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Patient
Education
Advice
for Care of the Professional Voice
Laryngopharyngeal
Reflux Disease and Recommendations to Prevent Acid Reflux
What is
Reflux?
When we eat something, the food reaches the stomach by traveling down
a muscular tube called the esophagus. Once food reaches the stomach, the
stomach adds acid and pepsin (a digestive enzyme) so that the food can
be digested. The esophagus has two sphincters (bands of muscle fibers
that close off the tube) that help keep the contents of the stomach where
they belong. One sphincter is at the top of the esophagus (at the junction
with the upper throat) and one is at the bottom of the esophagus (at the
junction with the stomach). The term REFLUX means "a backward or
return flow," and it usually refers to the backward flow of stomach
contents up through the sphincters and into the esophagus or throat.
What is
GERD and what is LPRD?
Some people have an abnormal amount of reflux of stomach acid up through
the lower sphincter and into the esophagus. This is referred to as GERD
or Gastroesophageal Reflux Disease. If the reflux makes it all the way
up though the upper sphincter and into the back of the throat, it is called
LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat
(pharynx, larynx, and lungs) are much more sensitive to stomach acid and
digestive enzymes, so smaller amounts of reflux into this area can result
in more damage.
Why don't
I have heartburn or stomach problems?
This is a question that is often asked by patients with LPRD. The fact
is that very few patients with LPRD experience significant heartburn.
Heartburn occurs when the tissue in the esophagus becomes irritated. Most
of the reflux events that can damage the throat happen without the patient
ever knowing that they are occurring. We have learned from pH probe testing
that most LPRD occurs during the day. Singers may be at increased risk
for reflux merely by using proper diaphragmatic breathing support.
Common
Symptoms of LPRD:
- Hoarseness
- Asthma-like
symptoms
- Chronic
(ongoing) cough
- Referred
ear pain
- Frequent
throat clearing
- Post-nasal
drip
- Pain or
sensation in throat
- Singing:
Difficulty with high notes
- Feeling
of lump in throat
- Problems
while swallowing
- Bad /
bitter taste in mouth
(Especially in morning)
Definitive diagnostic testing for LPRD:
We believe that we can be fairly certain of the diagnosis from the history
and physical examination. Based on this presumptive diagnosis, we usually
begin treatment for a trial period. However, the 24-hour Pharyngo-Esophageal
pH monitoring is often used to monitor reflux events associated with LPRD.
A small tube is passed through the nose into the esophagus in order to
monitor the amount and type of reflux during a typical day. One of the
biggest advantages is that it allows the testing of the patient's system
while performing his/her daily routine. In LPRD patients, it is important
that the upper channel is placed at the level of the laryngeal (voice
box) inlet.
Treatment
for LPRD:
1. Stress:
Take significant steps to reduce stress!
Make time in your schedule to do activities that lower your stress level.
Even moderate stress can dramatically increase the amount of reflux.
2. Foods:
You should pay close attention to how your system reacts to various foods.
Each person will discover which foods cause an increase in reflux. The
following foods have been shown to cause reflux in many people. It may
be necessary to avoid or minimize some of the following foods.
A.Spicy, acidic and tomato-based foods like Mexican or Italian food.
B.Acidic fruit juices such as orange juice, grapefruit juice, cranberry
juice, etc...
C.Fast foods and other fatty foods.
D.Caffeinated beverages (coffee, tea, soft drinks) and chocolate.
3. Mealtime:
A.Don't gorge yourself at mealtime.
B.Eat sensibly (moderate amounts of food).
C.Eat meals several hours before bedtime.
D.Avoid bedtime snacks.
E.Don't exercise immediately after eating.
4. Body
Weight: Try to maintain a healthy body weight. Being overweight can
dramatically increase reflux.
5. Nighttime
Reflux: If the 24-hour pH monitoring demonstrates nocturnal reflux,
elevate the head of your bed 4-6 inches with books, bricks or a block
of wood to achieve a 10 degree slant.
Do not prop
the body up with extra pillows. This may increase reflux by kinking the
stomach. Recent studies by the Texas Voice Center have shown that reflux
occurs much more often during the day when upright. Therefore, this suggestion
may be much less important than once believed.
6. Tight
Clothing: Avoid tight belts and other restrictive clothing.
7. Smoking:
If you smoke, STOP!! This dramatically causes reflux and many other evils
to your body!!!
Medications
for LPRD:
1. Take one
dose (as recommended on the label) at meals and at bedtime of an over
the counter antacid such as Tums®, Gaviscon® or Mylanta®.
Tums has the added benefit of containing calcium.
2. Medications
such as the following proton pump inhibitors: Prilosec® (omeprazole),
Prevacid® (lansoprazole), AcipHex® (rabeprazole), or
Protonix® (pantoprazole) may be prescribed by your physician.
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