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Laryngopharyngeal Acid Reflux (LPR) is also known as "silent reflux" because it is not usually associated with "heartburn". It is also called "the great masquerader" because it is responsible for many complaints that mimic allergy. Another synonym is reflux laryngitis. LPR is a major cause of post-nasal drip, chronic cough, throat irritation,ear and voice problems. There is some evidence it may cause chronic nasal congestion,nasal polyps and sinusitis. Treatment of reflux requires changes in lifestyle, diet  as well as medication. The following measures are recommended:

  • Avoid meals three hours before going to bed.
  • Sleep elevated on a wedge pillow or raise the front of the bed 6 inches with blocks.
  • Avoid caffeine and carbonated beverages, such as soda or mineral water.
  • Avoid chocolate or  mints
  • Chewing gum or frequently drinking liquids is helpful in mild cases as swallowing redirects the flow of gastric juices into the stomach.
  • Weight reduction to ideal body mass index is very helpful. Charts are available to determine your ideal weight.
  • Avoid alcoholic beverages such as beer, and mineral water.
  • Avoid fatty, fried or greasy foods.
  • Dairy products, salad dressing, cooking oils, deli meats, ginger,cinnamon, spicy foods and citrus fruits may also worsen symptoms.

Most people with LPR require medical therapy with drugs that reduce the amount of acid produced by the stomach. A class of drugs known as the proton pump inhibitors are the most effective, and includes omeprazole which is a non-prescription medication, and the prescription medications Nexium, Gexilant, Aciphex, Protonix and Prevacid. Unlike classic acid reflux, LPR requires medication twice daily to turn off acid production for a full twenty-four hours. Medical treatment must be continued indefinitely, unless lifestyle changes have a major impact on symptoms.

Even with medical therapy, improvement is sometimes not seen for three to six months. Some patients require multiple medications including motility agents to control symptoms. Refractory cases can be caused by a esophageal hiatus hernia, in which the valve between the stomach and esophagus leaks because it has slid above the diaphragm into the chest. In these instances, endoscopic surgery or ablation of the lower esophageal sphincter can control reflux without medication.