What is Laryngopharyngeal Reflux (LPR)?
Laryngopharyngeal reflux (LPR) is a condition in which stomach contents flow backward up the oesophagus (food pipe) and reach the throat and/or voice box (larynx).
Stomach juices contain strong acids and digestive enzymes that help break down food. While the stomach lining is designed to tolerate these substances, the tissues of the throat and voice box are much more sensitive. Exposure to these juices causes irritation and inflammation, leading to symptoms.
LPR is often referred to as “silent reflux” because many patients do not experience typical symptoms such as heartburn or indigestion. Reflux can occur during the day or night, even without recent food intake.
What are the symptoms?
Common symptoms include:
Hoarseness or weakness of the voice
Excessive or frequent throat clearing
Chronic dry cough
Excess mucus or phlegm in the throat, especially in the morning
Sore or irritated throat
Occasional breathing difficulty
Worsening of asthma or difficulty controlling asthma
Choking or coughing episodes, particularly at night
Excessive burping, especially during the day
How is LPR treated?
Treatment typically includes:
- Lifestyle and dietary modifications to reduce reflux
- Medications to reduce stomach acid
- Surgery in selected cases where medical treatment is ineffective
Lifestyle changes
- Take prescribed medication regularly as directed
- Sit upright while eating
- Bend at the knees (not the waist) when picking up objects
- Maintain a healthy weight
- Elevate the head of your bed by 10–15 cm (4–6 inches)
- Sleep on your left side
- Stop smoking
- Minimise stress
Do not:
- Wear tight clothing around the waist
- Bend forward from the waist
- Eat quickly or while rushing
- Lie down or slump after eating
- Eat within 3 hours before bedtime
- Use multiple pillows instead of elevating the bed
- Strain or lift heavy objects
Dietary advice
Do:
- Eat smaller, more frequent meals
- Eat slowly and chew thoroughly
- Drink water and decaffeinated beverages
- Limit alcohol intake
- Follow a low-fat diet
- Include natural yoghurt
- Consider alkaline water or bicarbonate-containing chewing gum
Do not:
- Eat spicy, fatty, fried, or greasy foods
- Consume chocolate, pastries, or excess dairy
- Eat and drink simultaneously
- Drink excessive tea, coffee, or fizzy drinks
- Consume acidic foods (tomatoes, citrus fruits, pineapple)
- Exercise immediately after meals
Medications used in LPR
Antacids / Alginates:
These are often taken after meals and before bedtime.
Proton Pump Inhibitors (PPIs):
These medications reduce stomach acid and should be taken 30 minutes before meals as prescribed.
Alternative medications:
May be used in patients who cannot tolerate PPIs.
Important:
Do not stop medication suddenly. A gradual reduction plan should be followed under medical supervision.
How long is treatment needed?
- Initial treatment is usually recommended for at least 6 months
- Many patients notice improvement within 2–3 months
- Full recovery of throat and voice symptoms may take longer
Will I need treatment forever?
Not necessarily. Many patients improve significantly with appropriate treatment. Long-term success depends on:
- Following lifestyle recommendations
- Maintaining dietary changes
- Taking medications as prescribed
- Consulting your doctor before stopping treatment
What is the role of surgery?
Surgery may be considered in more severe cases where medications are ineffective. The aim is to strengthen the valve between the stomach and oesophagus, usually through minimally invasive (keyhole) procedures.
