foods and smoking . But what happens when the symptoms are more confusing, such as the feeling of the airway constricting, a perceived lump in ones throat, asthma attacks, chronic coughing and swallowing difficulties that come on without notice and in the absence of ingesting any foods?
Then, you may have a more specialized diagnosis, explained by the stomach acids backing up past the esophagus and into the larynx and pharynx area, the problems and symptoms are even more difficult to identify as over half of those with Laryngopharyngeal Reflux (LPR) have no heartburn at all. The reason is that the acid doesn't have time to irritate the esophagus as it shoots up into the throat. This takes merely a few seconds to occur.
Even when small amounts of the reflux hit the throat and voice box area, this can set up the potential for more serious problems as that area is much more sensitive to injury and is not designed to withstand the effects of acid.
Symptoms of LPR are often confusing and vary from individual to individual:
Sensation of drainage down the back of the throat or excessive mucus
Feeling of a lump in the throat (sometimes a tickling or burning sensation)
Frequent throat clearing
Chronic cough “Asthma like symptoms”
Sore throat with a bitter taste in the mouth (especially in the mornings)
Voice changes “ Hoarse , weak voice”
Halithosis “Bad breath”
Some of the symptoms come and go, such as an intermittent hoarseness that may be mistakenly attributed to strain or fatigue . Others have a feeling of too much phlegm or mucus caused by drainage and they never link it to a digestive disorder. Still others can experience the feeling of a lump in the throat, giving rise to anxiety. This confusion in symptoms could lead to inappropriate diagnosis by general practitioners who feel that it is either an infection or a sinus problem.
A visit to an ENT Surgeon, will help you identify this condition and confirm it via and Outpatient Endoscopy to view the larynx(voice box).This will reveal any irritation, inflammation or swelling seen in the larynx.
Treatment for LPR focuses on injury and healing. This requires starting the patient on a proton-pump inhibiting drug that stops the production of acid, while concurrently advising them on some lifestyle changes such as maintaining a healthy weight, to have small frequent meals, avoid foods that are attributed to acid-reflux such as caffeinated beverages (coffe,tea,soft drinks), acidic,oily and spicy foods, as well as to stop smoking. The treatment plan can last up to several months and is targeted at healing the affected areas.
In extensively severe cases or those that do not resolve with lifestyle changes and medication, patients require surgery, either known as a Laparoscopic Nissen Fundoplication where the general surgeon wraps "a part of the stomach known as the gastric fundus around the lower esophagus" to prevent acid from flowing into the esophagus or a procedure called "anti-reflux surgery" where a stomach valve replacement might be in order.
If left untreated, LPR can cause serious problems such as choking episodes, asthma attacks and bronchitis and cancer of the throat or voice box. Cancer is very uncommon and here, LPR may be a precipitating factor not the causative one.
LPR can be silent, however as we are now more aware of it’s subtle symptoms, we can work together to arrest it. As we know,It can have devastating consequences without the appropriate course of action.
Dr Mallina Sivarajasingam
It isn't just heartburn anymore. With individuals being mistakenly treated for other disorders in relation to symptoms caused by the backup of stomach acid into the throat and sinus area, the potential for dangerous problems is rising.
It is a confusing and highly misdiagnosed disease that can go on for years and if left untreated, can be dangerous. It is Laryngopharyngeal Reflux, or LPR, which loosely translates to acid from your stomach backing up into your throat, voice box and nasal cavity.
For ages, heartburn has been associated with pain in the chest area, excessive gas or a bloated feeling often related to multiple lifestyle habits such as excess weight, skipping meals, eating spicy foods and smoking . But what happens when the symptoms are more confusing, such as the feeling of the airway constricting, a perceived lump in ones throat, asthma attacks, chronic coughing and swallowing difficulties that come on without notice and in the absence of ingesting any foods?
Then, you may have a more specialized diagnosis, explained by the stomach acids backing up past the esophagus and into the larynx and pharynx area, the problems and symptoms are even more difficult to identify as over half of those with Laryngopharyngeal Reflux (LPR) have no heartburn at all. The reason is that the acid doesn't have time to irritate the esophagus as it shoots up into the throat. This takes merely a few seconds to occur.
Even when small amounts of the reflux hit the throat and voice box area, this can set up the potential for more serious problems as that area is much more sensitive to injury and is not designed to withstand the effects of acid.
Symptoms of LPR are often confusing and vary from individual to individual:
Sensation of drainage down the back of the throat or excessive mucus
Feeling of a lump in the throat (sometimes a tickling or burning sensation)
Frequent throat clearing
Chronic cough “Asthma like symptoms”
Sore throat with a bitter taste in the mouth (especially in the mornings)
Voice changes “ Hoarse , weak voice”
Halithosis “Bad breath”
Some of the symptoms come and go, such as an intermittent hoarseness that may be mistakenly attributed to strain or fatigue . Others have a feeling of too much phlegm or mucus caused by drainage and they never link it to a digestive disorder. Still others can experience the feeling of a lump in the throat, giving rise to anxiety. This confusion in symptoms could lead to inappropriate diagnosis by general practitioners who feel that it is either an infection or a sinus problem.
A visit to an ENT Surgeon, will help you identify this condition and confirm it via and Outpatient Endoscopy to view the larynx(voice box).This will reveal any irritation, inflammation or swelling seen in the larynx.
Treatment for LPR focuses on injury and healing. This requires starting the patient on a proton-pump inhibiting drug that stops the production of acid, while concurrently advising them on some lifestyle changes such as maintaining a healthy weight, to have small frequent meals, avoid foods that are attributed to acid-reflux such as caffeinated beverages (coffe,tea,soft drinks), acidic,oily and spicy foods, as well as to stop smoking. The treatment plan can last up to several months and is targeted at healing the affected areas.
In extensively severe cases or those that do not resolve with lifestyle changes and medication, patients require surgery, either known as a Laparoscopic Nissen Fundoplication where the general surgeon wraps "a part of the stomach known as the gastric fundus around the lower esophagus" to prevent acid from flowing into the esophagus or a procedure called "anti-reflux surgery" where a stomach valve replacement might be in order.
If left untreated, LPR can cause serious problems such as choking episodes, asthma attacks and bronchitis and cancer of the throat or voice box. Cancer is very uncommon and here, LPR may be a precipitating factor not the causative one.
LPR can be silent, however as we are now more aware of it’s subtle symptoms, we can work together to arrest it. As we know,It can have devastating consequences without the appropriate course of action.
Dr Mallina Sivarajasingam
