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LPR

LPR stands for Laryngopharyngeal Reflux. Acid is produced in the stomach and you have a band of muscle at the entrance of the stomach that normally prevents this acid backing up into your throat. If this band of muscle is not working as it should then you can have a backflow of acid into your esophagus and into your throat and voice box.

What causes it?

Reflux is common in babies because their esophageal sphincter is undeveloped but less is known about the causes of this weakness in adults.

LPR can be caused by hiatal hernia, low pressure in the lower esophageal sphincter and what is sometimes called a ‘lazy’ esophagus where the muscle contractions are weak or uncoordinated and moving food into the stomach is delayed.

What are the associated problems?

There are a wide range of symptoms of LPR which range from continual throat irritation, chronic coughs, difficulty swallowing, problems with the voice from hoarseness to cracking through to spasms of the larynx or voice box, a constant sensation of something in the throat, wheezing and heartburn.

Another major symptom of LPR is postnasal drip, which is where excess mucus runs down the back of the throat. Patients are often told that their symptoms are abnormal nasal drainage or infections, however, this is rarely the cause of the irritation.

What are your treatment options?

Mr Fayad will take a detailed history and perform a head and neck examination, paying particular attention to the nose and throat area. Using an instrument called a flexible fibreoptic laryngoscope, Mr Fayad will examine your voice box and throat and if the area is very inflamed and red you might have LPR.

If your symptoms are severe then you might need another test called an Ambulatory 24-hour pH Monitoring to verify the diagnosis, which involves a tiny tube being inserted into your esophagus to monitor the amount of acid – the tube is connected to small, pocket-sized computer which records the activity over a 24-hour period.

Non-surgical
LPR can be improved by weight reduction – shedding a few pounds is often all that is required to prevent reflux – and diet modifications such as cutting out caffeine, citrus, mints, alcohol, fried food, eggs, chocolate and cheese. Smoking can also cause reflux. Other changes that you can control include avoiding wearing tight fitting clothes around the waist, not eating three hours prior to bedtime and sleeping with the head of the bed elevated.

Mr Fayad may prescribe medications to either reduce or completely shut off the amount of acid in the stomach acid or to promote normal motility. Generally, you will see an improvement in symptoms in about two weeks but it is usually recommended that you continue with the medication for approximately two months. If the symptoms completely resolve the medication can be tapered off and you may be symptom free but some patients may have relapses which require further medical treatment.

Surgical
In rare cases, it is not possible to medically manage LPR in which case Mr Fayad may feel that surgery is necessary to tighten the lower esophageal sphincter.

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