Dr. Denis Grillo, Ear, Nose & Throat, 01/29/13

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Signs of silent reflux

By Dr. Denis Grillo

Almost everybody knows what gastroesophageal reflux disease (GERD) is. Old terminology used to be heartburn. But I would be willing to bet not many people are familiar with laryngopharyngeal reflux (LPR) is, as it is a relatively new diagnosis.

Reflux is a word that comes from the Greeks and it means backflow — in this case, the contents usually from the stomach.

In normal situations, the things we eat don’t back up into the throat, but if there is a problem, that is where it usually ends up.

Laryngopharyngeal reflux refers to an area of the throat and voice box that can be affected by this backflow, and it can occur day or night, even if you haven’t eaten recently.

Some people suffer with the real, obvious discomfort called heartburn. But most people with LPR do not have heartburn, because the material that backflows from the stomach usually doesn’t have enough time in the esophagus or food tube to cause the typical heartburn pain and ends up quickly in the throat, causing its problem there.

Also, many times, especially if the patient hasn’t eaten recently, the contents are not acidic. You may or may not know that gastroesophageal reflux disease puts the esophagus or food tube at risk for cancer, but likewise LPR puts the throat at risk, because it is much more sensitive to injury and irritation from the stomach’s contents.

Here are the warning signs of LPR:

+ Chronic hoarseness or voice changes.

+ Repetitive throat clearing.

+ The sensation of too much mucous in the throat.

+ The feeling of having a lump in the throat.

+ Chronic cough.

+ Too much mucous or phlegm in the nose.

The above-mentioned warning signs may seem like rather minor problems, but LPR can lead to more serious issues such as bronchitis, initiating asthma attacks, causing patients to choke, and predisposing patients and putting them at risk for cancer of the esophagus, lung, throat and voice box.

I want to caution my readers, these are not common problems associated with LPR, but if left untreated for many years could result in one of these serious issues.

The age of onset of LPR is usually in the middle-aged adult. But as you will see in the upcoming paragraph, this disease can affect children and infants, as well, because of lifestyle issues.

Evaluation and treatment of LPR is done typically by ear, nose and throat doctors and can include a 24-hour test for acid in the throat, barium swallow, and looking down the throat with a lighted tube. These tests are usually easy to do and performed as an outpatient.

Each one of those tests is different and has a specific reason for being done and in some cases all three are combined to reach a diagnosis and treatment plan.

Treatment for LPR is of course dependent on the severity and damage found. Treatment usually consists of several different approaches. Most commonly, it includes changes in habits and diet combined with medication and very infrequently surgery.

Medications include antacids and more sophisticated medications to control acid from the stomach. This particular group of medications include H2 receptor blockers such as Zantac and proton pump inhibitors such as Nexium, to name two of many.

Some tips and guidelines for reducing the symptoms of LPR include control of your lifestyle and diet; discontinuing use of tobacco products, smoke and smokeless; not eating within four hours of bedtime; sitting in a chair as opposed to lying down on a couch, especially after a meal; and a low-fat healthy diet with the proper levels and intake of meat, dairy products and particularly offending items that put you at high risk of LPR that include fried foods, chocolate, cheese, caffeine. Avoid strong teas, highly carbonated soda pop, acidic juices and mint candies or beverages, and limit alcoholic beverages, particularly in the late evening hours.

Is LPR a diagnosis for life? Not in all cases. In fact, in most cases patients recover and do not require full-time treatment.

However, recovery may be for periods of months to years and there is a chance that a relapse can occur and at that time, resumption of treatment is usually successful.

So just remember that the nagging little sensation in your throat may be a bigger problem than you think it is.

It is always worth getting checked out and getting a professional opinion.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.